The research, published in BMC Psychiatry by Elif Aktan Mutlu and colleagues at Ankara Etlik City Hospital and the University of Health Sciences, examined the medical records of 342 patients diagnosed with gambling disorder according to DSM-5 criteria. All patients were seen at the same specialized addiction outpatient clinic between September 2023 and December 2025, giving the team a relatively large and clinically well-characterized sample for a condition that often goes undetected in general psychiatric settings. The study was approved by the hospital’s Scientific Research Evaluation and Ethics Committee, and informed consent was obtained from all participants.

The headline number from the analysis is sobering: 13.2 percent of the patients in the sample had made a lifetime suicide attempt related to their gambling. That figure alone underscores the scale of the problem, but what makes the study valuable is the way the researchers dissected the differences between patients with and without a history of gambling-related suicide attempts. They classified patients according to the presence or absence of such attempts, identified through retrospective review of clinical records, and then compared the two groups across sociodemographic, clinical, and financial dimensions.

Gambling severity was measured using the South Oaks Gambling Screen, a widely used self-report instrument that quantifies pathological gambling behavior. In the initial univariable analyses, five factors were significantly associated with gambling-related suicide attempts: higher gambling severity, depression, Cluster B personality disorders, a history of deliberate self-harm, and financial hardship. Each of these is clinically meaningful in its own right, and together they sketch a picture of patients whose gambling has infiltrated both their mental health and their economic lives.

The most technically important part of the study, however, came next. Because univariable analyses cannot disentangle factors that travel together — depressed patients may also be more severely addicted, and severe addiction often brings financial ruin — the researchers ran multivariable logistic regression to identify which factors remained independently associated with suicide attempts after adjustment for the others. Three survived: a history of deliberate self-harm, the presence of psychiatric comorbidity, and a debt-to-monthly-income ratio exceeding 30.

The strength of these associations is remarkable. A history of deliberate self-harm carried an odds ratio of 15.894, with a 95 percent confidence interval of 3.270 to 77.253, meaning patients with such a history had roughly sixteen times the odds of a gambling-related suicide attempt compared with those without one, with the true value likely falling somewhere in that wide interval. Psychiatric comorbidity showed an odds ratio of 14.549 (95 percent CI: 1.799 to 117.650). And the financial marker — owing more than thirty times one’s monthly income — carried an odds ratio of 8.806 (95 percent CI: 1.777 to 43.625). These are large effects by the standards of psychiatric epidemiology, and their convergence on clinical and financial variables rather than demographic ones is the study’s core message.

Perhaps the most counterintuitive finding is what did not matter. Marriage, parenthood, and social support are traditionally considered protective against suicide in the general population, and suicide risk assessment tools routinely weight them heavily. In this sample of patients with gambling disorder, none of these variables was significantly associated with suicide attempts. The authors interpret this as evidence that gambling-related suicide attempts are more closely tied to disorder-specific clinical and financial characteristics than to the sociodemographic factors that guide conventional risk assessment. In other words, a married father with a supportive family is not necessarily safer if his debts have spiraled to thirty times his income and he has a history of self-harm.

The debt-to-income ratio deserves particular attention because it offers something rare in suicide research: a quantifiable, objective threshold. Rather than treating financial hardship as a vague clinical impression, the researchers expressed it as total debt divided by monthly income, in Turkish lira, and found that crossing the threshold of 30 sharply elevated risk. This kind of metric could, in principle, be incorporated directly into routine screening — a clinician asking a patient with gambling disorder about their debts could translate the answer into a concrete risk indicator. The authors suggest that their findings support comprehensive suicide risk assessment in gambling disorder that incorporates self-harm history, psychiatric comorbidity, and financial strain in addition to gambling severity itself.

The study’s design imposes some limits on interpretation. As a retrospective, descriptive, and comparative analysis based on medical records, it can identify associations but cannot establish causation, and the classification of suicide attempts relied on retrospective review of clinical documentation rather than prospective follow-up. The wide confidence intervals around some of the odds ratios reflect the relatively small number of attempters within the sample, a common challenge in suicide research. The authors also note that the published version was shared early to provide faster access to peer-reviewed, accepted research and is subject to further edits before the final Version of Record.

