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Investigating Possible Reciprocal Relations Between Depressive and Problem Gambling Symptoms in Emerging Adults
Abstract
Objective:
Previous cross-sectional research has shown that depression and problem gambling co-occur. Longitudinal research, however, allows for a better determination of directionality, as behavioural changes in gambling involvement can be more reliably studied over time. Our study assesses symptoms of depression and problem gambling across 4 waves and addresses whether their relation is directional (with one reliably preceding the other), bidirectional, or pathoplastic.
Method:
As part of the Manitoba Longitudinal Study of Young Adults, prospective data were collected on Canadian young adults' (Wave 1: n = 679, 51.8% female, aged 18 to 20 years) depressive symptoms, involvement in gambling, and risky gambling behaviour. Recruitment and the first cycle of data collection (Wave 1) took place in fall 2007. Three additional waves of data collection then occurred in 12- to 18-month intervals: fall 2008, spring 2010, and spring 2011. The Problem Gambling Severity Index and the Composite International Diagnostic Interview-Short Form were administered through telephone interview at each wave.
Results:
Bivariate growth curves showed that depressive and problem gambling symptoms were positively correlated at Wave 1, Wave 2, and Wave 4. Neither disorder was found to be a risk factor for the other, and depression and problem gambling were not pathoplastically related (that is, increases in one did not result in increases in the other over time, and vice versa).
Conclusions:
While depression and problem gambling are related, their co-occurrence may be better explained not by depressive- or gambling-related risk, but by the presence of a common underlying factor (such as substance abuse).
... In contrast, the second pathway is based on harmful consequences associated with GD that could result in depression (Kennedy et al., 2010). Finally, the two pathways may co-occur due to common risk factors (Chinneck, Mackinnon, & Stewart, 2016). The present research aims to provide a deeper exploration of the first pathway. ...
... However, there are mixed findings related to their association over time. Most of the longitudinal research has failed to demonstrate an association between depression and following problem gambling (Afifi, Nicholson, Martins, & Sareen, 2016;Chinneck et al., 2016;Edgerton et al., 2015Edgerton et al., , 2018 whereas others have found them to be positively associated over time (Bilevicius et al., 2018;Dussault et al., 2016). ...
... This finding is consistent with the prior literature (Bilevicius et al., 2018;Dussault et al., 2016). In accordance with Jacobs' general theory of addiction (Jacobs, 1986) and Khantzian's self-medication hypothesis (Khantzian, 1997), individuals may engage in addictive behaviors such as gambling with the intention of temporarily escaping from painful emotions (Chinneck et al., 2016;Rømer Thomsen, Callesen, Linnet, Kringelbach, & Møller, 2009). In this regard, Bilevicius et al. (2018) and Arias-de la Torre et al. (2021) have reported that depressed young adults engage in gambling and drinking to regulate negative emotions. ...
Objective
The association between depression and gambling disorder (GD) has been well-researched. However, prior research lacks consensus on the temporal association between depression and GD. Furthermore, the extant literature has not explored the nature of the aforementioned relationship using objective research methodology data and large-scale samples. The present study addressed these research gaps by investigating the longitudinal relationship between antidepressant prescriptions and the likelihood of developing GD using registry data over a period of 11 years (2008–2018).
Methods
Data were derived from the Norwegian Patient Registry (NPR) that was matched with data from the Norwegian Prescription Registry (NorPD). The dataset comprised 27,420 individuals, where 5,131 were diagnosed with GD. A binary logistic regression analysis was conducted where individuals with GD were compared with 22,289 individuals matched on age and gender from NPR.
Results
The results show that individuals with antidepressant prescriptions had higher odds of developing GD (OR = 2.80, 95% CI: 2.60–3.01, p < 0.001). Furthermore, males and older adults were found to have a higher likelihood of being diagnosed with GD.
Conclusions
Depression is known to be one of the most common mental health disorders. The findings show that prior antidepressant prescription is associated with GD, which would be in accordance with the escape hypothesis because some individuals gamble to escape dysphoric feelings, such as depression. The study findings add to the existing knowledge on the temporal association of depression and GD. Furthermore, the results also have significant practical implications.
... These longitudinal studies employed a wide range of statistical techniques based on different conceptual assumptions of the relationship. Results from four prospective longitudinal studies (Bellringer et al., 2020;Billi et al., 2014Billi et al., , 2015el-Guebaly et al., 2015;Williams et al., 2015) based on population-based adult (18 years old and above) samples, and analyses on emerging adults (18-20 years and 14-23 years) (Chinneck et al., 2016;Dussault et al., 2011;Edgerton et al., 2014Edgerton et al., , 2018Scholes-Balog et al., 2015) provided a solid foundation and perspectives to inform future research to better understand the relationship. ...
... Developmental science framework was also used to explore the relationship in young adults (Chinneck et al., 2016;Edgerton et al., 2014Edgerton et al., , 2018. Under the developmental framework, problem gambling severity and mental distress followed a specific developmental trajectory. ...
... However, problem gambling severity was analysed as a continuous variable with 5 categories as defined in Currie et al. (2013). In a separate study (Chinneck et al., 2016) based on the same data set, parallel growth curves showed that depression and PGSI trajectories were not associated, despite being positively correlated at time point 1, 2, and 4. In this analysis, both PGSI and depression were considered as continuous with the original PGSI score used without categorisation. The variables were modelled using negative binomial distributions and a growth curve model using a linear relationship over time points. ...
This study employed parallel growth curve modelling to examine the changes in both psychological distress and at-risk and problem gambling as a development process. We used a prospective longitudinal population-based study to provide further insights beyond treatment samples and cross-sectional studies. A secondary data analysis was conducted by extracting a sample of 3460 Victorian adults from the Victorian Gambling Study 2008–2011. Findings suggested that psychological distress was a consistent risk factor for at-risk and problem gambling, as measured by the problem gambling severity index (PGSI), after controlling for other risk factors such as sex, age, histories of at-risk and problem gambling, and the experience of trauma. A more rapid increase in psychological distress over time was related to a more rapid increase in the PGSI trajectory. It is concluded that this study supports a positive association in the development trends of problem gambling severity and psychological distress in individuals who engaged in gambling. The association persists after adjusting for histories of gambling problem risk and the experience of trauma in life. The implications of the study suggest addressing the comorbidity of problem gambling risk and psychological distress in treatment and prevention, and the development of dual-diagnosis treatment programs.
... As for internalizing problems, mixed findings have been reported with these studies focusing primarily on emerging adults, with internalizing problems not being measured prior to the age of 17. Specifically, one study noted a significant predictive effect of internalizing problems for problem gambling (Dussault et al., 2011), and others identifying non-significant associations (Afifi et al., 2016;Allami et al., 2018;Chinneck et al., 2016;Edgerton et al., 2015Edgerton et al., , 2018. Investigating both externalizing and internalizing problems together, some studies have identified that youth with high levels of both externalizing and internalizing problems have a greater likelihood of endorsing gambling problems (Allami et al., 2017(Allami et al., , 2018. ...
... With regard to the prediction models, in line with previous research (Martins et al., 2013;Temcheff et al., 2016), it was hypothesized that greater externalizing problems at baseline and a trajectory involving a slower decline of externalizing problems over time would be predictive of past year gambling. Based on the paucity of evidence suggesting that early internalizing problems predict problem gambling/gambling engagement in adolescence (Afifi et al., 2016;Allami et al., 2018;Chinneck et al., 2016;Edgerton et al., 2015Edgerton et al., , 2018, it was hypothesized that baseline scores and the temporal trajectory of internalizing problems would not be predictive of past year gambling. Lastly, as no studies have investigated the interaction of externalizing and internalizing problems in predicting gambling engagement, exploratory analyses will be conducted for these effects with no hypotheses being specified. ...
... With regard to the longitudinal evidence investigating the predictive role of internalizing problems for youth gambling engagement and problem gambling, mixed findings have been reported with one study finding a significant predictive effect of internalizing problems (Dussault et al., 2011), and others identifying non-significant associations between internalizing problems and problem gambling (Afifi et al., 2016;Allami et al., 2018;Chinneck et al., 2016;Edgerton et al., 2015Edgerton et al., , 2018. Compared to the present study, these longitudinal surveys focused primarily on young adults, with internalizing problems and problem gambling being measured from the ages of 17 to 23. ...
