Fortune or foe: the fatal harm caused by a gambling disorder.

Abstract

Four suicides in Hong Kong were found to be related to football betting and unmanageable debt within 8 days of the FIFA (Fédération Internationale de Football Association) World Cup beginning in mid-June 2014. It is intriguing that there has been no further World Cup-related suicide news in Hong Kong since the event finished a month ago. The four suicides challenge us to rethink about gambling disorder 1, 2 and the suicide phenomenon. First, is World Cup-related suicide a local or global phenomenon? We performed a world-wide search ‘world cup suicide’ on Google and Yahoo! on 13 August 2014; two more World Cup and debt-related suicides were found that took place in Guangdong and Haihou, China. It seems that this World Cup-suicide phenomenon is in some way unique to Hong Kong or the wider Chinese community. Secondly, is the robustness of gambling as a risk factor for suicide in Hong Kong stronger than in other countries? We searched ‘gambling suicide’ on Google Scholar, PubMed and Web of Science on 13 August 2014 and found four academic papers published in English-speaking countries that examined gambling and completed suicides on the first 10 returned pages. Two Coroner's Court record-based descriptive studies on suicides with gambling behaviour from Victoria, Australia 3 and Quebec, Canada 4 suggested that gambling was a crucial risk factor for suicide and that the characteristics of suicides with gambling differed from non-gambling suicides. Two studies in the United States examined suicide rates and legalized gambling venues and did not yield conclusive evidence of a gambling effect in areas after gambling had been legalized in those areas 5, 6. Gambling and suicide, however, have been found to be closely related in Hong Kong. Our psychological autopsy study found that a gambling disorder is the third most contributory psychiatric disorder to completed suicides in Hong Kong, after psychotic and depressive disorders 7. Also, among the 1201 cases of suicide in 2003 in Hong Kong, 233 (19.4%) showed evidence of the individuals concerned gambling prior to their death, and 110 (47.2%) of the 233 individuals had gambling debts 8. We recently conducted a study which found that within the 3686 clients seeking treatment from problem gambling services in Hong Kong, (i) 20% had suicidal thoughts and (ii) 0.6% concealed the idea of killing of their family members before completing suicide (also known as familicide 9). We think the connection between a gambling disorder and suicide is poorly understood and possibly under-recognized. In the local context and the wider Asian region, the information needed to formulate preventive and crisis intervention approaches to minimize the harm caused is lacking. If the social costs of gambling disorders continue to be trivialized or ignored over the benefits of legalizing gambling, more money, health and lives will be lost. None.