A Protocol for Determining Gambling-Related Suicides in Psychological Autopsy Studies

Abstract

THERE HAS BEEN an unprecedented expansion of casino gaming throughout the United States in the 1990s as evidenced by the fact that, including casinos on native lands, 24 of the 50 states have legalized casino gaming. This rapid explosion in the availability of gambling opportunities has seen problem gambling emerge as a major public health issue.1 Epidemiological surveys seeking public opinion suggest that the vast majority of gamblers enjoy gambling and do it for recreation and leisure.2 However, there is a small minority who gamble excessively relative to their available income and eventually meet psychiatric criteria for pathological gambling. In a meta-analytic review of prevalence studies, Shaffer, Hall, and Vander Bilt3 estimated an adult population prevalence rate of 1.2% for pathological gamblers. The adverse consequences of pathological gambling have been well documented4 and include financial pressures, depression, anxiety, marital discord, substance abuse, involvement in criminal activity, and unemployment. These are known risk factors for suicide in the general population.5 Therefore it is not surprising that, given the psychosocial problems caused by excessive gambling, gambling counselors and welfare organizations have also expressed concern that pathological gamblers represent a sub-population at increased risk for suicide. Media reports linking suicide to excessive gambling losses have also drawn further community attention to this major public health issue. Two recent gambling-related suicides in gaming locations may exemplify this matter.6 The first case involved a casino visitor who shot himself at a table game in the casino. The gambler had already lost money on the day when he made two additional trips to the ATM to withdraw funds within a time span of 15 minutes. At face value it would appear the further loss of this amount led to his fatal decision to end his life. The second even more tragic case claimed not only the gambler’s life but those of his immediate family as well. In this media report, a businessman shot himself after taking the lives of his wife and three young children. The apparent motive for the murder suicide