Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study

J Behav Addict. 2018 Dec 1;7(4):1091-1099. doi: 10.1556/2006.7.2018.112. Epub 2018 Nov 14.


Background and aims: Gambling disorder (GD) appears to be an independent risk factor for suicide, and all-cause mortality has been sparsely studied in patients with GD. This study aims to explore mortality and suicide rates in individuals with GD compared to the general population as well as explore risk factors associated with all-cause mortality and suicide mortality.

Methods: This is a nationwide register study on 2,099 individuals with a GD diagnosis in the Swedish inpatient and/or outpatient specialist health care system between the years of 2005-2016. Comorbid diagnoses from treatment episodes included in national registers were categorized into diagnostic groups according to the 10th revision of International Classification of Diseases, and prevalence rates (any occurrence during 2005-2016) were calculated for each diagnostic group. Multivariate Cox regression analyses on risk factors for death and suicide were performed, controlling for age, gender, and major categories of comorbidity. Standardized mortality ratios (SMRs) were calculated for men and women with regard to overall mortality and suicide compared to the general Swedish population.

Results: The population consisted of 1,625 men and 474 women ranging from 18 to 83 years of age at first GD diagnosis (mean: 36.5 years). Sixty-seven individuals passed away, among whom 21 deaths were due to suicide. SMR calculations showed a 1.8-fold increase in mortality for individuals 20-74 years old with GD compared to the general population, and a 15-fold increase in suicide mortality. All-cause mortality was predicted by higher age and any treatment episode for cardiovascular disease, whereas suicide death was predicted by depression.

Discussion and conclusions: Mortality and suicide rates are significantly elevated among individuals with GD. Although common mental health comorbidities did not predict overall mortality, depression predicted suicide death. Findings call for attention to long-term risk of death in GD patients and interventions against comorbid health problems.

Keywords: comorbidity; gambling disorder; mortality; nationwide; standardized mortality ratios; suicide.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cause of Death*
  • Comorbidity
  • Depression / epidemiology*
  • Female
  • Gambling / epidemiology*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Registries / statistics & numerical data*
  • Suicide / statistics & numerical data*
  • Sweden / epidemiology
  • Young Adult

Grant support

Funding sources: No financial support was received specifically for this study. AH holds at position as professor at Lund University financed in collaboration between Lund University and the Swedish gambling operator monopoly, Svenska spel AB, as a part of the latter part’s responsibility for gambling and research policy, but this funding is not aimed for any projects specifically, and the funding body has no influence on the research ideas, research designs or interpretations, and publications of findings.