Gambling, Major Depression a Potentially Deadly Combination

Fran Lowry

December 21, 2020

Patients with major depressive disorder (MDD) who also gamble have a significantly increased suicide risk and need to be vigilantly monitored, new research suggests.

A retrospective review of more than 4 million patients showed that those with co-occurring MDD and a gambling diagnosis had a significantly higher risk for suicide vs those with MDD alone. In addition, gamblers had a higher prevalence of alcohol abuse.

Based on these findings, clinicians should be more vigilant about the suicide risk in this specific patient population, said study investigator Chintan Trivedi, MD, St. David's Medical Center, Austin, Texas.

"They should administer a suicide severity rating scale just for assessing suicidal thoughts and behaviors so they can better treat the patient. With a little more awareness about suicidality in gamblers, much of this can be prevented," Trivedi told Medscape Medical News.

However, he noted the study was observational and, as a result, should be considered hypothesis-generating and helpful in designing a large, randomized trial.

The findings were presented at the virtual American Academy of Addiction Psychiatry (AAAP) 31st Annual Meeting.

Born Out of the Pandemic

Trivedi noted that the investigators got the idea to study a possible association between suicide, gambling, and MDD during the pandemic.

"We were hearing from several news media of the rise in online gambling during the pandemic because of economic crisis and recession. The same thing happened during the last recession," he said.

The researchers found that although there were several studies on gambling and depression, they couldn't find any studies that compared suicide rates in patients who had both MDD and gambling with those who had MDD only.

They assessed the National Inpatient Sample dataset for the years 2006 to 2017 and queried all patients age 18 years and older who had a primary diagnosis of MDD. Data were also obtained on patients with, and without, a gambling diagnosis.

The investigators found 6646 patients with a gambling diagnosis in addition to MDD, and a huge number (n = 4,021,063 patients) with MDD only. The groups were then compared for baseline characteristics and suicide risk.

There was a higher prevalence of alcohol abuse in the depression plus gambling group compared with the depression-only group. Suicidal ideation and attempts occurred in 51% of the MDD plus gambling group vs 43% of the MDD-only group.

In addition, more patients in the MDD plus gambling group were older, white, and men. Besides alcohol abuse, there was also more obesity in the gambling group.

Results showed that the MDD with gambling group vs the MDD-only group had significantly greater rates of suicidal ideation (45.4% vs 39.5%, respectively; P < .001), suicidal attempt (7.2% vs. 4.5%; P < .001), and a composite of suicidal ideation/attempt (50.7% vs 43.1%; P < .001).

In multivariate analysis, gambling was also associated with a higher risk for suicidality (odds ratio,1.42; 95% CI, 1.35 - 1.49; P < .001).

Good Reminder

Commenting on the study for Medscape Medical News, Rebecca Payne, MD, University of South Carolina and Prisma Health in Columbia, said the investigators used "an impressively large dataset spanning 12 years" in their research.

The finding about the higher risk for suicidal thoughts or attempts "reminds us of the importance of assessing for depressive symptoms and suicidality in patients with either a current or historical gambling diagnosis or a suspected gambling diagnosis," said Payne, who was not involved with the study.

In clinical practice, gambling is seldom the presenting complaint and may be overlooked, she noted.

"These findings serve as a reminder to me, and perhaps others, that gambling should be routinely assessed at intake. Furthermore, this information could aid in the formulation of a more comprehensive suicide risk assessment," Payne said.

Trivedi and Payne have disclosed no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 31st Annual Meeting. Presented December 11, 2020.

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