Externalizing (e.g. conduct problems and antisocial behaviors) and internalizing (e.g. depression and anxiety) problems have been associated with gambling-related harms. However, there is a paucity of longitudinal research investigating how these problems and their patterns of change over time (i.e. trajectories) predict gambling engagement among youth. This study aimed to examine the trajectories of externalizing and internalizing problems and their predictive values for later gambling. Data came from a cohort of 744 children (53.2% male, Mage 8.3 years at baseline) from Québec, Canada, with 58.3% reporting significant externalizing behaviors at baseline. Participants were followed for 7 years. Externalizing and internalizing problems were measured annually, and past year gambling was assessed at the final measurement. Mean trajectories of externalizing and internalizing problems were identified through parallel process growth modeling, and logistic regression was utilized to examine whether these trajectories were predictive of gambling engagement. Thirty-one of the 659 participants remaining at the final measurement reported participation in gambling. Greater baseline externalizing problems, lower baseline internalizing problems, and a less significant decrease in externalizing problems over time predicted gambling engagement. These results provide evidence of the externalizing pathway toward youth gambling and the importance of early intervention involving youth and other relevant stakeholders.
... In Canada, the lifetime prevalence of depression is 11.2%, with 4.7% of individuals being affected annually (Knoll and MacLennan 2017). Depression is a commonly co-occurring disorder amongst those with gambling disorder (Chinneck et al. 2016;Lorains et al. 2011) and vice versa (Cox et al. 2005;Kennedy et al. 2010;Kessler et al. 2008). Specifically, in Canada, 24% of problem gamblers reported experiencing clinical depression during their lifetime (Statistics Canada 2003). ...
... Literature suggests that depression and problem gambling are related in several ways. Firstly, research has shown that symptoms of depression and problem gambling are positively associated (Chinneck et al. 2016). That is, individuals who have greater symptoms of depression tend to evidence greater symptoms of problem gambling and vice versa. ...
... Amongst adults aged 25 to 34, 4.5% exhibited gambling problems (Nova Scotia Department of Health Promotion and Protection 2008). Additionally, 40% of adolescents and young adults experiencing problem gambling also reported suffering from depression in the past year (Chinneck et al. 2016). While unusual, the stakeholders who did encounter gamblers noted that individuals in this population often seek help later in life when they are most desperate (e.g., bankrupt, failing marriage). ...
Behavioral activation (BA) is a well-established treatment for depression, often used as an adjuvant for gambling disorder. Internet-based BA programs exist and are easily accessible. However, many neglect to report program evaluations. DoNamic is an Internet-based BA program for individuals aged 14–40 years with depression and those with comorbid depression and problem gambling. We evaluated DoNamic in a pre-implementation context through interviews with 15 care providers and health care decision-makers (“stakeholders”) to guide improvements to enhance uptake. Stakeholders were interviewed regarding content, design, and implementation. Stakeholders believed DoNamic’s self-guided nature offered a unique means of enhancing access to care. Concerns with DoNamic involved its design, anonymity, and the language used within DoNamic. Suggestions included a brighter design, enhanced anonymity, and modifying language to enhance reach. Lastly, robust evaluations were deemed necessary to sustain DoNamic in certain settings. Stakeholder feedback informed integral changes to DoNamic, potentially enhancing uptake within the health system.
... Further, emerging adults are especially susceptible to developing gambling habits that are manifestations or co-morbidities of other ''problem behaviours'' (Jessor & Jessor, 1977), including sensation seeking, depression and anxiety, substance abuse, delinquency, impulsivity, and lack of effective coping strategies (Carbonneau, Vitaro, Brendgen, & Tremblay, 2015;Edgerton, Melnyk, & Roberts, 2015;Sanscartier, Edgerton, & Roberts, 2018). More recently, researchers have started to explore the ways in which these related problem behaviours are not simply the consequences of PG, but are indirectly related through antecedent biological, psychosocial, and demographic factors (Chinneck, Mackinnon, & Stewart, 2016;Mutti-Packer et al., 2017;Scholes-Balog, Hemphil, Toumbourou, & Dowling, 2015). ...
... A related but contrasting branch of literature is more inductive, linking behaviours related to PG in more particular and exploratory ways than deductive typological studies do. These behaviours include substance abuse (Cheung, 2014;Petry & Champine, 2012;Welte, Barnes, & Hoffman, 2004), depression and anxiety (Chinneck et al., 2016;Martin, Usdan, Cremeens, & Vail-Smith, 2014), maladaptive coping behaviours (e.g., distancing and avoidance strategies; Edgerton et al., 2015;Getty, Watson, & Frisch, 2000;Gupta, Derevensky, & Margret, 2004;Sleczka, Braun, Grüne, Bühringer, & Kraus, 2016), and impulsivity and delinquency (Chamberlain, Stochl, Redden, Odlaug, & Grant, 2017;Mishra, Lalumiere, & Williams, 2017). Although these studies are less concerned with etiological links between these behaviours and PG, they identify novel and nuanced relationships of problem behaviours, especially with respect to how they are moderated via demographic (e.g., gender, ethnicity, socio-economic status) and gambling level risk factors (typically measured by using the Problem Gambling Severity Index [PGSI]/South Oaks Gambling Screen; see e.g., Matheson, Wohl, & Anisman, 2009;Sanscartier et al., 2018;Wong, Zane, Saw, & Chan, 2013). ...
... We suggest that, when emerging adults are screened for potential gambling problems, those scoring a 3 or higher on the PGSI should be further screened for psychological distress. These syndromic associations may exacerbate gambling behaviours (Chinneck et al., 2016), meaning that a holistic intervention must be used to address gambling. Those scoring for lower risk for PG, in turn, are at higher risk of engaging in alcohol or substance abuse. ...
This study investigates mental health and substance use problems associated with gambling among Canadian emerging adults (ages 18–20 years). Drawing on a cross-sectional wave of 624 (47.8% male) participants from the Manitoba Longitudinal Study of Young Adults, our findings suggest that among emerging adults, problem gambling should be understood as part of a wider syndrome. The profile of syndromic associations varies with both problem gambling risk level and gender. With respect to risk level, regression models indicate that, relative to no-risk gamblers, lower risk gamblers are more likely to use drugs and alcohol, whereas higher risk gamblers report greater symptoms of depression and anxiety. Males and females present different barriers to recovery: High-risk female gamblers are more likely to rely on escape-avoidance coping mechanisms, whereas their male counterparts tend to lack perceived social support. Given the centrality of these two variables and the lack of literature addressing how they interact, we conclude that further research is needed to understand how gender and gambling severity interact to simultaneously influence gambling-related behaviours among emerging adults. RésuméCette étude porte sur les problèmes de santé mentale et de toxicomanie associés au jeu chez les jeunes adultes canadiens (âgés de 18 à 20 ans). Fondés sur une vague transversale de 624 participants (47,8% d’hommes) de l’étude longitudinale des jeunes adultes du Manitoba (MLSYA), nos résultats laissent entendre que, parmi les jeunes adultes, le jeu problématique devrait être abordé comme faisant partie d’un syndrome plus vaste. Le profil des associations syndromiques varie selon le niveau de risque de jeu problématique et le genre. En ce qui concerne le niveau de risque, les modèles de régression indiquent que, par rapport aux joueurs sans risque, les joueurs à faible risque sont plus susceptibles de consommer de la drogue et de l’alcool, tandis que les joueurs à risque plus élevé montrent des symptômes plus importants de dépression et d’anxiété. En parallèle, les hommes et les femmes rencontrent différents obstacles au rétablissement : les joueuses à haut risque sont plus susceptibles de compter sur des mécanismes d’adaptation comme l’échappement ou l’évitement, tandis que leurs homologues masculins ont tendance à manquer de soutien social perçu. Compte tenu de la centralité de ces deux variables et du manque de littérature traitant de leurs interactions, nous concluons qu’il est nécessaire de poursuivre les recherches pour comprendre les interactions entre le genre et la gravité du jeu pathologique afin d’influencer simultanément les comportements liés au jeu chez les jeunes adultes.
... Gambling problems have been associated with various disorders including substance abuse, depression, anxiety disorder, attention-deficit hyperactivity disorder, and suicide (Raisamo et al., 2013;Cook et al., 2014;Black et al., 2015;Chinneck et al., 2016). Also, gambling in adolescence has been linked to more severe gambling-related problems later in life (Burge et al., 2004;Lynch et al., 2004). ...
