A Meta-Analytic Investigation of Problem Gambling and Self-Harm: A Causal Inference Perspective

Session Title

Session 1-3-A: Compounding Issues in Problem Gambling

Presentation Type

Paper Presentation

Location

Park MGM, Las Vegas, NV

Start Date

23-5-2023 1:45 PM

End Date

23-5-2023 3:15 PM

Disciplines

Clinical Psychology

Abstract

This presentation will provide a theoretical foundation for the possible effect of problem gambling on self-harm, drawing on Joiner’s Interpersonal Theory of Suicide. Then, it will review pre-registered meta-analyses examining the effect of problem gambling on (a) suicide ideation and (b) suicide attempt (k = 14 unique studies between the two meta-analyses). We found a positive, statistically significant meta-analytic effect of problem gambling on each self-harm outcome (OR’s = 1.76 and 2.35, respectively). These meta-analytic estimates are comparable to well-established risk factors for suicide ideation and attempt (e.g., anxiety disorder, previous psychiatric hospitalization). Type of study sample (i.e., probability vs. non-probability) did not moderate the meta-analytic effect of problem gambling on self-harm; nor did the problem gambling measure used in each study or the number of confounds measured. Moreover, sensitivity analyses suggested that these effects were robust to measured (e.g., mood disorders) and unmeasured confounders. However, we detected potential publication bias, suggesting the need for greater adherence to open science practices. All 14 studies used a cross-sectional design; therefore, high-quality longitudinal studies are needed to uncover direct, indirect, and common factor pathways between problem gambling and self-harm and how they differ for different gamblers.

Behavioral health providers should incorporate routine screening and brief interventions for problem gambling, which may appreciably reduce the risk of self-harm. Gambling operators should consider incorporating self-harm prevention as a part of their responsible gambling initiatives. Communities should consider increased population-level self-harm risk as a potential consequence of gambling expansion.

Keywords

problem gambling, self-harm, meta-analysis, causality, risk factor, suicide

Author Bios

Heather Gray, PhD, is Director of Academic Affairs at the Division on Addiction, Cambridge Health Alliance, and Assistant Professor of Psychology in the Department of Psychiatry at Harvard Medical School. Her research spans behavioral and substance-based addiction. She has studied the reach, impact, and effectiveness of responsible gambling efforts. Additionally, she coordinates many of the Division on Addiction’s public outreach and education efforts, including the Brief Addiction Science Information Source (basisonline.org).

Funding Sources

Entain PLC (formally GVC Holdings PLC), a sports betting and gambling company, provided primary funding for this study. Other than providing funding, Entain had no involvement in this research. The Division on Addiction receives additional funding from a variety of federal, state, local, and private sources, as described on https://www.divisiononaddiction.org/funding-statement/.

Competing Interests

All Division on Addiction funders are listed on https://www.divisiononaddiction.org/funding-statement/. The authors declare no conflicts of interest.

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May 23rd, 1:45 PM May 23rd, 3:15 PM

A Meta-Analytic Investigation of Problem Gambling and Self-Harm: A Causal Inference Perspective

Park MGM, Las Vegas, NV

This presentation will provide a theoretical foundation for the possible effect of problem gambling on self-harm, drawing on Joiner’s Interpersonal Theory of Suicide. Then, it will review pre-registered meta-analyses examining the effect of problem gambling on (a) suicide ideation and (b) suicide attempt (k = 14 unique studies between the two meta-analyses). We found a positive, statistically significant meta-analytic effect of problem gambling on each self-harm outcome (OR’s = 1.76 and 2.35, respectively). These meta-analytic estimates are comparable to well-established risk factors for suicide ideation and attempt (e.g., anxiety disorder, previous psychiatric hospitalization). Type of study sample (i.e., probability vs. non-probability) did not moderate the meta-analytic effect of problem gambling on self-harm; nor did the problem gambling measure used in each study or the number of confounds measured. Moreover, sensitivity analyses suggested that these effects were robust to measured (e.g., mood disorders) and unmeasured confounders. However, we detected potential publication bias, suggesting the need for greater adherence to open science practices. All 14 studies used a cross-sectional design; therefore, high-quality longitudinal studies are needed to uncover direct, indirect, and common factor pathways between problem gambling and self-harm and how they differ for different gamblers.

Behavioral health providers should incorporate routine screening and brief interventions for problem gambling, which may appreciably reduce the risk of self-harm. Gambling operators should consider incorporating self-harm prevention as a part of their responsible gambling initiatives. Communities should consider increased population-level self-harm risk as a potential consequence of gambling expansion.