Fatal Wagers: Identification of Gambling As a Precipitating Factor in Deaths By Suicide in the National Violent Death Reporting System

Background

Previous research shows that the introduction of gambling venues is associated with increases in the number of deaths by suicide in surrounding areas. However, to date there is little research on how gambling is identified as a precipitating factor in deaths by suicide in administratively collected data. Death by suicide is one of the most devastating and costly correlates of problem gambling and has serious implications for public health. Due to sparse collection of data relevant to gambling harm, the US is poorly positioned to measure the social costs of gambling market liberalization. Improving the recording of information that is relevant to harms caused by gambling would help address this problem. The current study uses administratively collected data from the National Violent Death Reporting System to detect mentions of gambling in deaths by suicide. The current research is motivated by two questions: 1) How often is gambling mentioned as a precipitating factor to death by suicide in the US? And 2) Is the mention of gambling in death by suicide reports associated with state, demographic or case characteristics?

Methods

The current study used data from the National Violent Death Reporting System Restricted Access Datafile from January 1, 2003 to December 31, 2020. Deaths by suicide associated with gambling were determined through a text string search of the coroner/medical examiner reports and law enforcement reports. Cases selected by the text string search were then screened by the study team to identify cases where gambling was discussed as a precipitating factor to the death. Bivariate associations were tested between deaths by suicide associated with gambling and demographic categories including reported race, sex, age, state of residence, sexual identity, and marital status. Case characteristics examined included known mental health diagnosis, substance use disorder, financial problems, employment problems, relationship problems, and cases where the death was precipitated by another crime. States were compared across gambling policy and state revenues derived from gambling.

Results

Results show that approximately 1235 of 711,343 completed deaths by suicide identify gambling as a precipitating factor. Gambling as a precipitating factor was disproportionately high among victims identifying as Asian or Pacific Islander, 40–55-year-olds, men, and victims experiencing financial problems, and/or relationship problems. Gambling as a precipitating factor was more common in states with greater availability of gambling opportunities, with Nevada showing mentions of gambling at approximately 10 times the national average rate.

Conclusions

Higher numbers of deaths by suicide that identify gambling as precipitating factor in states with high gambling revenues suggests that there are real and measurable public health burdens associated with the current expansion of gambling markets in the US. Results of the current study suggest that those identifying as Asian or Pacific Islander, men, and middle-aged adults may be disproportionately hurt by this expansion. The low number of cases identified and the lack of agreement between cases found through the search string and relevant coding categories (“other addiction”) suggest problems in the current recording of issues related to gambling in the NVDRS.