... However, there is a lack of longitudinal research on gambling behavior in the transition from adolescence to emerging adulthood (Dussault et al., 2011;Scholes-Balog et al., 2014;Yücel et al., 2015). One limitation of previous longitudinal investigations (Adachi and Willoughby, 2013;Edgerton et al., 2015;Yücel et al., 2015;Chinneck et al., 2016) is that they have not been based on representative samples. Accordingly, the external validity of findings from these studies is limited. ...
... Moreover, our finding that the risky-and-problem gambling class had significantly higher physical and verbal aggression than the consistent non-gambling and non-risk gambling classes is in line with results obtained in previous longitudinal studies (Adachi and Willoughby, 2013;Yücel et al., 2015). Additionally, our findings that higher symptoms of anxiety and depression were associated with the risky-and-problem gambling class supports previous findings indicating that anxiety (Ste-Marie et al., 2006;Wanner et al., 2006;Hanss et al., 2015) and depression (Beaudoin and Cox, 1999;Dussault et al., 2011;Lee et al., 2011;Chinneck et al., 2016) co-occur with or are significant risk factors for progression to problem gambling. ...
... Finally, this study also builds on previous work analyzing the longitudinal relationship between depression and problem gambling in this data set. Chinneck et al. (2016) used the MLSYA data to examine overall growth in problem gambling and depression in young adults. They used parallel process latent growth curves (which assumes the same growth pattern in problem gambling and depression for all participants) and they found that changes in both behaviours were unrelated to one another. ...
... While there was some support for correlations at several waves, their analysis did not support correlated growth, like suggested in the clinical comorbidity literature. In this study, we aim to extend Chinneck et al. (2016) by examining potential subgroups or classes of individuals based on their codevelopment of problem gambling and depression over time. Identifying subgroups, therefore, has the potential to differentiate high risk from relatively low risk groups, with potentially important clinical implications. ...
... Consistent with Chinneck et al. (2016), we did not find support for reciprocal growth in problem gambling and depression in any of our joint classes. One possibility is that young adulthood is associated with dynamic changes in addictive behaviors and mood issues, and these may be difficult to capture in growth analyses with one-year measurement intervals. ...
This study examines whether there are multiple joint trajectories of depression and problem gambling co-development in a sample of emerging adults. Data were from the Manitoba Longitudinal Study of Young Adults (n = 679), which was collected in 4 waves across 5 years (age 18-20 at baseline). Parallel process latent class growth modeling was used to identified 5 joint trajectory classes: low decreasing gambling, low increasing depression (81%); low stable gambling, moderate decreasing depression (9%); low stable gambling, high decreasing depression (5%); low stable gambling, moderate stable depression (3%); moderate stable problem gambling, no depression (2%). There was no evidence of reciprocal growth in problem gambling and depression in any of the joint classes. Multinomial logistic regression analyses of baseline risk and protective factors found that only neuroticism, escape-avoidance coping, and perceived level of family social support were significant predictors of joint trajectory class membership. Consistent with the pathways model framework, we observed that individuals in the problem gambling only class were more likely using gambling as a stable way to cope with negative emotions. Similarly, high levels of neuroticism and low levels of family support were associated with increased odds of being in a class with moderate to high levels of depressive symptoms (but low gambling problems). The results suggest that interventions for problem gambling and/or depression need to focus on promoting more adaptive coping skills among more "at-risk" young adults, and such interventions should be tailored in relation to specific subtypes of comorbid mental illness.
... Gambling problems have been associated with various disorders including substance abuse, depression, anxiety disorder, attention-deficit hyperactivity disorder, and suicide (Raisamo et al., 2013;Cook et al., 2014;Black et al., 2015;Chinneck et al., 2016). Also, gambling in adolescence has been linked to more severe gambling-related problems later in life (Burge et al., 2004;Lynch et al., 2004). ...
... However, there is a lack of longitudinal research on gambling behavior in the transition from adolescence to emerging adulthood (Dussault et al., 2011;Scholes-Balog et al., 2014;Yücel et al., 2015). One limitation of previous longitudinal investigations (Adachi and Willoughby, 2013;Edgerton et al., 2015;Yücel et al., 2015;Chinneck et al., 2016) is that they have not been based on representative samples. Accordingly, the external validity of findings from these studies is limited. ...
... Moreover, our finding that the risky-and-problem gambling class had significantly higher physical and verbal aggression than the consistent non-gambling and non-risk gambling classes is in line with results obtained in previous longitudinal studies (Adachi and Willoughby, 2013;Yücel et al., 2015). Additionally, our findings that higher symptoms of anxiety and depression were associated with the risky-and-problem gambling class supports previous findings indicating that anxiety (Ste-Marie et al., 2006;Wanner et al., 2006;Hanss et al., 2015) and depression (Beaudoin and Cox, 1999;Dussault et al., 2011;Lee et al., 2011;Chinneck et al., 2016) co-occur with or are significant risk factors for progression to problem gambling. ...
There is a paucity of longitudinal investigations of gambling behavior in the transition from adolescence to emerging adulthood. We conducted a longitudinal investigation of the associations and patterns of change between mental health symptoms and gambling behavior. A representative sample of Norwegians completed questionnaires containing demographic, mental health, and gambling measures at age 17 (N = 2055), and at ages 18 (N = 1334) and 19 (N = 1277). Using latent class analysis, three classes of gambling behavior were identified: consistent non-gambling (71.1%), consistent non-risk gambling (23.8%), and risky-and-problem gambling (5.1%). Being male, showing higher physical and verbal aggression and having more symptoms of depression were associated with greater odds of belonging to the risky-and-problem gambling class at age 17. Overall, the risky-and-problem gambling class had the highest physical and verbal aggression, anxiety, and depression at 19 years. Our findings elucidate the reciprocal relationship between mental health and gambling behavior in the transition from adolescence to emerging adulthood, and the importance of recognizing these factors in designing targeted interventions.
... Descriptive statistics were calculated for the 740 emerging adult participants and 2504 older adults. Out of the total sample, 46.7% (n = 346) of the emerging adults (aged [18][19][20][21][22][23][24][25][26][27][28][29] gambled in the previous year. Of these, 67.6% were classified as non-problem gamblers, 20.2% as low-risk gamblers, 9.2% as medium-risk gamblers, and 2.9% as problem gamblers. ...
... The group differences related to problem gambling severity, gambling-related harm, depression, and anxiety highlight emerging adulthood as a developmental stage charac-terized by a greater risk of experiencing gambling-related harm and problem gambling severity, as well as higher levels of depression and anxiety. These findings resonate with previous research that has linked gambling behaviors and mental health during emerging adulthood [9,22,42]. ...
Growing concerns over gambling problems across age groups have sparked research in public health and psychology. During emerging adulthood, individuals are more susceptible to mental health problems and more likely to develop gambling problems than in other age groups. This study explored the potential differences between emerging adults and adults aged 30+ in terms of problem gambling severity (PGS), gambling-related harm (GRH), depression and anxiety, and the mediating role of depression and anxiety in the association between age, PGS, and GRH. A representative online sample of 3244 Israelis aged 18 and over was divided into two groups: 740 emerging adults aged 18–29 and 2504 adults aged 30+. Gambling behaviors, the Problem Gambling Severity Index, the Short Gambling Harm Screen, and the Patient Health Questionnaire-4 assessing depression and anxiety were administered. Emerging adults had significantly higher levels of GRH, PGS, and depression-anxiety than their older counterparts, above and beyond gender and education. Depression-anxiety fully mediated the associations between age and gambling-related outcomes. These findings underscore the importance of considering psychological well-being in efforts to address problem gambling and gambling-related harms, especially in emerging adults.
... Several studies have explored these relationships using growth curve modelling using longitudinal data. Using prospective data from four waves (12-to 18-month intervals) of the Manitoba Longitudinal Study of Young Adults (MLSYA), Chinneck and colleagues [36] examined whether the relationship between problem gambling and depression is directional (with one reliably preceding the other), bidirectional, or pathoplastic (whereby increases in one disorder result in increases in the other over time). Bivariate growth curves revealed that the disorders were positively correlated with each other at Waves 1, 2, and 4 but that neither disorder was a risk factor for the other and that they were not pathoplastically related. ...