Even with those caveats, the implications are significant for a disorder that is expanding globally alongside legalized online gambling. Gambling disorder is classified among behavioral addictions, and its sufferers frequently present late, after financial and relational damage has already accumulated. If the findings hold up in prospective studies and other populations, they point toward a practical triage strategy: every patient diagnosed with gambling disorder should be asked about past deliberate self-harm, screened for psychiatric comorbidity, and asked to quantify their debt relative to income. The patients who light up all three indicators would be the ones most urgently needing suicide risk intervention — a conclusion that could redirect scarce clinical attention toward those who need it most, and away from the demographic assumptions that this study suggests may quietly fail the very people they are meant to protect.

Subject of Research: Clinical and financial risk factors for suicide attempts in gambling disorder

Article Title: Clinical and financial correlates of suicide attempts among patients with gambling disorder: a retrospective study

Article References: Mutlu, E. A., Turgut Keser, B., Erdem, E., & Şafak, Y. (2026). Clinical and financial correlates of suicide attempts among patients with gambling disorder: a retrospective study. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08478-z

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08478-z

Keywords: gambling disorder, suicide attempt, suicidal behavior, deliberate self-harm, financial debt, debt-to-income ratio, psychiatric comorbidity, behavioral addiction, South Oaks Gambling Screen, DSM-5, risk factors, retrospective study

The study, led by Clément Vansteene of Université Paris Cité and Hôpital Sainte-Anne together with colleagues including Flinders University’s Professor Zsolt Demetrovics and Dr Andrea Czakó, is described as one of the most comprehensive reviews of behavioural addictions ever conducted. Rather than running a new experiment, the team performed what researchers call a multiple systematic review analysis, synthesising almost 250 existing systematic reviews and meta-analyses. These are the highest tiers of evidence in medical research, because they aggregate findings from many independent studies to reveal patterns that no single trial could detect on its own.

The methodological logic of the paper is elegant in its simplicity. The researchers used gambling disorder, one of the most extensively studied behavioural addictions and the only non-substance addiction recognised in the DSM-5 alongside gaming disorder, as a benchmark. They then compared gambling disorder with alcohol use disorder and with six commonly discussed behavioural addictions. Across 75 factors linked to addiction, spanning mental health, personality traits, emotional regulation, cognition and brain function, they assessed how closely each condition resembled the benchmark. The result was striking: gaming disorder was found to be 98.9 percent similar to gambling disorder, sharing many of the same risk factors, warning signs and underlying characteristics.

That figure is remarkable because gambling disorder has long served as the scientific prototype of a behavioural addiction. It produces tolerance, withdrawal-like distress, preoccupation, loss of control and continued engagement despite harm, the same core features that define substance use disorders. If gaming disorder matches that profile almost perfectly, the implication is that the neural and psychological machinery of addiction does not require a chemical substance at all. Compulsive sexual behaviour disorder and binge eating disorder also showed a high degree of overlap with gambling disorder, placing them close behind gaming in the similarity ranking.

The findings arrive at a moment when the clinical world is already moving in this direction. The World Health Organization included gaming disorder in the eleventh revision of the International Classification of Diseases, and binge eating disorder has been formally recognised as an eating disorder in its own right. What this new analysis adds is a comparative evidence base: a systematic demonstration that these conditions are not merely superficially similar to addiction but appear to converge on the same risk architecture, from impulsivity and emotional dysregulation to comorbid mood and anxiety problems.

Professor Demetrovics, Matthew Flinders Professor in Mental Health and Wellbeing and Director of Flinders’ Institute for Mental Health and Wellbeing, argues that the research highlights a need to look beyond substances when thinking about addiction. People often associate addiction with alcohol or drugs, he says, but the findings show that certain behaviours can share many of the same underlying characteristics. In his words, addiction is not defined by a substance alone; in some cases, behaviours can become compulsive, difficult to control and continue despite causing harm.

That point carries real weight for public health. Behaviours such as gaming, eating, shopping and working are woven into everyday life, which makes it genuinely difficult to tell when a normal pattern has tipped into something unhealthy. A person losing sleep and damaging relationships because they cannot stop gaming, someone repeatedly binge eating despite serious health consequences, a shopper spending beyond their means, or an individual whose sexual behaviour begins to erode their wellbeing may not recognise the pattern as an addiction at all. Demetrovics notes that many people who experience these problems may not identify them as potential addictions, and as a result may not seek help until the effects on their health, relationships, finances or daily life become severe.

