Self-reported Suicidal Ideation Research Articles

The impact of minimum wage increase on suicidal ideation in South Korea: a difference-in-differences analysis using nationally representative panel data.

South Korea had the highest suicide rates in the OECD and one of the largest (16.4%) increases in the minimum wage in 2018. Prior studies have provided evidence that increases in minimum wage reduce suicide rates in the population, but no study examined the effects of the policy change on individual-level suicidal behaviour. Our study sample was built using the 2015-2019 waves of the Korean Welfare Panel Survey, a population-representative longitudinal survey. The sample consisted of 5146 participants, including those earning above minimum wage (control) and minimum wage earners (treatment) based on their 2018/19 earnings. The outcome of the study was suicidal ideation, which is an important precursor to other suicidal behaviours, and was captured using self-reported measures. We examined the impact of the 2018 minimum wage hike in Korea on suicidal ideation, using a difference-in-differences design. The minimum wage increase was associated with a 1.6% points reduction (95% CI: -2.8% to -0.5%) in self-reported suicidal ideation. Stronger policy effects were shown among women and older age groups. Our study demonstrates that public policies employing a population-based approach, such as increasing minimum wages, could serve as an effective intervention to mitigate suicidal ideation among low-income workers.

Examining the effects of response monitoring instructions on endorsements of suicidal ideation in an online study.

It is common practice for researchers to monitor responses to items assessing suicidal ideation and follow-up with high-risk participants, when their identities are known. However, it is becoming increasingly common for researchers to administer fully anonymous online surveys that do not allow for follow-ups with participants at higher risk. The aim of the current study was to investigate whether these two different approaches-monitoring and follow-up versus no monitoring or follow-up-affect the willingness of participants to endorse suicidal ideation. The sample included N = 555 undergraduate students, who were randomly assigned to the monitoring (n = 275) or anonymous (n = 280) instruction conditions, with the monitoring condition shifting to anonymous, non-monitored responses at Time 2. There were no significant differences in self-reported suicidal ideation between those in the monitoring and anonymous condition at Time 1. At Time 2, no significant interaction was identified between condition and time, suggesting that the change in instructions across timepoints for the monitoring condition had no impact on endorsement of suicidal ideation. Findings indicate that both monitoring and anonymous instruction methods should elicit the same pattern of endorsements of suicidal ideation.

HIV and Mental Health: A Three-Phased Program Development Study in the Philippines

A three-phased study and program development on HIV and Mental Health were conducted for a period of two years. This study encompasses a baseline survey of mental health issues among people living with HIV (PLHIV), the design and development of virtual learning modules on mental health and HIV for health providers, and a pre-implementation qualitative study on the delivery of online modules to target health workers. The results of the quantitative survey reveal moderately high self-reported depression, anxiety, and suicide ideation among patients with HIV. After the survey, topics for e-modules on mental health were identified including self-help modules for health workers. These mental health modules were consolidated with modules pertaining to HIV treatment. A qualitative study on the acceptability and feasibility of the use of the e-modules was conducted by interviewing health workers from different HIV treatment and care sites. Significant insights into the learning experiences among health workers gave researchers a deeper understanding of the cognitive acceptance and resistance towards virtual and self-paced modules.

Internet-based behavioural activation therapy versus online psychoeducation for self-reported suicidal ideation in individuals with depression in Indonesia: a secondary analysis of an RCT

BackgroundSoutheast Asia has the highest suicide mortality worldwide. To improve our knowledge on the effectiveness of interventions for suicidal ideation (SI) in individuals with depression in Indonesia, we conducted a...

EEG wakefulness regulation in transdiagnostic patients after a recent suicide attempt

ObjectiveDecades of research have not yet produced statistically reliable predictors of preparatory behavior eventually leading to suicide attempts or deaths by suicide. As the nature of suicidal behavior is complex, it is best investigated in a transdiagnostic approach, while assessing objective markers, as proposed by the Research Domain Criteria (Cuthbert, 2013). MethodsA 15-min resting-state EEG was recorded in 45 healthy controls, and 49 transdiagnostic in-patients with a recent (<6 months) suicide attempt. Brain arousal regulation in eyes-closed condition was assessed with the Vigilance Algorithm Leipzig (VIGALL) (Sander et al., 2015). ResultsA significant incline of median vigilance and vigilance slope was observed in patients within the first 3-min of the EEG recording. Additionally, a significant positive correlation of self-reported suicidal ideation with the vigilance slope over 15-min recording time, as well as a significant negative correlation with EEG vigilance stage A1 during the first 3-min was found. ConclusionsTransdiagnostic patients with a recent suicide attempt show a distinct vigilance regulation pattern. Further studies including a control group consisting of patients without life-time suicide attempts are needed to increase the clinical utility of the findings. SignificanceThese findings might serve as potential objective markers of suicidal behavior.

Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury.

The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

Changes in self-reported suicidal ideation during treatment with electroconvulsive therapy: A retrospective cohort study.

Suicidal ideation (SI) is common in patients with depressive symptoms, who are the most common recipients of electroconvulsive therapy (ECT). We sought to quantify changes in self-reported SI occurring during treatment with ECT, and to identify factors associated with persistence of SI in patients beginning treatment with SI. Retrospective, single-center cohort study of patients receiving ECT and who self-reported symptoms using Quick Inventory of Depressive Symptomatology (QIDS) prior to ECT and after treatment #5 or #10. Changes in QIDS-reported SI over the course of ECT were calculated, and logistic regression models were performed to assess factors associated with reporting SI at the end of treatment. 2554 provided baseline and follow-up SI scores, of whom, 1931 (75.6%) endorsed SI at baseline. There was a reduction in SI with ECT treatment (McNemar's test; df = 1, Χ2 = 803.7; p < 0.001), and in adjusted models 64.0% of individuals with baseline SI reported resolution of SI with ECT treatment, while 3.3% without baseline SI reported SI at the end of treatment. Higher baseline SI severity and outpatient treatment were associated with a higher odds of persistent SI among individuals beginning treatment with SI. Electroconvulsive therapy treatment was associated with reductions in self-reported SI. These results support the use of ECT in the treatment of patients with SI, but further research is needed to determine the effects of ECT on suicidal behavior.

New form of addiction: An emerging hazardous addiction problem of milk tea among youths

BackgroundMilk tea has experienced tremendous growth in popularity in China, especially among youths. The primary objective of this study is to investigate whether milk tea addiction may have a detrimental impact on youths' mental health, such as anxiety, depression, and suicidal ideation. Additionally, we aim to explore its potential role in influencing various mental health outcomes. MethodsA large-scale, cross-sectional study was conducted from 5281 college students in Beijing, China. Participants self-reported depressive, anxiety symptoms, suicidal ideation, and milk tea addiction symptoms including milk tea consumption, dependence, guilty feelings, withdrawal, tolerance, unable to stop, craving, and intention to stop. ResultsNearly 77 % of participants consumed milk tea at least 6–11 cups in the last year. The confirmatory factor analysis (CFA) supported the one-factor structure of the milk tea addiction scale, developed according to DSM-5 substance use guidelines. Moreover, we found that a higher level of milk tea addiction was significantly associated with a higher risk of depression (b = 0.24, p < 0.001), anxiety (b = 0.21, p < 0.001), and suicidal ideation (b = 0.06, p < 0.001), respectively, after controlling confounding variables, among youths consuming milk tea. The possible mediating role of milk tea addiction between loneliness feelings and mental health outcomes was further addressed. Conclusions and implicationsOur findings highlighted that milk tea consumption might lead to addiction, and it is associated with depression, anxiety, and suicidal ideation. Current findings can assist policymakers in developing regulations such as restricting advertising, providing psycho-education, establishing food hygiene standards for such a prosperous youth-dominant consumption industry while protecting their mental health.

Testing the interpersonal theory of suicide in adolescents: A multi-wave longitudinal study.

Suicide is a major public health crisis among youth. Several prominent theories, including the Interpersonal Theory of Suicide (IPTS), aim to characterize the factors leading from suicide ideation to action. These theories are largely based on findings in adults and require testing and elaboration in adolescents. Data were examined from high-risk 13-18-year-old adolescents (N = 167) participating in a multi-wave, longitudinal study; 63% of the sample exhibited current suicidal thoughts or recent behaviors (n = 105). The study included a 6-month follow-up period with clinical interviews and self-report measures at each of the four assessments as well as weekly smartphone-based assessments of suicidal thoughts and behaviors. Regression and structural equation models were used to probe hypotheses related to the core tenets of the IPTS. Feelings of perceived burdensomeness were associated with more severe self-reported suicidal ideation (b = 0.58, t(158) = 7.64, p < .001). Similarly, burdensomeness was associated with more frequent ideation based on weekly smartphone ratings (b = 0.11, t(1460) = 3.41, p < .001). Contrary to IPTS hypotheses, neither feelings of thwarted belongingness, nor interactions between burdensomeness and thwarted belongingness were significantly associated with ideation (ps > .05). Only elevated depression severity was associated with greater odds of suicide events (i.e., suicide attempts, psychiatric hospitalizations, and/or emergency department visits for suicide concerns) during the follow-up period (OR = 1.83, t(158) = 2.44, p = .01). No effect of acquired capability was found. Perceptions of burdensomeness to others reflect a critical risk factor for suicidal ideation among high-risk adolescents. Null findings with other IPTS constructs may suggest a need to adopt more developmentally sensitive models or measures of interpersonal and acquired capability risk factors for youth. Refining methods and theoretical models of suicide risk may help improve the identification of high-risk cases and inform clinical intervention.