... Moreover, there are some inconsistencies in this literature, with equivocal findings in relation to the indices of mental health symptoms or substance use variables under investigation [32][33][34][35]37,38]. The failure to identify significant findings in the context of a cross-lagged design in which any-risk gambling and mental health symptoms or substance use variables at the initial time-point are adjusted for is consistent with previous findings that some prospective associations are attenuated after controlling for other factors [32,[34][35][36][37][38]. Again, however, it may be that the effects from a subgroup of respondents with mental health symptoms or substance use variables were washed out in the estimates from the full sample [23,57]. ...
To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous alcohol use, daily tobacco use, and drug use) using cross-lagged path models in a prospective general population cohort sample; and (2) determine whether these associations are moderated by age and gender. This study involved secondary data analysis from 1109 respondents who provided data during Wave 2 or 3 (12-months apart) of the Tasmanian Longitudinal Gambling Study (Australia). Depression (odds ratio (OR) = 2.164) and generalized anxiety (OR = 2.300) at Wave 2 were found to have cross-lagged associations with the subsequent development of any-risk gambling (low-risk, moderate-risk, or problem gambling) at Wave 3. Hazardous alcohol use, daily tobacco use, and drug use at Wave 2 were not associated with the development of any-risk gambling at Wave 3. Any-risk gambling at Wave 2 was not associated with the subsequent development of any mental health symptoms or substance use variables at Wave 3. Age and gender failed to be significant moderators in the associations between any-risk gambling and mental health symptoms or substance use variables. Future longitudinal and event-level research is required to further substantiate these prospective relationships, with a view to developing targeted preventions and interventions.
... However, the completed suicide rate is higher in men [18]. In contrast, other studies acknowledging the association between depression and problem gambling proposed that their co-occurrence may be better explained by a common underlying factor, such as substance abuse, rather than specific characteristics of depression or gambling [27]. ...
... Emotional disorders, such as depression, can also be a consequence of problem gambling (Dussault et al., 2011). Cross-lagged analyses support the suggestion of depressive and anxiety disorders as an etiological risk factor and possible maintenance factor for problem gambling (Kessler et al., 2008), although this finding has not always been consistent (Chinneck et al., 2016). Of note, while reviews consistently find a higher prevalence of gambling problems in men compared to women (Hing et al., 2016), findings are mixed on significant gender differences in comorbidity rates among problem gamblers, wherein some report higher comorbidity rates in women and others report no gender differences in problem gambler comorbidity (El-Guebaly et al., 2006;Desai and Potenza, 2008;Yakovenko and Hodgins, 2018). ...
Introduction:
While individuals have many motives to gamble, one particularly risky motive for gambling is to cope with negative affect. Conflict with one's romantic partner is a strong predictor of negative affect, which may elicit coping motives for gambling and, in turn, gambling-related problems. Support for this mediational model was demonstrated in relation to drinking-related problems. We extended this model to gambling.
Method:
Using a cross-sectional design, we examined links between romantic conflict (Partner-Specific Rejecting Behaviors Scale), negative affect (Depression, Anxiety, and Stress Scales-21), coping gambling motives (Gambling Motives Questionnaire, coping subscale), and gambling-related problems [Problem Gambling Severity Index (PGSI)] in 206 regular gamblers (64% men; mean age = 44.7 years; mean PGSI = 8.7) who were in a romantic relationship and recruited through Qualtrics Panels in July 2021.
Results:
Results supported our hypothesis that the association between romantic conflict and gambling-related problems would be sequentially mediated through negative affect and coping gambling motives, β = 0.38, 95% CI [0.27, 0.39], and also showed a strong single mediation pathway through negative affect alone, β = 0.27, 95% CI [0.17, 0.38].
Discussion:
Negative affect and coping gambling motives partially explain the link between romantic conflict and gambling-related problems. Interventions should target both negative affect and coping gambling motives in response to romantic conflict to reduce gambling-related problems in partnered gamblers.
... Research indicates a greater propensity for emerging adults to engage in risky behaviour as a means to make friends or impress peers (Obedzinski et al., 2019). The co-occurrence of multiple risky behaviours in young adults (LaBrie et al., 2003), including drinking, gambling, violence and general deviance, as well as use of other substances including marijuana and "hard drugs" (Chinneck et al., 2016;Sanscartier, Shen, et al., 2019), suggests emerging adults are at elevated risk for substance and behavioural addictions (Sussman & Arnett, 2014). Although many will "mature out" of such problematic behaviours, for some it may set the basis for long-lasting problems (Schulenberg et al., 2004). ...
Cette étude explore les interrelations entre le jeu compulsif, les sentiments de honte et de culpabilité, et l’utilisation de stratégies d’adaptation d’évitement et de non-évitement parmi un échantillon de nouveaux joueurs adultes (N = 391) de l’Université du Manitoba. Une analyse factorielle exploratoire a été utilisée pour évaluer la structure factorielle de la mesure d’adaptation aux pertes dues au jeu (CWGL), puis des modèles de cheminement observés ont été utilisés pour tester trois hypothèses concernant la détermination de la honte et de la culpabilité dans l’adaptation aux pertes dues au jeu. L’analyse factorielle a produit une solution à cinq facteurs, ce qui s’oppose à la solution à six facteurs trouvée dans les travaux précédents. Le jeu compulsif a été mesuré par le Problem Gambling Severity Index (PGSI), et la honte et la culpabilité ont été mesurées à l’aide de mesures créées par Yi et Kanetkar (2011). Les résultats confirment l’hypothèse 1 selon laquelle le jeu compulsif est plus fortement associé aux sentiments de honte qu’aux sentiments de culpabilité. L’hypothèse 2, selon laquelle le sentiment de culpabilité est fortement et positivement associé à la stratégie d’adaptation de non-évitement et la honte à la stratégie d’adaptation d’évitement, n’a pas été confirmée. Enfin, l’hypothèse 3, selon laquelle la honte et la culpabilité influencent la relation entre le jeu compulsif et la décision du joueur à trouver une stratégie d’adaptation, a été confirmée. Les implications de cette étude plaident en faveur d’une expansion et d’une mise à l’épreuve plus poussée du CWGL, ainsi que d’une application de la relation causale explorée à différents échantillons, car les résultats de la présente étude diffèrent de ceux trouvés dans une population normative.
... The ALSPAC sample size was too small to look at alcohol intake change between age 24 years and during lockdown. The lack of association with mental health and well-being was surprising given the alcohol link, but previous studies have suggested that gambling and mood have a complex bi-directional relationship in young people (Chinneck et al., 2016;Dussault et al 2011). ...
Gambling is a common activity amongst young adults in the UK, and was a behavior of interest during the early mitigation against COVID-19 (first lockdown). The Avon Longitudinal Study of Parents and Children (ALSPAC) was used to investigate attitudes, moods and behavior during lockdown in England. ALSPAC participants were invited to complete online questionnaires in May 2020, including a set of questions about frequency of gambling and gambling activities which had been asked three years previously. Mental health and wellbeing data and alcohol use were also collected as part of lockdown questionnaires. Gambling questions were completed by 2632 young adults, 71% female, with a mean age of 27.8 years. Overall, gambling frequency reduced during lockdown for both males and females, but more males engaged in regular (weekly) gambling. Gambling activities became more restricted compared to previous reports, but online gambling (e.g. online poker, bingo, casino games) was more frequent. Previous gambling behaviour predicted gambling frequency during lockdown. No associations were apparent between gambling frequency and measures of mental health and well-being. Heavy alcohol use was strongly linked with regular gambling during lockdown. Gamblers were more than twice as likely as non-gamblers to have experienced financial difficulties pre-COVID, but gambling frequency was not related to employment status during lockdown. Online gambling increased during lockdown, whilst offline gambling activities decreased in frequency. A small minority of regular weekly gamblers, who tended to be male and heavy users of alcohol, participated in a wide range of online and offline gambling activities.
... Overall, it was not possible to conclude any causal direction of the relationship between depression and gambling, which may be reciprocally associated, as has been suggested by Dussault et al., (2011). Alternatively, the co-occurrence of gambling and depression in young adults may be better explained by a common underlying factor such as substance abuse (Chinneck et al. 2016). ...
