Association between gambling disorder and suicide mortality: a comparative cohort study using Norwegian health registry data

Joakim Hellumbråten Kristensen; Carl Michael Baravelli; Tony Leino; Ståle Pallesen; Mark D Griffiths; Eilin Kristine Erevik

doi:10.1016/j.lanepe.2024.101127

Association between gambling disorder and suicide mortality: a comparative cohort study using Norwegian health registry data

Lancet Reg Health Eur. 2024 Nov 11:48:101127. doi: 10.1016/j.lanepe.2024.101127. eCollection 2025 Jan.

Authors

Joakim Hellumbråten Kristensen^{1

2}, Carl Michael Baravelli³, Tony Leino^{1

2}, Ståle Pallesen^{1

2}, Mark D Griffiths⁴, Eilin Kristine Erevik^{1

2}

Affiliations

¹ Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Post Box 7807, Bergen 5020, Norway.
² Norwegian Competence Center for Gambling and Gaming Research, University of Bergen, Post Box 7807, Bergen 5020, Norway.
³ Department of Disease Burden, Norwegian Institute of Public Health, Post Box 973 Sentrum, Bergen 5808, Norway.
⁴ International Gaming Research Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, United Kingdom.

Abstract

Background: Gambling disorder has been consistently linked to suicidal ideation and suicide attempts, but few studies have investigated the association between gambling disorder and suicide mortality. This study examined the risk of suicide mortality associated with gambling disorder compared to the general population and other patient groups.

Methods: A registry-based cohort study was conducted employing individual-level linked and aggregated data from Norwegian nationwide health registries. The study population comprised all patients with gambling disorder in Norway (n = 6899) for the period 2008 to 2021. Standardized mortality ratios were estimated to assess suicide risk among gambling disorder patients against the adult Norwegian general population. Cox regressions were used to estimate hazard ratios comparing suicide risk among patients with gambling disorder to 12 comparison groups comprising patients treated for other conditions (n = 391,897).

Findings: Suicide was the leading cause of death among patients with gambling disorder (37 of 148 deaths; 25%). Patients with gambling disorder had a higher suicide risk than the general population (standardized mortality ratio = 5.12, 95% CI [3.71; 7.06]), and 5 of 12 patient groups with other conditions. Suicide risk was not significantly different when compared to that of patients with anxiety disorders, personality disorders, or depression. However, suicide risk was lower among patients with gambling disorder than patients with substance use disorders, alcohol dependence, psychotic disorders, or mood disorders.

Interpretation: Norwegian patients with gambling disorder have an elevated risk of suicide mortality but the risk is similar to or lower than other patient groups known to be at increased suicide risk.

Funding: Norwegian Competence Center for Gambling and Gaming Research and the Faculty of Psychology at the University of Bergen (no specific grant).

Keywords: Addiction; Pathological gambling; Register; Standardized mortality ratios; Suicidality.