The Role of Individual Discrimination and Structural Stigma in the Mental Health of Sexual Minority Youth

Sexual minority (SM) youth experience a greater mental health burden compared with their heterosexual peers. This study aimed to characterize mental health disparities among SM compared with non-SM youth, test main and interactive associations of SM identity and stressors targeting SM youth at the individual level (interpersonal SM discrimination) and structural level (state-level structural SM stigma) with youth mental health, and explore the contribution of interpersonal SM discrimination to the mental health burden of SM youth. Participants included 11,622 youth (ages 9-13; 47.6% assigned female at birth) from the Adolescent Brain Cognitive Development (ABCD) Study. Linear mixed-effects models tested main and interactive associations of SM identity, interpersonal SM discrimination, and structural SM stigma with mental health measures (self-reported overall psychopathology, suicidal ideation, and suicide attempts), adjusting for demographics and other interpersonal stressors not specific to SM (other discrimination types, peer victimization, and cyberbullying). Longitudinal mediation models tested whether interpersonal SM discrimination mediated the associations between SM identity and mental health measures. SM youth (n= 1,051) experienced more interpersonal SM discrimination and overall psychopathology compared with their non-SM peers (n= 10,571). Adjusting for demographics, there were significant associations (main effects) of interpersonal SM discrimination and structural SM stigma with overall psychopathology. When further adjusting for other non-SM-related stressors, the main effect of structural SM stigma was no longer significant. Interpersonal SM discrimination was also significantly associated with suicidal ideation and attempt, accounting for demographics, while structural SM stigma was not. Accounting for both demographics and other non-SM stressors, there was a significant interaction between SM identity and structural SM stigma in association with psychopathology (p= .02), such that, compared with their peers, SM youth showed a greater association between structural SM stigma and psychopathology. Longitudinal mediation revealed that interpersonal SM discrimination was a significant mediator explaining approximately 10% to 15% of the variance of the pathways between SM identity and all mental health outcomes. Results delineate contributions of interpersonal discrimination and structural stigma targeting SM youth to their heightened mental health burden in early adolescence. These findings underscore the need to address microlevel and macrolevel SM discrimination and structural stigma when caring for this population. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Prevalence of suicidal tendencies among the students at the University of Peshawar, Pakistan

Suicide is a serious social and mental health problem; considering the recent hike in the country’s young population, it is essential to study the influential factors of suicide. This study is designed to identify the prevalence of suicide tendencies among students at the University of Peshawar. Students from various disciplines, such as psychology, statistics, computer science, English, pharmacy, journalism, international relations, and management sciences, among others, were submitted on the self-reported suicidal ideation scale (SIQUE). There was a higher prevalence rate of 30% of students having suicidal ideation among 844 students, in which the female predominance rate was higher than males. Furthermore, the married and ailing students also showed significant patterns of suicidal ideation on the SIQUE scale. The results also showed that among the students at the University of Peshawar, drug addicts had statistically higher average suicidal ideation. Those with mental disorders, physical disorders, death of loved ones, history of suicide, and weakness in religious beliefs increase the relative rates of suicidal ideation and propensity among students. Students who are married and suffer from mental disorders or other emotional or physical problems have a soaring inclination to suicide among the University of Peshawar students aged 19-30.

Depression and thoughts of self-harm and suicide among people living with dementia: results of a cross-sectional survey.