The aims of this study were to investigate stability of problem gambling between 20 and 24 years of age, and the antecedents and consequences of problem gambling at age 20 years. Young adult participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) completed computer-administered gambling surveys on paper, or online. Responses to the Problem Gambling Severity Index (PGSI) were complete for 2624 participants at 20 years, and 1921 participants at 24 years. Responses were categorized into ‘non-problem’ (71–78%), ‘low-risk gambling’ (16–21%), ‘moderate-risk gambling’ (4–5.5%), and ‘problem gambling’ (1–1.5%). The overall frequency of moderate-risk/problem gambling varied little between age 20 and 24 years, and scratch cards, online betting and gambling were the most frequent activities. Problem gamblers at age 20 years had a history of hyperactivity and conduct problems in adolescence, high sensation seeking, and an external locus of control. They were more likely to have mothers who had problems with gambling, reported less parental supervision, and higher social media usage. Moderate-risk/problem gambling at age 20 years was associated with regular cigarette smoking, high levels of illicit drug use, and problematic use of alcohol at age 24 years. A significant minority of young adults (mainly males) showed problem gambling behaviours which appeared to be established by the age of 20 years and were associated with other potentially addictive behaviours.
... Numerosi studi hanno dimostrato che, tanto negli adolescenti che negli adulti, ansia e depressione coesistono con il gioco d'azzardo problematico e che queste ultime aumentano in funzione del genere , e del coinvolgimento nel gioco d'azzardo (Martin et al., 2014;Estevez et al., 2015;Chinneck et al., 2016;Cunningham et al., 2016;Toneatto & Pillai, 2016;Takamatsu et al., 2016). Può darsi che la depressione preceda il gioco d'azzardo problematico che serve ad alleviare emozioni negative e tensioni interne (Blaszczynski & Nower, 2002), o che il coinvolgimento nel gioco d'azzardo problematico produca sempre più sintomi depressivi a causa del conseguente isolamento sociale e problemi di denaro (Dussault et al., 2011). ...
Riassunto: Il gioco d’azzardo è diventato negli ultimi decenni uno dei comportamenti di dipendenza più frequentemente segnalati tra i giovani. E ciò, sia perché c’è stata una maggiore accettabilità sociale del fenomeno, sia perché si è assistito ad una massiccia e diversificata offerta di gioco d’azzardo legalizzato, soprattutto on line, attraverso le moderne tecnologie digitali, cui i giovani hanno frequente e facile accesso.
Nonostante il gioco d'azzardo adolescenziale sia illegale, i giovani sono coinvolti nel gioco d'azzardo ad un tasso di prevalenza superiore rispetto agli adulti. Inoltre, studi internazionali hanno dimostrato che fino al 12,3% dei giovani soddisfa i criteri per il gioco d'azzardo problematico.
L'obiettivo del presente studio è stato quello di esaminare la relazione tra impulsività e problemi di gioco d'azzardo in adolescenza attraverso un'ampia rassegna dei principali contributi della recente letteratura nazionale e internazionale sui fattori di rischio che incidono sull’insorgenza e il mantenimento del disturbo da gioco d’azzardo tra i giovani.
Abstract: Gambling has become one of the most frequently reported addictive behaviors among young people. And this, both because there has been a greater social acceptability of the phenomenon, and because there has been a massive and diversified offer of legalized gambling, especially online, through modern digital technologies, which young people have frequently and easly access.
In spite of adolescent gambling being an illegal activity, youth engage in gambling with a prevalence rate higher than adults. Moreover, international studies showed that up to 12.3% of youth meet criteria for problem gambling.
The main aim of the present study has been to examine the relationship between impulsivity and problem gambling in adolescence through a wide review of the main contributions in recent national and international literature on risk factors affecting the onset and maintenance of gambling disorder among young people.
... Les situations, comportements et expériences indiqués ci-dessous accroissent le risque qu'un adolescent ne développe un problème de jeu : • père, mère ou autre membre de la famille ayant un problème de jeu (Dickson, Derevensky et Gupta, 2008) ; • pratiquer plusieurs formes différentes de jeu (Afifi et coll., 2016) ; • usage de médicaments psychotropes à mauvais escient ou abus de drogues (Afifi et coll., 2016) ; • vente de drogues par l'adolescent (Cook et coll., 2015) ; • abus d'alcool (Edgerton, Melnyk et Roberts, 2015a, 2015b ; • dépression ou anxiété (Chinneck, Mackinnon et Stewart, 2016 ;Edgerton et coll., 2015b) ; • troubles de santé mentale ou profonde détresse (Cook et coll., 2015) ; ...
... As for the question of which one is preceding which, there have been conflicting results (Afifi, Nicholson, Martins, & Sareen, 2016;Kessler et al., 2008). Analyzing data from a longitudinal study on the relationship between gambling problems and depression in a sample of young adults aged 18-20, Chinneck, Mackinnon, and Stewart (2016) concluded that the frequent co-occurrence of gambling problems and depressive disorders is not due to one of them being a risk-factor for the other, but due to an underlying factor that both disorders have in common. People's response styles (Nolen-Hoeksema, 1991) might be such a factor. ...
Background and aims
Symptoms of pathological gambling (SPG) and depression often co-occur. The nature of this relationship remains unclear. Rumination, which is well known to be associated with depression, might act as a common underlying factor explaining the frequent co-occurrence of both conditions. The aim of this study is to analyze associations between the rumination subfactors brooding and reflection and SPG.
Methods
Participants aged 14–64 years were recruited within an epidemiological study on pathological gambling in Germany. Cross-sectional data of 506 (80.4% male) individuals with a history of gambling problems were analyzed. The assessment included a standardized clinical interview. To examine the effects of rumination across different levels of problem gambling severity, sequential quantile regression was used to analyze the association between the rumination subfactors and SPG.
Results
Brooding (p = .005) was positively associated with the severity of problem gambling after adjusting for reflection, depressive symptoms, and sociodemographic variables. Along the distribution of problem gambling severity, findings hold for all but the lowest severity level. Reflection (p = .347) was not associated with the severity of problem gambling at the median. Along the distribution of problem gambling severity, there was an inverse association at only one quantile.
Discussion and conclusions
Brooding might be important in the development and maintenance of problem gambling. With its relations to depression and problem gambling, it might be crucial when it comes to explaining the high comorbidity rates between SPG and depression. The role of reflection in SPG remains inconclusive.
... Recent Canadian research on emerging adults provides support for this characterisation. It has been found, for example, that depression and gambling are not directly related, but both are the result of some antecedent variable, possibly substance abuse (Chinneck et al. 2016). As such, we would not expect higher scores on enhancement or coping motives, since depression and gambling may not be directly causally linked. ...
This analysis of gambling habits of Canadian university students (ages 18–25) dovetails two recent developments in the field of gambling studies. First, the popularity of latent class analysis to identify heterogeneous classes of gambling patterns in different populations; second, the validation of the Gambling Motives Questionnaire (with financial motives) among university students—specifically to understand both how and why emerging adults gamble. Our results support a four-class model of gambling activity patterns, consisting of female-preponderant casual and chance-based gambling groups, and male-preponderant skill-based and extensive gambling groups. Each class shows a specific combination of motives, underscoring the necessity for nuanced responses to problem gambling among emerging adults. More specifically, gambling for the skill-based group appears primarily to be a source of thrill and a way to cope; for the chance-based group, gambling appears but one symptom of a set of wider issues involving depression, anxiety, substance use, and low self-esteem; while extensive gamblers seem to seek excitement, sociality, and coping, in that order. Only the chance-based group was significantly more likely than casual gamblers to be motivated by financial reasons. Situating our analysis in the literature, we suggest that interventions for the predominantly male subtypes should address gambling directly (e.g. re-focusing excitement seeking into other activities, instilling more productive coping mechanisms) while interventions for predominantly female subtypes should address low self-esteem in conjunction with depression, substance abuse, and problematic levels of gambling. We conclude future research should focus on links between self-esteem, depression, substance abuse, and financial motives for gambling among female emerging adults.
... The following realities, behaviours and experiences increase the risks that an adolescent will develop a gambling problem: • a parent or other family member with a gambling problem (Dickson, Derevensky & Gupta, 2008) • several different kinds of gambling behaviours (Afifi et al., 2016) • drug misuse or abuse (Afifi et al., 2016) • selling drugs (Cook et al., 2015) • alcohol misuse or abuse (Edgerton, Melnyk & Roberts, 2015a, 2015b) • depression and/or anxiety (Chinneck, Mackinnon & Stewart, 2016;Edgerton et al., 2015b) • mental health concerns and/or a high level of distress (Cook et al., 2015) • suicidal ideation or suicidal behaviour (Cook et al., 2015) Ensuring that you are taking care of yourself can make a difference for your children. Children worry and are affected when either or both parents are not doing well. ...
