Special Subspecialty

Double or Nothing: Fifteen Years of Gambling Disorder, Depression and Suicidal Behaviour in a 41-Year-Old Man in Rwanda — A Case Report

A case report describing a 41-year-old Rwandan man with a longstanding history of gambling disorder, characterized by persistent sports betting, chasing financial losses, repeated unsuccessful attempts to stop, and severe financial and family consequences. The case also highlights associated depressive symptoms and a history of suicidal behaviour, emphasizing the complex relationship between gambling disorder, mental health, and psychosocial functioning. This case report explores the clinical presentation, progression, and psychosocial impact of gambling disorder in a 41-year-old man in Rwanda. It examines the development of problematic gambling over several years, significant financial losses, family disruption, depressive symptoms, and previous suicidal behaviour. The report highlights the importance of early identification, comprehensive psychiatric assessment, suicide risk evaluation, and integrated treatment approaches for individuals experiencing gambling

Melanie Special Subspecialty

Published on : 30.10.2026 - 15:55

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Anthropometric

Age 41 years

Weight 65 kg

Height 165 cm

Sex Boy

BMI 23.9 kg/m²

History of Presenting Illness

The patient presented with a longstanding history of problematic gambling, characterized by progressive loss of control, persistent engagement in betting activities, repeated unsuccessful attempts to stop, and considerable financial and psychosocial consequences.

According to his account, his first exposure to gambling occurred during his university studies, when he participated in a single betting activity before discontinuing it. However, in 2013, following the commencement of his professional career, he resumed gambling. What initially appeared to be occasional betting progressively developed into a recurrent pattern of gambling behaviour.

Over subsequent years, his involvement in gambling increased

considerably, eventually becoming a daily activity involving sports betting and online gambling. He identified the age of 34 as the period when gambling became particularly problematic. He described difficulty resisting the urge to gamble, particularly when he received his monthly salary or had access to money. Despite recognizing the negative consequences, he repeatedly returned to betting.

A particularly prominent feature of his gambling behaviour was chasing losses. Following unsuccessful bets, he would continue gambling in an attempt to recover previously lost money. This pattern contributed to further financial losses and increasing indebtedness.

Financial and Occupational Consequences

The gambling behaviour progressively undermined the patient's financial stability. By 2016, he reported having experienced substantial financial losses, including the sale of family property and borrowing money to finance his gambling activities.

He reported obtaining a bank loan of approximately 5,000,000 RWF and selling land valued at approximately 6,000,000 RWF. In addition, he borrowed money from friends and relatives.

Although his monthly income had previously exceeded 1,000,000 RWF, he experienced significant difficulties managing his finances. He frequently spent substantial portions of his salary shortly after receiving it, mainly on betting activities.

The consequences eventually extended to his professional functioning. At the time of presentation, he had stopped attending work, indicating substantial impairment in his occupational and social functioning.

Marital and Family History

The patient's gambling behaviour had a significant impact on his family relationships. He acknowledged concealing his gambling activities from his wife and other family members, as well as withholding information about the extent of his financial losses.

The resulting financial difficulties and interpersonal conflicts placed considerable strain on his marriage. In 2018, his wife temporarily left their matrimonial home because of the consequences associated with his gambling. She subsequently returned.

Despite these events, the patient continued gambling, suggesting that the behaviour persisted even in the presence of serious family-related consequences.

Domain	Impact
Financial	Large losses, a bank loan, sale of family land
Marital and family	Serious conflict; wife left the home in 2018; family stability disrupted
Occupational	Difficulty keeping up duties; currently absent from work
Psychological	Persistent depressive symptoms, possible hopelessness (needs assessment), suicidal behaviour
Behavioural control	Repeated failed attempts to stop; betting continues despite awareness of harm

Attempts to Control Gambling

The patient reported several unsuccessful attempts to discontinue gambling. He recognized that access to money and exposure to online betting platforms were important triggers.

As an attempt to control his behaviour, he deliberately avoided owning a smartphone because he associated smartphone access with increased opportunities and temptation to gamble online.

Nevertheless, these self-imposed restrictions did not result in sustained cessation. His continued gambling despite repeated attempts to stop, financial losses, and family disruption demonstrated considerable difficulty maintaining behavioural control.

Associated Depressive Symptoms and Suicidal Behaviour

Over approximately the two years preceding the assessment, the patient reported persistent depressive symptoms, including low mood, reduced motivation, and diminished interest in his usual activities.

These symptoms occurred in the context of longstanding gambling-related difficulties, substantial financial losses, marital conflict, and occupational impairment.

He also reported a history of suicidal ideation, suicidal planning, and at least one previous suicide attempt. However, the exact date, method, circumstances, and medical consequences of the attempt were not available during the initial assessment.

At the time of the current psychiatric evaluation, he denied active suicidal thoughts, intent, or plans. Nevertheless, his history of suicidal behaviour, together with depressive symptoms and significant psychosocial stressors, warranted continued suicide-risk assessment and appropriate safety planning.

Possible Mood-Spectrum Symptoms

During the psychiatric interview, the patient also acknowledged previous periods characterized by symptoms suggestive of elevated mood or possible manic or hypomanic episodes.

He reported experiences potentially involving excessive energy, reduced need for sleep, and elevated mood. However, the available information did not establish the duration, frequency, severity, associated symptoms, or functional consequences of these episodes.

Further clinical assessment is therefore necessary to determine whether these experiences meet diagnostic criteria for mania or hypomania and whether a bipolar-spectrum disorder is present.

This aspect of the history is particularly important because an underlying mood disorder could influence the patient's impulsivity, gambling behaviour, depressive symptoms, and response to pharmacological treatment.

