STASH, Vol. 11(3) – Suicidal behaviors among people with substance use or gambling disorders


Research indicates that suicide attempts are more prevalence among people experiencing chemical dependencies, compared with the general population (Wilcox et al., 2004; Roy, 2003). However, less is known about predictors of suicide among people with behavioral expressions of addiction. This week, as part of our Special Series on Gambling Disorders, we review a study that  sought to identify prevalence and  predictors of suicidal behaviors among patients seeking outpatient treatment for substance use disorders or gambling disorders (Manning and colleagues, 2015).


  • Researchers recruited 2,193 treatment seekers in Singapore to join a prospective study called the Treatment Outcome Monitoring program.
    • The analytic sample included 2,187 (86.8% male, 61.3% Chinese, mean age= 42.1) participants who had data related to suicidal behavior.
  • Patients completed assorted surveys and an initial assessment with a psychiatrist using DSM-IV-TR criteria for substance use and gambling disorders. They also accessed for co-occurring psychiatric disorders (i.e., psychiatric co-morbidity; examples include depression and anxiety).
  • Researchers examined how those with substance use disorders and gambling disorders differed for the following self-reported suicidal behaviors:
    • “Have you had any suicidal thoughts in the past month?” (past-month suicidal ideation).
    • If they answered “yes,” participants were asked “Do you have a suicide plan?” (past-month suicide plan).
    • All participants were also asked “Have you ever in your lifetime made a suicide attempt?” (lifetime suicide attempt).
  • They ran a series of logistic regressions to identify significant predictors of these suicidal behaviors.


  • Suicidality was high in this sample. Altogether, about 25% of the sample reported past-month suicidal ideation, 12% had made a suicide plan in the past month, and 12% had ever made a previous attempt.
  • Individuals with a gambling disorder reported significantly higher rates of suicidal ideation compared to those with substance use disorders (37% compared to 21%), and the same was true for suicide plans (16% versus 10%). But, they did not differ in prevalence of lifetime attempts.
  • A range of characteristics predicted suicide ideation, plans and attempts, as Table 1 illustrates.
    • Having any kind of psychiatric comorbidity, being in debt, being older, and having a gambling disorder predicted past-month suicidal ideation.
    • Psychiatric comorbidity was the strongest predictor of past-month suicidal plans. Being in debt also increased the risk.
    • Being female, having psychiatric comorbidity, and being in debt all increased the risk of lifetime suicide attempts.


Figure. Odds ratios and confidence intervals of potential predictors of suicidality (adapted from Manning et al., 2015). (click to enlarge).        * Statistically significant at p < 0.05. ** Statistically significant at p < 0.01. without a co-occurring substance use disorder. Click image to enlarge.


  • The sample was made up of treatment seekers, and may not be representative of other populations (e.g., non-treatment seekers, non-Singaporean/Chinese).
  • Although we and the authors of the study use the term “predictor,” we cannot conclude, on the basis of this study’s design, that any characteristics actually used an increase in the risk for suicidality.
  • The researchers found that that 1.1% of the sample qualified for both a substance use disorder and a gambling disorder, but they did not report rates of suicidal ideation for people who qualified for both substance use disorders and gambling disorders.
  • The researchers did not report on whether or not they included substance use disorder as a predictor variable in their logistic regressions.


Individuals seeking treatment for gambling disorders were more likely to report past-month suicidal ideation and plans compared to individuals seeking treatment for substance use disorders. It could be that people with gambling disorders acquire more debt compared to those with substance use disorders, leading them to contemplate suicide as a solution to their problems. Although suicide ideation is a potent risk factor for attempted and completed suicide, in this case the difference between patient groups did not translate into suicide attempts. Still, clinicians treating patients with either gambling disorders or substance use disorders should screen regularly for suicidal ideation. This study’s findings suggest that gambling disorder patients with psychiatric comorbidity or debt are particularly at risk.

– Kat Belkin

What do you think?  Please use the comment link below to provide feedback on this article.


Manning, V., Koh, P.K., Yang, Y., Ng, A., Song, G., Kandasami, G., Wong, K.E. (2015). Suicidal ideation and lifetime attempts in substance and gambling disorders. Psychiatry      Research, 225, 706-709

Roy, A. (2003). Characteristics of drug addicts who attempt suicide. Psychiatry Research, 121, 99–103.

Wilcox, H.C., Conner, K.R., Caine, E.D. (2004). Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug and Alcohol Dependence, 76, 11–19.

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