... As with previous research (Lee et al., 2011;Hartmann and Blaszczynski, 2016; for reviews see Ciccarelli et al., 2017), the present study found that the more individuals have a problematic gambling involvement, the more they experience anxiety and depression. These results confirm the findings of previous studies demonstrating that among both adolescents and adults anxiety and depression co-occur with problematic gambling (Blaszczynski and McConaghy, 1989;Coman et al., 1997;Raylu and Oei, 2002;Kim et al., 2006;Barrault and Varescon, 2013;Martin et al., 2014;Estevez et al., 2015;Chinneck et al., 2016;Cunningham et al., 2016;Toneatto and Pillai, 2016;see also, Takamatsu et al., 2016). It may be that depression foregoes problem gambling, which serves to relieve negative emotions and to avoid problems (Blaszczynski and Nower, 2002) or that problematic gambling involvement increasingly leads to depressive symptoms due to the consequent social isolation and money problems (Dussault et al., 2011). ...
The main purpose of this study was to investigate the interplay of functional and dysfunctional impulsivity, delay discounting, time perspective, and emotional negative states on gambling severity in Italian adolescents. A second aim of the study was to analyze the developmental trajectories of gambling involvement, functional and dysfunctional impulsivity, delay discounting, consideration of future consequences, and negative affectivity in a cross-sectional perspective. One thousand and ten Italian adolescents aging between 12 and 19 years were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Functional and Dysfunctional Impulsivity Scale (FDIS), the Monetary Choice Questionnaire (MCQ), the Consideration of Future Consequences Scale (CFC-14), and the Depression, Anxiety and Stress Scales-21 (DASS-21). Data analyses were conducted using correlational analysis, Chi-square test, analysis of variance, and hierarchical regression analysis. Results indicated that, relative to non-gamblers and non-problem gamblers, at-risk and problem gamblers showed higher levels of impulsivity, steeper delay discounting, shorter time horizon, and reported experiencing significantly higher levels of depression, anxiety, and stress. Results of hierarchical regression analysis, with SOGS-RA scores as the dependent variable, and gender, age, FDIS, MCQ, CFC-14, and DASS-21 scores as independent variables, indicated that, along with gender and age, low scores of future orientation and high scores of dysfunctional impulsivity, depression, anxiety, present orientation, and delay discounting significantly predicted gambling severity. These findings provide further evidence that the higher the gambling involvement, the greater the tendency to devalue delayed rewards and to focus on the immediate consequences of one's behavior. Interestingly, for the first time these results reveal an association between gambling severity and both dysfunctional impulsivity and negative affective states across adolescence. Finally, results of cross-sectional analyses suggest that gambling severity contributes more than age in shaping the developmental trajectories of functional and dysfunctional impulsivity, delay discounting, time perspective, and negative affective states.
Externalizing and internalizing problems have been associated with problem gambling and gambling-related harms in children and adults. However, there is a paucity of longitudinal research investigating these variables and their change over time in predicting gambling engagement among youth. Therefore, the objective of the present study is to examine the effect of the externalizing and internalizing problem pathways in predicting gambling among adolescents. Data came from a longitudinal cohort of 774 children (53.2% male, aged 6 to 10 years), with half of the sample presenting with significant externalizing behaviors at baseline. Participants were followed for a period of seven years, with externalizing and internalizing problems being measured annually. Past year gambling engagement was assessed at the final measurement period. Parallel process growth modelling was utilized to identify the mean trajectories of externalizing and internalizing problems and a logistic regression was conducted to examine whether baseline scores or the change over time in externalizing, internalizing, or an interaction of these problems, were predictive of gambling engagement seven years later. Thirty-one participants reported gambling participation at final measurement. The trajectories of externalizing and internalizing problems indicated that participants had elevated levels of both problems at baseline, with a significant decrease of these problems over time. The logistic regression indicated that baseline externalizing and internalizing problems were significant predictors of later gambling participation, with a less significant decrease of externalizing problems being predictive of gambling engagement. These results provide valuable information specific to the developmental trajectories towards early gambling participation among youth.
Link to video for poster on the ICRG Youtube Channel:
https://www.youtube.com/channel/UC-7db3FayYuhR7uxMcPPH0A
Background and aims
Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults.
Methods
Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors.
Results
Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors.
Discussion and Conclusions
Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.
The Problem Gambling Severity Index, the scored module of the Canadian Problem Gambling Index, is a population-based survey instrument that is becoming the preferred epidemiological tool for estimating the prevalence of disordered gambling. While some validation evidence for the Problem Gambling Severity Index is available, very little is known about its psychometric characteristics in developing countries or in countries the populations of which are not highly Westernised. The aim of this study was to investigate the validity of the Problem Gambling Severity Index with a specific focus on its criterion-related and construct (concurrent) validity in a community sample of gamblers in South Africa (n = 127). To this end, the Problem Gambling Severity Index was administered alongside the Diagnostic Interview for Gambling Severity and measures known to associate with gambling severity (impulsivity, current debt, social problems, financial loss, race, sex). Results showed that the Problem Gambling Severity Index was predictive of Diagnostic Interview for Gambling Severity diagnosis from both a categorical and dimensional point of view and demonstrated high discrimination accuracy for subjects with problem gambling. Analysis of sensitivity and specificity at different cut-points suggests that a slightly lower Problem Gambling Severity Index score may be used as a screening cut-off for problem gambling among South African gamblers. The Problem Gambling Severity Index also showed significant correlations with the Barratt Impulsiveness Scale, a widely known measure of impulsivity, and with some of the predicted behavioural variables of interest (gambling activities, money lost to gambling, current debt, interpersonal conflict). This article therefore demonstrates initial criterion and concurrent validity for the Problem Gambling Severity Index for use in South African samples.
Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18–25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
The authors investigated the emergence of gender differences in clinical depression and the overall development of depression from preadolescence to young adulthood among members of a complete birth cohort using a prospective longitudinal approach with structured diagnostic interviews administered 5 times over the course of 10 years. Small gender differences in depression (females greater than males) first began to emerge between the ages of 13 and 15. However, the greatest increase in this gender difference occurred between ages 15 and 18. Depression rates and accompanying gender differences for a university student subsample were no different than for a nonuniversity subsample. There was no gender difference for depression recurrence or for depression symptom severity. The peak increase in both overall rates of depression and new cases of depression occurred between the ages of 15 and 18. Results suggest that middle-to-late adolescence (ages 15–18) may be a critical time for studying vulnerability to depression because of the higher depression rates and the greater risk for depression onset and dramatic increase in gender differences in depression during this period.
Critical research questions in the study of addictive behaviors concern how these behaviors change over time: either as the result of intervention or in naturalistic settings. The combination of count outcomes that are often strongly skewed with many zeroes (e.g., days using, number of total drinks, number of drinking consequences) with repeated assessments (e.g., longitudinal follow-up after intervention or daily diary data) present challenges for data analyses. The current article provides a tutorial on methods for analyzing longitudinal substance use data, focusing on Poisson, zero-inflated, and hurdle mixed models, which are types of hierarchical or multilevel models. Two example datasets are used throughout, focusing on drinking-related consequences following an intervention and daily drinking over the past 30 days, respectively. Both datasets as well as R, SAS, Mplus, Stata, and SPSS code showing how to fit the models are available on a supplemental website. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
University students from southern Alberta (n = 585) were administered a questionnaire to assess their gambling behaviour. Seventy-two percent reported gambling in the past 6 months, with the most common types being lotteries and instant win tickets (44%) and games of skill against other people (34%). Most students who gambled spent very little time and money doing so (median time spent = 1.5 hrs; median amount of money spent = $0). While gambling is an innocuous activity for most, a significant minority of students are heavy gamblers who experience adverse consequences from it. Seven and one-half percent of students were classified as problem or pathological gamblers, a rate significantly higher than in the general Alberta adult population. The characteristics that best differentiated problem gamblers from non-problem gamblers were more positive attitudes toward gambling, ethnicity (41% of Asian gamblers were problem gamblers), university major (kinesiology, education, management), superior ability to calculate gambling odds, and older age.
A national sample of 500 members of Gamblers Anonymous was surveyed by mail in order to gather information on suicidal history. One hundred sixty two usable surveys were returned representing 32.4% of the original sample. Compulsive gamblers who had a history of suicidal preoccupation began gambling at an earlier age than nonsuicidal gamblers and were more likely to have stolen to support their gambling. They also tended to have addicted relatives and children more than nonsuicidal gamblers did. The data suggest that those gamblers who had been suicidal tend to be more serious gamblers than nonsuicidal respondents.
