Recurrent High-Lethality Suicide Attempts Associated with Online Crash Gambling in Mozambique: A Case Report from a Low-Resource Setting

Background: To report and analyse the intersection between the neurobiology of crash gambling addiction, psychosocial collapse, and extreme suicide risk in a low-resource context. Case presentation: A 45-year-old man in Mozambique, diagnosed with Severe Gambling Disorder (DSM-5-TR), engaged with the digital platform “Aviator.” He experienced a rapid escalation of betting driven by high-frequency intermittent reinforcement cycles, resulting in catastrophic financial losses, dismissal for embezzlement, and progressive social isolation. The patient undertook five high-lethality suicide attempts, including extreme-risk behaviours, influenced by the suicide of a peer with a similar gambling pattern, illustrating social contagion. Discussion and conclusions: The analysis integrates evidence of dopaminergic dysfunction (D2/D3 receptors and dopamine transporter) and prefrontal cortex hypoactivation with the Interpersonal-Psychological Theory of Suicide (IPTS). The near-miss mechanics and rapidity of crash games accelerate functional collapse, favouring habit-based over reflective decision-making. The convergence of perceived burdensomeness, thwarted belongingness, and acquired capability for suicide, potentiated by social contagion and familial vulnerability, underpins the observed extreme suicide risk. Clinical management, despite the unavailability of opioid antagonists, was effective through psychopharmacological stabilization, environmental containment, and structured family support. This case highlights the urgent need for regulation of digital gambling platforms in vulnerable settings and the systematic assessment of suicide lethality in individuals with gambling disorder, integrating neurobiological, clinical, and public health approaches.