Wong PW, Chan WS, Conwell Y, Conner KR, Yip PS.
HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong. J Affect Disord. 2009 Apr 23.

BACKGROUND: Pathological gambling is associated with suicidal ideation and attempt. There is no known report on pathological gambling preceding suicide. By examining a series of 17 suicide cases with evidence of pathological gambling prior to death, we sought to generate hypotheses for further study of this under-researched but rapidly-increasing worldwide public health problem.

METHOD: Psychological autopsy interviews using a semi-structured format were conducted with proxy respondents for suicide and control subjects aged 15-59 years in Hong Kong SAR, China.
RESULTS: Of the 150 suicides and 150 controls examined, 17 suicides (11.3%) and one control case (0.6%) met criteria for the diagnosis of pathological gambling at the time of death or interview. All 17 suicide cases with pathological gambling had unmanageable debt at the time of death. Fourteen cases (82.4%) had other associated psychiatric disorders, most often major depressive disorders (n=10, 58.9%) and substance-use disorders (n=3, 17.6%). None had ever received psychiatric treatment.
LIMITATIONS: Descriptive, retrospective case series with a small sample size.
CONCLUSIONS: Along with unmanageable debt, a high proportion of the suicide cases with pathological gambling also experienced other psychiatric illnesses, most often depression, at the time of death. None sought treatment for their addictive behavior or psychiatric illness prior to death. Pathological gambling is a modifiable risk factor for suicide for which means to enhance case identification and engagement in treatment are urgently needed. Clinicians treating depression should explore the presence of pathological gambling behavior or unmanageable debts among their patients. Addressing pathological gambling should be one important component of a comprehensive suicide prevention strategy especially in countries where gambling activities are legalized and expanding.