Dr Czakó, Senior Research Fellow in Psychology at Flinders, emphasises the implications for individuals, families and health professionals. Many people struggle with behaviours they feel ashamed of, or simply do not recognise as a potential addiction, she says, and understanding that these difficulties may share common underlying mechanisms can help people seek support earlier and help clinicians respond more effectively. The researchers argue that better recognition of behavioural addictions could reduce stigma, improve access to care and allow intervention before significant harm occurs, a framing that shifts the conversation from moral failing to treatable condition.

The study was published in European Psychiatry under the title ‘Concordance between gambling disorder, alcohol use disorder, and other behavioural addictions provides evidence for a comprehensive approach to addictive behaviours: A multiple systematic review analysis’, with a team spanning Université Paris Cité, Hôpital Sainte-Anne, Flinders University, Semmelweis University, the University of Gibraltar and Aga Khan University. Its authors hope the evidence will encourage a comprehensive approach to addictive behaviours, one in which clinicians assess the full spectrum of compulsive patterns rather than treating substance and behavioural problems as separate universes. For the millions of people quietly wrestling with behaviours that feel out of control, the message is that loss of control is a recognised medical phenomenon, and that open conversations, earlier identification and appropriate support are far more achievable when the science acknowledges what they are experiencing.

Subject of Research: Behavioural addictions and their similarity to gambling and substance use disorders

Article Title: From binge eating to gaming: when everyday behaviors become addictions

Article References: From binge eating to gaming: when everyday behaviors become addictions. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: behavioural addiction, gaming disorder, gambling disorder, binge eating disorder, compulsive sexual behaviour, systematic review, European Psychiatry, mental health, loss of control, stigma, Flinders University, addiction research

The scale of the analysis is notable. The cohort consisted of patients recruited from addiction treatment centers across Quebec in 2012 and 2013 who received a diagnosis of gambling disorder at any point between 2009 and 2022. The investigators linked these clinical records with provincial health administrative databases, allowing them to track diagnoses, service use, and hospitalizations over more than a decade. Using the discharge date from each patient’s last hospitalization carrying a gambling disorder diagnosis as the index date, they identified 470 hospitalized patients and matched them by age and sex to 1,606 patients with gambling disorder who had never been hospitalized. Controls qualified only if they had received their gambling disorder diagnosis within the three years preceding the index date, a constraint designed to ensure that the two groups were genuinely comparable in the recency of their diagnosis.

Methodologically, the study relied on conditional logistic regression stratified by age and sex, a technique appropriate for matched case-control designs because it compares each case with its matched controls while automatically accounting for the matching variables. The models produced adjusted odds ratios, a statistical measure expressing how much each factor changes the odds of hospitalization after controlling for everything else in the model. This approach matters because hospitalization in psychiatric populations is rarely the product of a single cause; it emerges from an interplay of illness severity, treatment history, social circumstances, and the way health systems respond to crises. By separating these strands statistically, the researchers could ask which factors carry independent weight.

The answer, in descending order of magnitude, was striking. Patients with comorbid mental disorders in the three years before the index date had nearly ten times the odds of hospitalization compared with those without such comorbidity, an adjusted odds ratio of 9.81. Suicidal behaviors more than doubled the odds, at 2.88, and comorbid substance-related disorders raised them by more than half, at 1.58. These figures align with a growing international literature. A Finnish nationwide register study published in Addiction in 2024 documented elevated somatic and psychiatric comorbidity among people with diagnosed gambling disorder, and a systematic review and meta-analysis in the Australian and New Zealand Journal of Psychiatry found psychiatric comorbidity to be the rule rather than the exception among treatment-seeking problem gamblers. Research from Denmark has similarly linked gambling disorder treatment with heightened comorbidity, criminality, and healthcare costs.

The suicide signal deserves particular emphasis. Gambling disorder carries one of the highest suicide rates of any addiction, and studies of treatment samples in Austria and national inpatient data in the United States have repeatedly documented elevated rates of suicidal ideation and attempts among people with gambling problems, especially when depression is present. The Quebec findings quantify this danger in service terms: a history of suicidal behavior in the preceding three years nearly triples the odds that a patient with gambling disorder will require hospitalization. For clinicians, this suggests that suicide risk assessment should be a routine, systematic component of every encounter with a patient receiving treatment for gambling disorder, not an occasional add-on reserved for obvious crises.