The Problem Gambling Severity Index (PGSI) is a widely used nine item scale for measuring the severity of gambling problems in the general population. Of the four gambler types defined by the PGSI, non-problem, low-risk, moderate-risk and problem gamblers, only the latter category underwent any validity testing during the scale's development, despite the fact that over 95% of gamblers fall into one of the remaining three categories. Using Canadian population data on over 25,000 gamblers, we conducted a comprehensive validity and reliability analysis of the four PGSI gambler types. The temporal stability of PGSI subtype over a 14-month interval was modest but adequate (intraclass correlation coefficient = 0.63). There was strong evidence for the validity of the non-problem and problem gambler categories however the low-risk and moderate-risk categories showed poor discriminant validity using the existing scoring rules. The validity of these categories was improved with a simple modification to the scoring system.
To investigate the frequency of gambling in people who have been diagnosed with major depressive disorder (MDD) or bipolar disorder (BD). Secondary objectives were to examine: sex differences in the rates of gambling behaviour, the temporal relation between onset of mood disorders and problem gambling, psychiatric comorbidities associated with problem gambling, and the influences of problem gambling on quality of life.
People (aged 18 years and older) who met criteria for lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision-defined MDD or BD I or II, and were confirmed by the Mini International Neuropsychiatric Interview, were enrolled. Participants were recruited from 5 sites in Canada and 1 in the United States. Prevalence of past-year problem gambling was assessed with the Canadian Problem Gambling Index. Associated comorbidities with problem gambling are presented.
A total of 579 participants were enrolled (female: n = 379, male: n = 200). Prevalence of problem gambling did not differ significantly between the MDD (12.5%) and the BD (12.3%) groups. There was a significant difference in the prevalence of problem gambling between males (19.5%) and females (7.8%) in the BD group (chi-square = 8.695, df = 1, P = 0.003). Among people meeting criteria for problem gambling, the mood disorder was the primary onset condition in 71% of cases. People with a mood disorder with comorbid current panic disorder (OR = 1.96; 95% CI 1.02 to 3.75), obsessive-compulsive disorder (OR = 1.86; 95% CI 1.01 to 3.45), specific phobia (OR = 2.36; 95% CI 1.17 to 4.76), alcohol dependence (OR = 5.73; 95% CI 3.08 to 10.65), or lifetime substance dependence (OR = 2.05; 95% CI 1.17 to 3.58), had significantly increased odds of problem gambling. Problem gambling across MDD and BD populations was also associated with lower quality of life ratings.
These results reaffirm a higher prevalence of gambling both in BD and in MDD populations, compared with previously published community samples. Our study also identifies risk factors for gambling behaviours within these populations.
The authors examined cross-lagged links among gambling, substance use, theft, and violence from midadolescence to young adulthood and whether behavioral disinhibition, deviant peers, and parental supervision as common risk factors explain or moderate those links. In 2 community samples, male Caucasians were assessed for gambling participation and problems with the South Oaks Gambling Screen-Revised for Adolescents (K. C. Winters, R. Stinchfield, & J. Fulkerson, 1993) at age 16 years and the South Oaks Gambling Screen (H. R. Lesieur & S. B. Blume, 1987) at age 23. Other problem behaviors were also assessed both times. Risk factors were measured at age 16. Adolescent substance use was related to subsequent theft and violence but not gambling. Gambling problems were linked to subsequent gambling participation. For adolescents with deviant peers, gambling problems were linked to subsequent theft; this was not the case for adolescents without deviant peers. Only for individuals high on disinhibition did stability of gambling problems resemble moderate stabilities of other problem behaviors. Each risk factor was related to each problem behavior (exception: parenting unrelated to gambling). These risk factors partly explained the cross-lagged links among behaviors and thus may be useful targets of prevention. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
The South Oaks Gambling Screen is a 20-item questionnaire based on DSM-III criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM-III (DSM-III-R). It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.
Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
This study updates prevalence estimates of gambling-related disorders in the United States and Canada, identifies differences in prevalence estimates among population segments, and identifies changes in prevalence over the past 25 years.
A meta-analytic strategy guided the synthesis of 180 estimates derived from 146 prevalence studies.
Prevalence estimates among adolescent samples were significantly higher than estimates among adult samples for both clinical (level 3) and sub-clinical (level 2) measures of disordered gambling within both lifetime and past-year time frames. Among adults, level 3 prevalence estimates continue to increase significantly.
Membership in youth, treatment, and prison population segments is significantly associated with experiencing gambling-related disorders. Understanding sub-clinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Prospective studies of incidence are necessary to determine whether the prevalence of disordered gambling continues to increase among the adult general population and how adolescent gambling experiences change as this cohort ages.
The authors' goal was to determine the frequency of psychiatric comorbidity among treatment-seeking pathological gamblers, compare the severity of gambling and psychological problems in gamblers with and without comorbid disorders, and investigate differences between gamblers with and without comorbid disorders in the dopamine D(2) receptor gene (DRD(2)).
Sixty-nine pathological gamblers who consecutively applied to a specialized outpatient treatment program were evaluated with structured interviews, self-report questionnaires, and psychological scales and were genotyped for a DRD(2) polymorphism.
A comorbid psychiatric disorder was present in 43 (62.3%) of the gamblers. The most frequent diagnoses were personality disorders (N=29 [42.0%]), alcohol abuse or dependence (N=23 [33.3%]), and adjustment disorders (N=12 [17.4%]). Gamblers with comorbid psychiatric disorders had gambling scores and psychological scale scores indicating greater severity of gambling and psychopathology. Significant differences in DRD(2) allele distribution were found in gamblers with and without comorbid disorders.
Psychiatric comorbidity is common among pathological gamblers and is associated with greater severity of clinical problems. The DRD(2) gene could be a liability genetic factor for psychiatric comorbidity in pathological gambling.
Aggregate-level prevalences and individual-level developmental trajectories of untreated problem gambling were examined in an 11-year, 4-wave longitudinal study spanning the adolescent through young adult years. The past-year prevalences, 3-4 year incidences, and lifetime prevalences of problem gambling from adolescence through young adulthood were relatively stable at 2%-3%, 1%-2%, and 3%-5%, respectively. Despite the stability of the prevalences at the aggregate level, problem gambling appeared to be more transitory and episodic than enduring and chronic at the individual level. The present study is consistent with the limited evidence available on the natural history of problem gambling in the community in suggesting that natural recovery may be the rule rather than the exception.
The authors report findings from the first national survey of gambling among college students. They collected information from 10,765 students attending 119 scientifically selected colleges included in the 2001 Harvard School of Public Health College Alcohol Study (CAS), which indicated that 42% of responding students gambled in the last school year and 2.6% gambled weekly or more frequently. These findings contradict the widely held opinion based on previous studies that gambling is prevalent among college students. Previous studies used convenience samples that might have overestimated the risk for gambling problems. Male students and students of legal age (> or = 21 y) were more likely than others to gamble. Availability of gambling, measured by the number of types of gambling venues located in the schools' states, influenced their decisions to gamble. The concordance of characteristics associated with both gambling and binge drinking suggested a disposition to take risks that is independent of the risk objects.
This paper aimed to investigate associations between major depressive episode (MDE) and chronic illness, disability, self-perceived health and number of sick-days among adolescents and young adults in the general population.
The Finnish Health Care Survey 1996 was a cross-sectional nationwide epidemiological study. A random sample of 509 adolescents and 433 young adults was interviewed in 1996. DSM-III-R MDE during the past 12 months was defined using The University of Michigan Composite International Diagnostic Interview Short-Form algorithm. Data on physical health were gathered in the interview.
In multivariable logistic regression, chronic illness [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.03, 3.05], poor self-rated health (OR 2.26; 95% CI 1.01, 5.07), more than three sick-days in the past 6 months (OR 1.72; 95% CI 1.02, 2.92) and respiratory allergies (OR 2.40; 95% CI 1.00, 5.75) were associated with MDE. Among 15- to 19-year-olds, disabling chronic illness was related to MDE (OR 2.59; 95% CI 1.06, 6.36), and thoughts of death were more prevalent in the presence of chronic illness among those with MDE [35.2% versus 65.7%; F(1,67) P = 0.024]. Migraine was associated with MDE among young adults (OR 6.18; 95% CI 1.14, 30.8).
