A paper titled ‘A qualitative analysis of people who died by suicide and had gambling documented in their coronial file’,1 which explores the relationship between death by suicide and gambling in Ireland, was published in April 2025. It is the first study to explore this topic using coronial records in Ireland.

Context

Since the mid-1990s, the availability of gambling and gambling products (including online products) has increased dramatically. In turn, rates of gambling and problematic gambling have also increased. In Ireland, the estimate of adults with problematic gambling behaviours is 3.3%, with a further 7.1% having ‘multiple problematic gambling experiences’ (p. 2).2

The Reynolds et al. paper is grounded in the context of a growing body of international evidence of the harms associated with gambling, including an association with an increased risk of suicidal ideation and suicide attempts. Among the other harms associated with gambling found in the literature are financial difficulties, mental health issues, relationship problems, addiction, and crime.

Research aim

The aim of the research carried out by Reynolds et al. is to identify and profile individuals who died by suicide in Ireland between 2015 and 2020 and had gambling documented in their coronial file. A qualitative approach was taken to analysing the data to describe any other proximal (or acute) and distal (or chronic) risk factors documented in the file.

The Irish Probable Suicide Death Study

The Irish Probable Suicide Death Study (IPSDS) for 2015–2020 collected its data through an annual census of closed coronial files. Researchers working on the IPSDS have access to all relevant coronial documents. They classify a death as a suicide ‘on the balance of probabilities (i.e. civil standard of proof)’ (p. 2),1 and therefore the IPSDS includes ‘all coroner-determined and research-determined suicides, meaning deaths that were more likely than not, based on the weight of evidence, to have been a suicide’ (p. 2).1 The IPSDS is a valuable resource for those working in the field of suicide prevention, and is at the core of this study.

Methodology

Information on an individual’s gambling history is not routinely collected as part of Irish coroners’ investigations. The authors screened the files of the 3,625 deaths from the IPSDS (2015–2020) for any mention of gambling. They found 23 deaths where gambling was mentioned in the notes for these cases. Further analysis was carried out on these cases using a database into which demographic and clinical variables, as well as adverse events experienced by the person, were logged. Thematic analysis was used to identify the long-term distal and the short-term proximal risk factors reported in the context of these deaths. 

Findings

The mean age of the sample was 38.7 years (standard deviation (SD): 9.82), 21 were male, and 21 were parents. More than one-half (57%) of cases had been in contact with health services prior to their death, including with a general practitioner (GP) (in 46% of cases) and with a counselling-related service or inpatient/outpatient psychiatric service (in 38% of cases).

The findings on risk factors echoed those in the international literature.

Distal risk factors

Mental health conditions (including a history of substance use) featured heavily in these cases. A history of a mental health condition was noted for more than two in every three cases; these included a recurrent depressive disorder, bipolar disorder, schizophrenia, and borderline personality disorder. A history of substance use was recorded in over one-half of the deaths, ‘most notably’ (p. 3)1 cocaine use, followed by alcohol dependency. Past suicidal intent and/or behaviour was also a feature for one-half of these cases. Other social and environmental distal risk factors identified included adverse childhood experiences (ACEs), chronic illness, reclusiveness, and social isolation.

Proximal risk factors

Acute distress and mental health symptoms were reported around the time of death for more than one-half of cases. Some people had recently been discharged from inpatient hospitals or had changed psychiatric medications prescribed. Financial problems also featured, including those related specifically to gambling. Other factors included interpersonal problems, such as relationship difficulties with a spouse, alcohol and drug use/intoxication at the time of death, work stress, employment issues, and legal/criminal issues.

Discussion

The authors’ exploration of the risk factors experienced by these people leading up to and at the time of their deaths presents a complex picture. In discussing their work, Reynolds et al. outline the findings of four international studies that use coronial data to investigate gambling and suicide, as well as a systematic review and meta-analysis of 40 risk factors for suicide. The meta-analysis found that ‘the presence of any mental, drug or alcohol disorder, suicide attempt history and adverse life events, including relationship conflict and legal problems, were associated with an increased suicide risk’ (p. 4).1 Based on their own analysis, Reynolds et al. suggest that those with reported gambling issues have a similar pattern of risk factors. ‘It indicates that those with gambling-related behaviours already have a vulnerable profile with an increased suicide risk, in addition to their gambling’ (p. 4).1

Limitations

This study, which is based on a comprehensive national database, provides the first estimates of the numbers of those who died by suicide in Ireland and for whom gambling was documented in their coronial records. However, the authors identify some limitations to their work. For example, it does not involve analysis of association and so cannot be taken to infer causality between suicide and gambling. Coroners across Ireland vary in the way they conduct their investigations and there is no routine collection of information on gambling. This will impact on data recording, and Reynolds et al. argue that it may contribute to the underreporting of gambling in these cases. Underreporting may be further accentuated given the stigma and hidden nature of gambling. 

Conclusions

The authors argue that further research is needed to ‘understand and visualise the complex interplay between gambling and other factors for suicide based on coronial information’ (p. 4).1 To facilitate this, improvements need to be made to the collection of data on gambling and its harms, especially as it relates to cases of suicide. They suggest support for interventions and policies that reduce all risk factors associated with suicide, including gambling and its associated harms. A new suicide reduction strategy for Ireland is to be developed and this offers ‘an opportunity to include gambling as an area for action’ (p. 2).1 Based on their findings, Reynolds et al. conclude that ‘a public health approach to reducing gambling harm should be embedded in a wide range of policies, including mental health, men’s health, substance use, online safety, and suicide prevention’ (p. 4).1

1    Reynolds CME, Cox G, Lyons S, McAvoy H, O’Connor L and Kavalidou K (2025) A qualitative analysis of people who died by suicide and had gambling documented in their coronial file. Addict Behav, 163: 108267. Available from: https://www.drugsandalcohol.ie/42583/

2    O’Ceallaigh D, Timmons S, Robertson D and Lunn P (2023) Measures of problem gambling, gambling behaviours and perceptions of gambling in Ireland. ESRI Research Series 169. Available from: https://www.drugsandalcohol.ie/39671/