Elsevier

Journal of Affective Disorders

Volume 202, 15 September 2016, Pages 110-114
Journal of Affective Disorders

Short communication
Gambling problems in treatment for affective disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

https://doi.org/10.1016/j.jad.2016.05.023Get rights and content

Highlights

  • Gambling problems in a US representative sample reporting treatment for mood and anxiety.

  • Rates of lifetime problem gambling ranged from 3.1% for depression to 5.4% for social phobia.

  • There were 8.9% of all respondents indicating a history of at least some gambling problems.

  • Gambling problems had mainly psychosocial implications in treatment for affective disorders.

Abstract

Background

Gambling problems co-occur frequently with other psychiatric difficulties and may complicate treatment for affective disorders. This study evaluated the prevalence and correlates of gambling problems in a U. S. representative sample reporting treatment for mood problems or anxiety.

Methods

n=3007 respondents indicating past-year treatment for affective disorders were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses examined correlates of gambling problems.

Results

Rates of lifetime and past-year problem gambling (3+DSM-IV symptoms) were 3.1% (95% CI=2.4–4.0%) and 1.4% (95% CI=0.9–2.1%), respectively, in treatment for any disorder. Rates of lifetime problem gambling ranged from 3.1% (95% CI=2.3–4.3%) for depression to 5.4% (95% CI=3.2–9.0%) for social phobia. Past-year conditions ranged from 0.9% (95% CI=0.4–2.1%) in dysthymia to 2.4% (95% CI=1.1–5.3%) in social phobia. Higher levels were observed when considering a spectrum of severity (including ‘at-risk’ gambling), with 8.9% (95% CI=7.7–10.2%) of respondents indicating a history of any gambling problems (1+ DSM-IV symptoms). Lifetime gambling problems predicted interpersonal problems and financial difficulties, and marijuana use, but not alcohol use, mental or physical health, and healthcare utilisation.

Limitations

Data were collected in 2001–02 and were cross-sectional.

Conclusions

Gambling problems occur at non-trivial rates in treatment for affective disorders and have mainly psychosocial implications. The findings indicate scope for initiatives to identify and respond to gambling problems across a continuum of severity in treatment for affective disorders.

Introduction

The terms ‘pathological gambling’ or ‘gambling disorder’ describe psychiatric conditions in the ICD-10 (World Health Organization, 1992) and DSM-5 (American Psychiatric Association, 2013), respectively, which are characterised by persistent and recurrent maladaptive gambling that precedes gambling-related harms (e.g., severe debt, relationship breakdown). The term ‘problem gambling’ is often used to describe a broader spectrum of difficulties that are defined by occurrences of gambling-related harms, and these range from moderate problems to severe harms (Delfabbro, 2013). The latter terminology is aligned with a public health framework (Korn et al., 1999) that recognises additional impacts of gambling at lower levels of severity, which are commonly described in terms of ‘at-risk’ gambling (Toce-Gerstein et al., 2003). Such problems co-occur frequently with other Axis I conditions, the most common of which are substance use, mood and anxiety disorders (reported by around 58%, 38% and 37% of problem gamblers, respectively) (Lorains et al., 2011). Although rates of gambling problems among individuals suffering other primary disorders are generally lower, there are studies showing non-trivial levels (>10%) of moderate to severe problems in patients seeking treatment for various psychiatric conditions, including psychotic (Haydock et al., 2015) and posttraumatic stress (Biddle et al., 2005) disorders. These include treatment for substance use problems, where studies indicate around 23% of patients that report difficulties across the spectrum of problem gambling (Cowlishaw et al., 2014). Within such contexts, these co-occurring issues are associated with psychosocial harms (e.g., relationship breakdown) (Cowlishaw et al., 2015) that highlight implications for treatment and prognosis of the primary presenting problem.

Data from patients in treatment for affective disorders also indicates high levels of comorbid conditions (Brown et al., 2001), including obsessive-compulsive and substance-related disorders (Rush et al., 2005). However, there has been limited recognition of gambling problems in treatment for affective disorders, with only two relevant studies available (Quilty et al., 2011, Kennedy et al., 2010). These recruited patients (n=275 (Quilty et al., 2011) and n=579 (Kennedy et al., 2010)) from selected treatment services (k=1 (Quilty et al., 2011) and k=6 (Kennedy et al., 2010)) in Canada and the US. They indicated rates of gambling problems among patients with depression that range from 5 to 13%, with variablity observed across studies, measurement scales, and levels of problem severity. Comparable estimates in bipolar disorder extend from 3 to 12% (Quilty et al., 2011, Kennedy et al., 2010). These studies indicate associations with clinical outcomes including severity of mood disorders and suicide risk. Such findings, however, should be interpreted cautiously given the limited number of studies and their limitations. The latter include a tendency to derive data from small numbers of services that do not generalise across regions or settings, and consideration of limited correlates. There are no relevant studies that have examined treatment for anxiety disorders (apart from one study of posttraumatic stress disorders) (Biddle et al., 2005). In this context, the purpose of this short communiction is to describe an evaluation of prevalence and clinical correlates of gambling problems in a nationally representative sample reporting treatment for a range of affective disorders. This was derived from the U. S. National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) (Grant et al., 2004).

Section snippets

Sample

The NESARC is a representative survey of U. S. adults (≥18 years) in non-institutionalised settings, which was conducted in 2001–02. The study was based on a multi-stage stratified sampling design, with Census primary sampling units (PSUs; stratified by socio-demographics), households, and individuals sampled in succession. Black and Hispanic households were oversampled. One person from each household (or ‘group living’ arrangement) was randomly selected, with respondents aged 18–24 years

Results

Table 1 provides weighted estimates of lifetime and past-year gambling problems. In treatment for any affective disorder, the estimated rates of lifetime and past-year problem gambling (3+ symptoms) were 3.1% (95% CI=2.4–4.0%) and 1.4% (95% CI=0.9–2.1%), respectively. Across disorders, the rates of lifetime problem gambling ranged from 3.1% (depression: 95% CI=2.3–4.3%) to 5.4% (social phobia: 95% CI=3.2–9.0%), with past-year disorders ranging from 0.9% (dysthymia: 95% CI=0.4–2.1%) to 2.4%

Discussion

In a representative sample reporting past-year treatment for affective disorders, the results indicated that around 3.1% of respondents reported lifetime problem gambling, and around 1.4% demonstrated a comparable condition in the past year. These estimates are towards the lower end of comparable figures from two prior studies of smaller samples of patients in treatment services (Quilty et al., 2011, Kennedy et al., 2010), but are elevated relative to the general population (the rate of

Role of the funding source

None of the funding sources listed below had any role in the design, analysis or interpretation of the data, writing of the report, or decision to submit the article for publication.

Authors’ contributions

SC was primarily responsible for all stages of this paper. JH contributed to the design and interpretation of the findings, and conducted the analyses. ND contributed to writing of the paper.

Conflict of interests

The authors report no conflicts of interest.

Acknowledgements

SC receives salary support from the University of Bristol (UK). JH receives salary support from the U. S. Census Bureau. ND receives salary support from Deakin University (Australia). There were no other funding sources for this research. The opinions expressed are those of the authors and do not necessarily reflect those of the U.S. Census Bureau or the NIAAA.

References (20)

There are more references available in the full text version of this article.

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