Depression is common among people with dementia. Despite most people with dementia living in the community, there have been few investigations of self-reported depressive symptoms and suicidal ideation among community-dwelling people with dementia in Australia. This study aimed to explore the proportion of people with mild, moderate and severe levels of depressive symptoms, and suicidal ideation among a sample of people living with dementia in Australia. Correlates of reporting depressive symptoms were also explored. Adults diagnosed with dementia by a medical professional who were English speaking and community-dwelling were asked to complete a paper and pencil survey. Those who were unable to provide independent consent were excluded. Depression was assessed using the Geriatric Depression Scale -15, and suicidal ideation was assessed using two study-specific items. Multivariable analyses examined quality of life, unmet needs and sociodemographic factors associated with having a score of five or more on the Geriatric Depression Scale-15. Ninety-four people participated in the study. Thirty-seven percent (n = 35) reported some level of depressive symptoms, with most of these (21%, n = 20) classified as having mild depressive symptoms. Five participants (5%) reported they had had thoughts of being better off dead or hurting themselves, while three (3%) reported having had a plan to end their life. For each additional unmet need, the odds of being depressed increased by 25%(P < 0.001). For each point increase in quality of life, the odds of being depressed decreased by 48% (P < 0.001). The high proportion of people with dementia who report depressive symptoms suggests the need to routinely assess depressive symptoms among this group. There may also be benefits in assessing unmet needs and addressing these where possible as part of an approach to reducing depression among people living with dementia in the community.

Suicidal ideation and its relationship with mental health reported by different informants among children aged 6–12

BackgroundSuicidal ideation in children has received less attention than in adolescents. This study aimed to explore the self-reported prevalence of suicidal ideation among children aged 6–12 and to identify the relationship between self-reported suicidal ideation and children's mental health reported by different informants in Chinese setting. MethodThe study sample was 1479 children aged 6–12 from three elementary schools in Tianjin. Children completed the Dominic Interactive to report their mental health and suicidal ideation. Parents and teachers completed the Socio-Demographic Questionnaire and the Strengths and Difficulties Questionnaire (SDQ). ResultsThe prevalence of suicidal thoughts and death thoughts was 18.05 % and 16.90 %, respectively. Parent reported emotional symptoms, ADHD, and externalized problems were associated with death thoughts, and ADHD was associated with suicidal thoughts. For teacher's reports, emotional symptoms, and impact were associated with death thoughts, and ADHD, peer problems, internalized problems, and internalized and externalized comorbidity were associated with suicidal thoughts. All of the children's self-reported mental health problems were associated with suicidal thoughts and death thoughts. LimitationsCausality cannot be inferred in a cross-sectional study. ConclusionSuicidal ideation is not uncommon in Chinese children. The relationships between mental health problems and suicidal ideation varied in different informants. Suicide prevention in young children should be enhanced, and screening for suicidal ideation is recommended at the onset of different informants who reported specific mental health problems.

A Suicide-Specific Diagnosis – The Case For

A Suicide-Specific Diagnosis – The Case For

Assessing Trends and Risk Factors of Suicidal Ideation in Young People During the COVID-19 Pandemic Through Quarterly Monitoring in The Netherlands.

Introduction:The COVID-19 pandemic has impacted populations internationally, through infections and consequences of infections, and by the countermeasures to prevent the spread of the coronavirus. Concerns exist surrounding the impact of the COVID-19 pandemic on the mental health of youths in the Netherlands. Consequently, we studied quarterly trends and risk factors of suicidal ideation among Dutch youths from September 2021 onwards.Method:The Network GOR-COVID-19, a research group consisting of different organizations, monitors the effect of the COVID-19 pandemic on population health. As one element of this monitoring, quarterly data collections have been undertaken since September 2021 from a panel of youths (12 – 25 years of age) representative of the Dutch population. Online questionnaires collect data on self-reported health and wellbeing. We analyzed a selection of demographic, social activity, and mental health variables as potential risk factors for self-reported suicidal ideation in the previous three months. We assessed trends, performed longitudinal analyses, and conducted logistic and random forest regressions per quarterly round of data collection. Analyses were weighted for age, sex, educational level, and province where appropriate.Results:Approximately 4,500 youths participated in each quarterly questionnaire, with some participating more than once. Results showed substantial increases in self-reported suicidal ideation during and immediately after the third lockdown in the Netherlands in December 2021, rising from 9% to 17%, then slowly decreasing to 16% in May/June 2022, and to 13% in September 2022. In all multivariable analyses variables relating to mental health were indicated as risk factors. The strongest associations were seen in those experiencing mental health complaints and loneliness. Demographic variables were not strongly associated with suicidal ideation.Conclusion:The monitoring conducted by The Network GOR-COVID-19 enables the tracking of trends in the impact of the COVID-19 pandemic on the mental health of Dutch youths in The Netherlands.

