A Meta-Analytic Investigation of Problem Gambling and Self-Harm: A Causal Inference Perspective

Objective: Problem gambling may be an underappreciated treatment target for reducing self-harm. Multivariate studies examining the relationship between problem gambling and self-harm have returned inconsistent results, perhaps due to insufficient power or differences in study quality. Method: We con...

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Bibliographic Details
Published in:Psychology of addictive behaviors 2023-11, Vol.37 (7), p.946-960
Main Authors: Edson, Timothy C., Slabczynski, John M., Lee, Taylor G., McAuliffe, William H. B., Gray, Heather M.
Format: Article
Language:English
Subjects:
Analysis
Attempted Suicide
Averages
Bias
Business Organizations
Cross-Sectional Studies
Gambling
Gambling - epidemiology
Gambling Disorder
Human
Humans
Inference
Meta-analysis
Nonsuicidal Self-Injury
Pathological gambling
Self destructive behavior
Self injury
Self-Injurious Behavior - epidemiology
Suicidal Ideation
Suicide
Suicide, Attempted
Suicides & suicide attempts
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Summary:Objective: Problem gambling may be an underappreciated treatment target for reducing self-harm. Multivariate studies examining the relationship between problem gambling and self-harm have returned inconsistent results, perhaps due to insufficient power or differences in study quality. Method: We conducted a series of meta-analyses examining the effect of problem gambling on self-harm outcomes of varying severity. We assessed the sensitivity of results to study characteristics, publication bias, and influential cases. To highlight threats to causal inference, we evaluated each study for residual confounding bias. Results: In total, two types of meta-analyses were adequately powered: those assessing (a) the effect of problem gambling (binary) on suicide ideation and (b) problem gambling (binary) on suicide attempt (k = 14 unique studies between the two meta-analyses). For both meta-analyses, we found a positive, statistically significant average effect of problem gambling on the respective self-harm outcome. We did not detect any influential studies among these two meta-analyses, nor residual confounding. However, these findings are limited by the overall quality of included literature. PET-PEESE analysis detected substantial potential publication bias in the main results, with both meta-analytic effects being reduced to statistical nonsignificance. All included studies also used a cross-sectional design for their analysis of interest, thus simultaneity bias cannot be ruled out. Conclusion: While these findings suggest there is an appreciable relationship between problem gambling and at least two forms of self-harm (suicide ideation and attempts), well-designed longitudinal research is needed to make more firm conclusions. Public Health Significance Statement Our study suggests there is an appreciable (i.e., nonzero) relationship between problem gambling and at least two forms of self-harm (suicide ideation and attempts). These findings have important implications for treatment providers, gambling operators, and other stakeholders, especially as gambling becomes more liberalized. Given the paucity of longitudinal studies we examined, the results also emphasize the need for more quality research examining the relationship between problem gambling and self-harm.
ISSN:0893-164X
1939-1501
DOI:10.1037/adb0000858