Background: Studies have consistently reported high rates of suicidal ideation (SI) among individuals with disordered gambling. None have explored gambling-related familicidal-suicidal ideation (FSI). Aims: This study examined the (1) prevalence of SI and FSI among treatment-seeking gamblers in Hong Kong, (2) characteristic profile of factors associated with SI and FSI, and (3) factors that predict SI and FSI. Method: This is a retrospective analysis of data collected at initial clinical assessments from a specialized gambling counseling centre in Hong Kong. Participants were gamblers (N = 3,686) who sought treatment at the centre between 2003 and 2012. Information about socio-gambling demographics, physical and mental health status, current presenting problems, self-rated South Oaks Gambling Screen (SOGS, Chinese version), and occurrence of SI or FSI were examined. Descriptive analysis and ordinal regression analysis were used to investigate the characteristics of the gamblers and the association of variables. Results: In our sample, 720 (20.0%) individuals reported SI, and 22 (0.6%) individuals reported FSI at the initial assessment. Individuals with SI and FSI differed from the nonsuicidal individuals in terms of their demographics, gambling experiences and severity, mental and physical wellbeing, and types of gambling-related problems. The adjusted ordinal regression model shows that participating in table games in casinos and having familial and financial problems seem to enhance the likelihood of having SI and FSI. Conclusion: While mental health issues are significantly related to SI and FSI among gambling treatment seekers, the impacts of physical, family, and financial strains should not be underestimated.