Suicidal ideation and psychiatric comorbidity in a nationally representative sample of ED visits with documented...

Gambling disorder is associated with suicide and other severe harms. In an era of rapid gambling expansion, psychiatrists might benefit from information about the clinical needs of patients with gambling concerns who present to the emergency department (ED). We explored the characteristics of ED visits involving patients with gambling concerns and examined the prevalence and correlates of suicidal ideation within these visits.

This cross-sectional study used data from the 2022 Nationwide Emergency Department Sample, representing 111,340,613 weighted visits by adult patients. Visits were assigned to the "gambling concerns" group if the record included a diagnostic code for gambling disorder or the "gambling and betting" lifestyle factor.

Several characteristics distinguished visits by patients with gambling concerns (weighted N = 1089) from the full sample, including a primary diagnosis of affective/anxiety disorder or a substance use disorder (SUD); hospitalization; and presence of suicidal ideation or intentional self-harm injury. Suicidal ideation and intentional self-harm injuries were documented in 39.7% and 7.8% of visits by patients with gambling concerns, respectively. Gambling concerns were rarely recorded as the primary diagnosis. Instead, over half of visits by patients with gambling concerns included a primary diagnosis of a psychiatric or SUD. Among visits by patients with gambling concerns, a primary diagnosis of affective/anxiety disorder was associated with higher likelihood of suicidal ideation.

Gambling problems are often hidden within behavioral health ED presentations. The ED might provide a novel setting for detecting gambling disorder and gambling-related suicidality among patients with urgent behavioral health concerns.