The Associated Factors of Self-Harm and Suicide Ideation Among Chinese Indonesians During the COVID-19 Pandemic

Abstract: Background: This study aimed to identify the associated factors of self-harm and suicide ideation among Chinese Indonesians during the COVID-19 pandemic. Methods: A nonrandom sampling was performed through a nationwide online survey in Indonesia (May–June 2021). The online survey covered participants’ demographic information, suicide literacy, suicide stigma, loneliness, and self-harm and suicide ideation. A series of t-tests, χ2 tests, and hierarchical logistic regressions with the backward stepwise method were used to identify the factors associated with self-harm and suicide ideation. Responses from a total of 484 Chinese Indonesians were analyzed in this study. Results: The predictive model showed a significant goodness of fit to the observed data [χ2(17) = 174.1, p &lt; .001; R N2 = .41]. Chinese Indonesians with an average monthly income of ≥USD 843 were found to be 0.23 times (95% CI = 0.07–0.99) less likely to experience self-harm and suicide ideation than those who did not have an income. A one-point increase in the intensity of suicide glorification and loneliness were associated with 3.06 and 3.67 increase in the chance of experiencing self-harm and suicide ideation, respectively. Conclusion: One third of Chinese Indonesians self-reported self-harm and suicide ideation during the COVID-19 pandemic. Mental health and suicide prevention intervention programs are recommended to target those with low socioeconomic status, high glorification toward suicide, and high perceived loneliness.

Efficacy of a digital mental health intervention embedded in routine care compared with treatment as usual in adolescents and young adults with moderate depressive symptoms: protocol for randomised controlled trial

IntroductionThere are unmet mental health needs of depressed adolescents and young adults (AYAs) across the USA. Behavioural technology adequately integrated into clinical care delivery has potential to improve care access...

Role of rumination and hope on negative life events and suicidal ideation under the background of normalization of pandemic prevention and control: A moderated mediation model.

The study aimed to investigate the impact and mechanism of negative life events on college students' suicidal ideation during the COVID-19 pandemic and the buffering effect of hope under the background of normalization of pandemic. A total of 5211 participants took part in this study. Self-reported negative life events, rumination, hope and suicide ideation were measured using a range of questions and scales. Our research demonstrated that the incidence of suicidal ideation among college freshmen in the past week was higher during the COVID-19 pandemic than that before the pandemic. In this study, conditional process model 15 was used to verify the hypothetical model of rumination as a potential mediator and hope as a moderator. The hypothesized moderated mediation model was verified significant (β = -0.047, 95% CI = [-0.061, -0.035]), and hope was found to moderate the direct effect of negative life events on suicidal ideation (β = -0.039, t = -2.937, 95% CI = [-0.065, -0.013]) as well as the indirect effect of through the mediator rumination (β = -0.134, t = -10.850, 95% CI = [-0.158, -0.110]). We found that rumination partially mediated the effect of negative life events on suicidal ideation, and hope buffered the direct and indirect effect of negative life events on suicidal ideation. The implications of the findings for clinical interventions are discussed, including the importance of hope arousal as a protective factor and rumination as a cognitive mechanism for emotion regulation under the background of normalization of pandemic.

Suicidal Ideation Disparities Among Transgender and Gender Diverse Compared to Cisgender Community Health Patients.

Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences. To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals. Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation. 29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018. Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001). TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.

18 Years of Changing Trends: Swiss Data on the Clinical Characteristics and Game Types Associated with Problem Gambling.

Recent changes in the Swiss gambling context include the introduction of a new gambling policy (Swiss Federal Act on Gambling; GA), and the associated opening of the online gambling market. Within this context it is important to observe evolving trends in gambling behavior. This study therefore aims to identify the gambling behavior and clinical characteristics of a treatment-seeking population over an 18-year period (2001 to 2018). Specifically, the proportion of referrals relating to the three most popular game-types; VLT play, slot machines and online gambling, and associated socio-demographic characteristics, gambling-related spending and clinical features. The results indicate the high addictive potential for VLT and slot-machine use, over the 18-year period with an increasing use of online gambling from 2012 to 2018 (even before the official opening of the market). Problem-gambling vulnerability factors such as low income, unemployment and debts as well as self-reported suicidal ideation, were also over-represented in the sample. This longitudinal overview provides a detailed picture of treatment-seeking referrals, for future comparisons and can be used to tailor clinical interventions.