Service use patterns in the year before the index date also proved predictive. High emergency department use carried an adjusted odds ratio of 2.45, and any hospitalization in the prior year raised the odds by 79 percent. These findings echo a broader pattern documented in patients with substance-related disorders, where frequent emergency department visits and prior hospitalizations reliably flag patients at risk of subsequent acute care. Emergency departments, in this sense, function as early warning systems, but also as symptoms of a system under strain. Studies of frequent emergency department visitors have shown that these patients often report unmet primary care needs, suggesting that heavy emergency use reflects gaps in community-based care rather than simply greater illness. The Quebec data now extend that insight to the gambling disorder population.

Perhaps the most actionable findings concern what protects patients. High-intensity outpatient care in the year before the index date halved the odds of hospitalization, with an adjusted odds ratio of 0.50, and high continuity of care reduced the odds by 26 percent, at 0.74. Continuity of care, a concept with a long history in health services research dating back to work on primary care in the 1970s, refers to the extent to which a patient sees the same providers or a coherent team over time rather than a rotating cast of strangers. Research on patients with serious mental illness has shown that family practice continuity reduces unplanned hospital use, and studies of general practitioner regularity have linked it to lower rates of high-use hospitalization. The Quebec study demonstrates that the same principle applies to behavioral addiction: patients whose outpatient care is intensive and consistent are markedly less likely to crash into the acute care system.

Sociodemographic factors added their own texture. Unemployment raised the odds of hospitalization by 45 percent, and living in semi-urban or rural areas increased them by 51 percent, a pattern that likely reflects both the socioeconomic stress associated with joblessness and the thinner supply of specialized addiction services outside major urban centers. Intriguingly, living alone was associated with lower odds of hospitalization, at 0.61, a counterintuitive result the authors note as significant. One possible interpretation is that patients living alone who reach treatment may differ systematically from those with co-residing partners or family, or that cohabiting patients are more often pushed into care by distressed relatives at moments of crisis that otherwise might have escalated to hospitalization. The authors frame the overall picture through the lens of vulnerability: unemployment, rural residence, and social isolation mark patients whose clinical needs intersect with limited community support.

The study’s framework draws on Andersen’s behavioral model of health services use, a foundational framework in health services research that organizes predictors into predisposing, enabling, and need characteristics. This theoretical scaffolding helps explain why both clinical severity and service system factors appear side by side in the results. Gambling disorder, classified as a behavioral addiction in both the DSM-5 and the ICD-11, remains frequently underdiagnosed and undertreated, partly because of stigma. Research on perceived social stigmatization of gambling disorders shows that stigma deters help-seeking and shapes how patients and professionals view treatment, while systematic reviews of general practitioners’ management of gambling disorder reveal persistent gaps in knowledge and screening. Patients may therefore cycle through primary care and emergency departments with depression, anxiety, or substance problems while the underlying gambling disorder goes unrecognized.

The Lancet Public Health Commission on gambling, published in 2024, framed gambling as a significant and growing public health concern, and the Quebec study adds a concrete service-delivery dimension to that call. The authors’ conclusion is direct: the key clinical needs and vulnerabilities among patients with gambling disorder should be addressed through outpatient interventions that prioritize high continuity and intensity of care. In practical terms, that means building treatment pathways in which a patient with gambling disorder sees a stable, coordinated team that can manage comorbid depression, screen for suicide risk, treat concurrent substance use, and maintain contact over time, rather than relying on episodic crisis-driven care. The chronic disease management model long advocated for addiction, which treats addiction as a relapsing condition requiring sustained monitoring rather than a discrete episode to be cured, fits these findings closely. As jurisdictions worldwide expand legalized gambling and online platforms multiply access, the population of diagnosed patients will likely grow, and the Quebec data offer a template for identifying, early and precisely, those most at risk of hospitalization, and for designing the outpatient systems that could keep them out of hospital beds altogether.

Subject of Research: Clinical, service use, and sociodemographic predictors of hospitalization among patients diagnosed with gambling disorder in Quebec, Canada.

Article Title: Predictors of Hospitalization Among Patients with Gambling Disorder: a Retrospective Matched Case–Control Study

Article References: Predictors of Hospitalization Among Patients with Gambling Disorder: a Retrospective Matched Case–Control Study. (n.d.). https://doi.org/10.1007/s11469-026-01729-w

Image Credits: AI Generated

DOI: 10.1007/s11469-026-01729-w

Keywords: gambling disorder, hospitalization, comorbid mental disorders, suicidal behavior, substance-related disorders, emergency department use, continuity of care, outpatient treatment, case-control study, Quebec, behavioral addiction, health services research