Abstract
Background: Gambling-related harms are an important public health issue, with suicide representing one of their most serious potential consequences. However, although previous literature has identified elevated prevalence of suicidality among people who gamble, less is known about how gambling-related harms develop and subsequently relate to suicidal crisis.Aims: To characterise the events and circumstances preceding gambling-related suicide and serious suicide attempts, and to examine the interacting socioecological, environmental and psychological processes through which gambling-related harms may have been linked to suicidal crisis.Design: Exploratory multi-source psychological autopsy and qualitative inquiry, co-produced with people with lived experience. Narrative interviews were integrated, where available, with banking, gambling operator, health and coronial records. Interviews underwent iterative thematic analysis; records were analysed descriptively at case level using time series, case timelines and cross-case matrices.Setting: United Kingdom. Study period: Jan 2023 to Dec 2025.Participants/Cases: Twenty core cases were examined: 10 people who had died by gambling-related suicide, represented by close relatives or other affected people, and 10 people who had survived a serious suicide attempt associated with gambling-related harms. People who died were aged 19-46 years (9 male, 1 female); attempt survivors were aged 34-62 years (7 male, 3 female).Measurements: Narrative interviews lasted approximately 3-4 hours and covered broad life history, key aspects of gambling history, industry interactions, suicidality, health, money, perceptions of gambling, and help-seeking and treatment. Record data were available for 14 of 20 cases. Sources included banking and operator activity, communications, health records and, in a small number, coronial or inquest material; coverage varied substantially between cases.Results: Ten interconnected themes were identified: normalisation of gambling; the ‘responsible gambling’ narrative and individualisation of responsibility; industry practices and products; regulatory and policy weaknesses; lack of knowledge, information and understanding; shame, self-blame and stigma; money, debt and financial desperation; lack of recognition and ineffective treatment; lapse and recurrence; and entrapment and hitting the lowest point. Documentary records were consistent with interview findings, including intense or renewed gambling close to serious suicide attempts in several cases, substantial financial losses and borrowing, inducements and, in some cases, account restrictions followed by switching between operators.Conclusions: In these cases, gambling-related suicidal crises involved interacting commercial, financial, psychological, relational and service-level processes. The findings identify potential opportunities for earlier recognition, stronger safeguards and sustained support.