What is the relationship between problem gambling and mental illness?
Research shows that, in general, the link between problem gambling and concurrent mental illness is quite strong. The connection between problem gambling and depression and anxiety is well documented (Dowling et al., 2015a; Lorains et al., 2011; Parhami et al., 2014; Toneatto & Pallai, 2016). Studies have also shown that there is a higher prevalence of impulsivity (e.g., attention-deficit/hyperactivity disorder [ADHD]) (Waluk et al., 2016), bipolar disorder (Dowling et al., 2015a; Lorains et al., 2011), personality disorders (Brown et al., 2016; Dowling et al., 2015b; Lorains et al., 2011) and psychotic disorders in the problem gambling population (Haydock et al., 2015). However, more research is needed to determine cause-and-effect relationships.
A complex mix of biological and environmental factors likely contribute to whether people develop problem gambling and co-occurring mental illnesses or substance use issues. The following diagram depicts how biological and environment factors can interact to create risk factors and protective factors for substance use, mental illness and problem gambling and how these concerns can influence each other (Moore et al., 2002).
Some notable research findings on problem gambling and mental illness
A meta-analysis conducted by Lorains and colleagues (2011) illustrates the prevalence rates of co-occurring disorders in problem gambling populations:
- High prevalence for nicotine dependence (60.1%), alcohol use disorder (28.1%), illicit drug dependence (17.2%) and other substance use disorders (57.5%).
- High prevalence for mood (37.9%) and anxiety (37.4%) disorders.
- Mood and anxiety disorders often
precede gambling problems, whereby gambling is used as a coping mechanism.
- Mood disorders may manifest as secondary symptoms in response to the financial loss associated with problem gambling.
- Prevalence of antisocial personality disorder is substantially higher (28.8%) than in the general population (0.6-3.6%).
Previous studies pertaining to the prevalence of co-occurring disorders in problem gambling have been largely based on people who are receiving treatment. However, the meta-analysis by Lorains and colleagues (2011) was based on population studies, providing crucial evidence about problem gambling populations at the community level.
What is the relationship between problem gambling and suicide?
People who gamble excessively experience higher rates of suicide, suicidal thoughts and attempts. These risks increase in people who have co-occurring mental illnesses or substance use issues (Cook et al., 2015; Hodgins et al., 2006). This is why it is important to perform ongoing screening for suicidality and suicide ideation with all clients experiencing gambling problems. Learn more about
problem gambling and suicide.
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Journal of Gambling Studies,
32 (4), 1079-1100. DOI:
- Cook, S., Turner, N.E., Ballon, B., Paglia-Boak, A., Murray, R., Adlaf, E.A., . . .Mann, R.E. (2015) Problem gambling among Ontario students: Associations with substance abuse, mental health problems, suicide attempts, and delinquent behaviours.
Journal of Gambling Studies, 31, 1121-1134. DOI:
- Dowling, N.A., Cowlishaw, S., Jackson, A.C., Merkouris, S.S., Francis, K.L. & Christensen, D.R. (2015a). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis.
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- Haydock, M., Cowlishaw, S., Harvey, C. & Castle, D. (2015). Prevalence and correlates of problem gambling in people with psychotic disorders.
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- Hodgins, D.C., Mansley, C. & Thygesen, K. (2006). Risk factors for suicide ideation and attempts among pathological gamblers.
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- Lorains, F.K., Cowlishaw, S. & Thomas, S.A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys.
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- Moore, K., Matthews, C., Hunt, W.M. & Pape, L. (2002).
Co-occurring disorders problem gambling integrated treatment manual. Retrieved from Connecticut’s Official State website [link].
- Parhami, I., Mojtabai, R., Rosenthal, R.J., Afifi, T.O. & Fong, T.W. (2014). Gambling and the onset of comorbid mental disorders: A longitudinal study evaluating severity and specific symptoms.
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- Toneatto, T. & Pillai, S. (2016). Mood and anxiety disorders are the most prevalent psychiatric disorders among pathological and recovered gamblers.
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14 (3), 217-227. DOI:
- Waluk, O.R., Youssef, G.J. & Dowling, N.A. (2016). The relationship between problem gambling and attention deficit hyperactivity disorder.
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