Preventing gambling-related suicides

The normalisation of gambling means it is often overlooked as an underlying source of harm, but gambling-related suicides could be prevented with the right strategies and support.

Gambling is widely promoted and readily available in Australia, to the extent that it has been normalised. Most of us have seen betting odds being promoted during sports matches, with even the Prime Minister labelling these advertisements “annoying”. The sights and sounds of the poker machines flashing behind the bistro at the local pub or club are familiar to many of us. For those of us who don’t regularly venture into these spaces, or who haven’t been directly affected, the severe harms that can arise from these products may not be immediately apparent. Gambling has been promoted as a bit of harmless fun, glamourised as an exciting form of entertainment, and as a key source of funds for community activities and government revenues.

We now know that gambling harms include not only financial distress, bankruptcy and relationship breakdown, but can exacerbate family violence and lead to financial abuse and income-generating crime. A recent Swedish registry case–control study found people with gambling disorder had a higher prevalence of cardiovascular disease, diabetes, obesity and somatic conditions than controls. We are only beginning to understand the full extent of these harms. For many years, the dominant responsible gambling approach focused attention on “problem gamblers” and paid little attention to the commercial and other factors that lead to harm, such as predatory practices that encourage people to spend as much time and money as possible gambling. Industry insiders call this “playing to extinction”.

The role of gambling in suicide

Suicide is a major cause of preventable death in Australia, with 3249 deaths registered during 2022, and is the leading cause of death for men and women aged 15–44 years. Our recent study documented gambling-related suicides in Victoria. To identify cases, I worked alongside colleagues at the Coroners Prevention Unit in Victoria to review cases that had been coded to the Victorian Suicide Register. This database contains all suicide deaths that occurred in Victoria during 2009–2016. Unfortunately, unlike drugs and alcohol, there is currently no systematic way that gambling is captured as a contributing factor in suicide deaths. We ran a text search of financial stressors and gambling terms, and then reviewed over 1776 case records to ascertain if these suicide deaths may have been gambling-related. Records contain narrative reports provided by witnesses to police, and other information that the coroner collects during the course of their investigation, such as medical records or statements from treating health professionals, and suicide notes from the deceased (where available) to ascertain if the death was gambling-related.

Over this period, we found 184 cases where direct gambling (ie, the gambling of the deceased) was a factor in the suicide, and another 17 cases where the deceased was an affected other. These “others” are the mothers, wives, daughters, fathers, husbands and sons of the person who gambled. Together, these 201 cases account for at least 4.2% of suicide deaths in Victoria during this time. The gambling-related suicides we could identify were more likely to be men (84%) than all suicide cases (75%). It was striking that in only 38 cases (20.7%) a general practitioner, allied health, or other health professional knew about the deceased’s gambling problems. Family and friends were far more likely to be aware of the gambling of the deceased (n = 135, 73.4%). We could only identify eight cases (4.4%) in which the deceased had a gambling disorder diagnosis. Because of this, our study is undoubtedly an undercount of the true number of gambling-related suicides.

We identified many more cases where there was evidence of serious financial problems, but the source of the debt was not specified. We also need to know more about the gambling products most associated with this harm, by documenting the gambling products used by the deceased. When attending a death, there is a box police can tick for financial problems, but there is no requirement in Australia for police or coroners to determine the source of debts. The reason this information may be missing could be because shame and stigma associated with gambling problems meant that they did not disclose their problems, or their family did not want to raise it during the death investigation process. It might also be because they were not connected to the health system and/or the treating clinicians did not think to ask if patient was gambling. Further, debts are not the only reason why someone may end their life because of their experience of gambling harm. Many people I have spoken with, who have survived a gambling-related suicide attempt, describe how loss of control, irrational thinking, and sense of defeat are debilitating features of their condition.

Reframing gambling as a health issue

The normalisation of gambling, and its framing as a recreational pursuit, has meant it is often overlooked as an underlying source of harm. This also creates stigma and shame for those harmed, creating a barrier to seeking help before they reach the point of a suicidal crisis, further contributing to the suicide toll. The coronial system is not the only area undercounting harm from gambling. Gambling harm may underlie many more emergency department presentations and ambulance call outs than we realise. A 2010 study from Hong Kong identified 19.2% of all suicides in that country as gambling-related. There, police are required to obtain financial records allowing the coroner to determine the source of debt.

Health professionals could make it their practice to routinely ask simple questions such as, “In the past 12 months, have you ever felt that you had a problem with gambling?”, or “Has anyone commented that you might have a problem with gambling?”. Simple questions like these can give patients an opportunity to raise problems. Support to address gambling harm may include referral to financial, specialist gambling, or relationship counselling to address immediate concerns, as part of a more holistic counselling process.

Gambling suicides are preventable, and there are many strategies available to prevent harm before it occurs. The commercial determinants of suicide are an emerging field that complements existing efforts aimed at preventing suicide. Making sure we accurately determine and assess the full extent of harms associated with gambling is just the beginning. GPs and allied health professionals have a valuable role to play here, advocating for governments to adopt upstream strategies, such as a complete ban on gambling advertising, a universal account registration systems to allow people to set limits on their gambling losses, establishing a consistent national regulator, and requiring gambling operators to provide data to a data vault, to allow both for improved monitoring of operators to ensure compliance and for improving research data.

Angela Rintoul is an Associate Professor at Federation University with expertise in gambling harm reduction, health inequities and the commercial determinants of health.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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