Substance Use History

The patient denied alcohol consumption, cannabis use, and the use of other psychoactive substances. No substance-related explanation for the reported behavioural pattern was established from the available history.

Mental Status Examination

At admission, the patient appeared appropriately groomed, with good personal hygiene. He was calm and cooperative throughout the psychiatric interview. His speech was coherent, and no obvious communication difficulties were reported.

His mood was described as sad, with an affect congruent with his reported emotional state. Attention and memory were preserved during the assessment.

There were no reported hallucinations or identified delusional ideas. His insight into his difficulties was considered good, as he acknowledged the harmful consequences of his gambling behaviour. However, his judgment was considered poor, particularly in relation to financial decisions and his repeated continuation of gambling despite significant adverse consequences.

Clinical Impression

The clinical presentation was strongly suggestive of gambling disorder, with substantial financial, marital, occupational, and psychological consequences. Associated depressive symptoms and a history of suicidal behaviour were also identified.

Clinical progress

1. Clinical Progress and Evolution

During the course of hospitalization, the patient demonstrated a progressive improvement in his overall clinical condition. His mental state gradually stabilized, with a reduction in psychological distress associated with his longstanding gambling behaviour and its financial, occupational, and family consequences.

He became increasingly engaged in the therapeutic process and demonstrated a growing awareness of the impact of gambling on his personal life, family relationships, and professional responsibilities. His participation in treatment provided an opportunity to explore the factors contributing to his gambling behaviour, identify situations that triggered the urge to bet, and develop healthier coping strategies.

His depressive symptoms also showed improvement, with a gradual positive change in his emotional state and motivation. He was encouraged to strengthen his ability to manage gambling-related impulses, avoid high-risk situations, and adopt healthier daily routines.

Particular attention was given to relapse prevention, financial responsibility, and the restoration of family and occupational functioning. The importance of continued psychiatric follow-up and psychological support was emphasized to consolidate the progress achieved during hospitalization.

Overall, the patient's clinical evolution was favourable, with progressive improvement in his psychological well-being, treatment engagement, and insight into his condition. Continued therapeutic support and structured follow-up remain important to maintain recovery, prevent relapse, and support his long-term psychosocial reintegration.

Clinical Conclusions

This case illustrates the significant clinical and psychosocial burden associated with longstanding gambling disorder, particularly when accompanied by depressive symptoms and a history of suicidal behaviour. Over approximately 15 years, the patient's gambling behaviour progressively affected several aspects of his life, resulting in substantial financial losses, indebtedness, marital difficulties, and occupational impairment. The presence of depressive symptoms and previous suicidal behaviour highlights the importance of comprehensive psychiatric assessment and continuous suicide-risk monitoring in individuals presenting with gambling-related problems. Furthermore, the reported history of possible manic or hypomanic episodes emphasizes the need to investigate underlying mood-spectrum disorders, as these may influence both clinical presentation and treatment decisions. The patient's progressive clinical improvement during hospitalization demonstrates the potential benefits of a comprehensive, multidisciplinary approach combining psychiatric care, structured psychotherapy, behavioural interventions, and psychosocial support. This case also highlights the importance of addressing gambling disorder as a significant mental health condition rather than viewing it solely as a financial or behavioural problem. Early identification, appropriate psychiatric assessment, family involvement, relapse-prevention strategies, and continuity of care are essential to supporting long-term recovery. In the Rwandan context, this case underscores the need to strengthen awareness, screening, and access to specialized interventions for behavioural addictions, particularly gambling disorder, which can have profound consequences for individuals, families, and communities. Continued psychiatric follow-up, psychological support, and relapse-prevention interventions are recommended to consolidate the patient's improvement and promote sustained recovery.

Gambling disorder

A behavioural addiction in which a person gambles persistently and repeatedly, cannot control it, and carries on despite serious financial, family, work and health harm.

Losses, debt, family conflict and shame deepen distress, and low mood can make betting more tempting as an escape. Each can reinforce the other, so suicide risk must be assessed in every patient with gambling problems.

Removing one trigger does not treat the underlying disorder. He still gambled whenever he received money, so he needs full addiction treatment, not only trigger avoidance.

Inpatient addiction admission with suicide-risk management, laboratory tests, fluoxetine for the depressive symptoms, and therapy: CBT, motivational interviewing, relapse prevention and family intervention.

No. It is used here for the depressive symptoms; it is not an established specific drug treatment for gambling disorder.

Speak to a doctor or mental health professional. If you are having thoughts of suicide, contact local emergency or mental health services right away

Melanie

I am a qualified medical doctor currently undertaking residency training in psychiatry in Rwanda, with clinical experience in patient assessment, clinical reasoning, mental health evaluation, and evidence-based medical practice. My medical training has strengthened my ability to interpret scientific information, communicate complex health concepts clearly, and approach healthcare topics with accuracy, empathy, and professionalism. As an author, I plan to cover topics related to mental health and psychiatry, including anxiety, depression, stress management, psychological well-being, stigma surrounding mental illness, and the importance of early intervention and access to mental healthcare. I am also interested in general health education, the relationship between physical and mental health, preventive medicine, patient-centred care, and the role of digital health in improving healthcare accessibility. My goal is to produce evidence-based, accessible, and engaging articles that translate medical knowledge into practical information for both healthcare professionals and the general public. I value accuracy, ethical communication, credible scientific sources, and responsible health reporting. I aim to contribute content that educates readers, promotes informed health decisions, encourages appropriate help-seeking, and raises awareness of mental health challenges, particularly in underserved communities.