Symptoms of depression should be investigated among adolescents with chronic illness or frequent sick-days. The degree of reported disability should be noted. Young people with both chronic illness and depressive symptoms should be assessed for thoughts of death and possible suicidality.
Marital and family researchers often study infrequent behaviors. These powerful psychological variables, such as abuse, criticism, and drug use, have important ramifications for families and society as well as for the statistical models used to study them. Most researchers continue to rely on ordinary least-squares (OLS) regression for these types of data, but estimates and inferences from OLS regression can be seriously biased for count data such as these. This article presents a tutorial on statistical methods for positively skewed event data, including Poisson, negative binomial, zero-inflated Poisson, and zero-inflated negative binomial regression models. These statistical methods are introduced through a marital commitment example, and the data and computer code to run the example analyses in R, SAS, SPSS, and Mplus are included in the online supplemental material. Extensions and practical advice are given to assist researchers in using these tools with their data.
The aims of this study were to examine the associations between psychiatric disorders and pathological gambling (PG) and the clustering of psychiatric disorders in high risk gambler populations. The sample comprised 140 regular gamblers who were recruited from the general public. A variety of self- report and semi structured questionnaires was administered, including the Mini International Neuropsychiatric Interview, The Personality Diagnostic Questionnaire-4th Edition, NORC DSM-IV Screen for Gambling Problems Self- administered and Problem Gambling Severity Index. Axis I and Axis II psychiatric disorders and personality disturbances were found to be more prevalent amongst pathological gamblers than other gamblers with the strongest differences observed for mood and anxiety-related disorders. Almost two-thirds of pathological gamblers reported both an anxiety or mood disorder in conjunction with another type of disorder. These differences between the gambling groups existed even after controlling for gender. The results highlight the high rates of co-morbidity in pathological gamblers in the community and the extent to which anxiety and mood disorders co-existing with other forms of pathology. These results highlight the significant challenges facing treatment services in the treatment of PG and the extent to which this should be treated as the primary disorder.
We assessed the occurrence of co-morbid psychiatric disorders (i.e., problem drinking, anxiety, and depression) among college students who met the threshold for disordered gambling. The participants included a large sample of undergraduate students (n = 1,430) who were enrolled in an introductory health course at a large, southeastern university in Spring 2011 and completed an online assessment that included scales to assess disordered gambling, problem drinking, anxiety, and depression. We calculated screening scores, computed prevalence rates for each disorder, and calculated Pearson correlations and Chi square tests to examine correlations and co-morbid relationships between the four disorders. Analyses indicated that all disorders were significantly associated (p < .01) except for disordered gambling and anxiety. Because college students who experience disordered gambling (and other psychiatric disorders) are at increased risk of experiencing co-occurring disorders, it might be useful for college health professionals to concurrently screen and intervene for co-occurring disorders.
It is the intent of this study to examine the relationship between the number of co-occurring disorders in a sample of pathological gamblers and variables associated with clinical presentation and treatment outcomes. Participants were given screening tools for four common psychological disorders: the hands depression screen, the Mood Disorder Questionnaire, the Carroll-Davidson generalized anxiety disorder screen, and the Sprint-4 PTSD Screen. The number of co-occurring disorders, as indicated by the results of these screening instruments, was compared to severity of gambling problems at outset of treatment, as measured by the NORC diagnostic screen for gambling problems-self administered. The number of co-occurring disorders was also compared to psychosocial functioning at the outset of treatment, as well as level of improvement in psychosocial functioning through treatment. Psychosocial functioning was measured using the Outcome Questionnaire 45 (OQ-45). The number of co-occurring disorders was compared to participant satisfaction with the therapeutic relationship as measured by the working alliance inventory-short form. Results suggest that co-occurring disorders are commonplace among treatment seeking pathological gamblers. Over 86 % of the sample screened positively for at least one of the four targeted psychological disorders. Furthermore, the number of co-occurring disorders was found to be positively related to severity of gambling problems at outset of treatment and negatively related to level of psychosocial functioning at outset of treatment. However, the number of co-occurring disorders was not found to be significantly related to level of improvement in psychosocial functioning through treatment. Overall, those that attended at least six sessions reported significantly improved psychosocial functioning by the end of their sixth session. Finally, the number of co-occurring disorders was not found to be significantly related to participants' reported level of satisfaction with the therapeutic relationship.
This book examines the prevalence and consequences of problem gambling as well as approaches to treatment. In this comprehensive book, the author, Nancy M. Petry, clarifies the current understanding of gambling as a disorder, including its levels of intensity; possible origins in biological, neurological, developmental, and environmental spheres; and special issues surrounding populations that seem to be more susceptible to problem gambling, including youth, ethnic minorities, and those with comorbid affective disorders such as depression. The author reviews treatments commonly used for pathological gambling as well as nonprofessionally guided interventions such as Gamblers Anonymous. Petry then presents her own brief cognitive-behavioral approach, whose success is empirically proven in the largest known study of psychosocial treatments of problem gamblers. In this book, Petry reviews what we currently know about problem gambling and analyzes promising treatment approaches, making it an invaluable, comprehensive resource for both therapists and researchers in the field of pathological gambling. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Data are reported on a series of short-form (SF) screening scales of DSM-III-R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi-step procedure was used to generate CIDI-SF screening scales for each of eight DSM disorders from the US National Comorbidity Survey (NCS). This procedure began with the subsample of respondents who endorsed the CIDI diagnostic stem question for a given disorder and then used a series of stepwise regression analyses to select a subset of screening questions to maximize reproduction of the full CIDI diagnosis. A small number of screening questions, between three and eight for each disorder, was found to account for the significant associations between symptom ratings and CIDI diagnoses. Summary scales made up of these symptom questions correctly classify between 77% and 100% of CIDI cases and between 94% and 99% of CIDI non-cases in the NCS depending on the diagnosis. Overall classification accuracy ranged from a low of 93% for major depressive episode to a high of over 99% for generalized anxiety disorder. Pilot testing in a nationally representative telephone survey found that the full set of CIDI-SF scales can be administered in an average of seven minutes compared to over an hour for the full CIDI. The results are quite encouraging in suggesting that diagnostic classifications made in the full CIDI can be reproduced with excellent accuracy with the CIDI-SF scales. Independent verification of this reproduction accuracy, however, is needed in a data set other than the one in which the CIDI-SF was developed. Copyright © 1998 Whurr Publishers Ltd.
A Monte Carlo simulation examined the performance of 4 missing data methods in structural equation models: full information maximum likelihood (FIML), listwise deletion, pairwise deletion, and similar response pattern imputation. The effects of 3 independent variables were examined (factor loading magnitude, sample size, and missing data rate) on 4 outcome measures: convergence failures, parameter estimate bias, parameter estimate efficiency, and model goodness of fit. Results indicated that FIML estimation was superior across all conditions of the design. Under ignorable missing data conditions (missing completely at random and missing at random), FIML estimates were unbiased and more efficient than the other methods. In addition, FIML yielded the lowest proportion of convergence failures and provided near-optimal Type 1 error rates across both simulations.
A general theory of addictions is proposed, using the compulsive gambler as the prototype. Addiction is defined as a dependent state acquired over time to relieve stress. Two interrelated sets of factors predispose persons to addictions: an abnormal physiological resting state, and childhood experiences producing a deep sense of inadequacy. All addictions are hypothesized to follow a similar three-stage course. A matrix strategy is outlined to collect similar information from different kinds of addicts and normals. The ultimate objective is to identify high risk youth and prevent the development of addictions.
This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers.
A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies.
Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution.
Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.
Research shows high co-morbidity between gambling problems and depressive symptoms, but the directionality of this link is unclear. Moreover, the co-occurrence of gambling problems and depressive symptoms could be spurious and explained by common underlying risk factors such as impulsivity and socio-family risk. The goals of the present study were to examine 1) whether common antecedent factors explain the concurrent links between depressive symptoms and gambling problems, and 2) whether possible transactional links between depressive symptoms and gambling problems exist from late adolescence to early adulthood.
A total of 1004 males from low SES areas participated in the study.
Analyses revealed a positive predictive link between impulsivity at age 14 and depressive symptoms and gambling problems at age 17. In turn, gambling problems at age 17 predicted an increase in depressive symptoms from age 17 to age 23, and depressive symptoms at age 17 predicted an increase in gambling problems from age 17 to age 23.
Common antecedent factors may explain the initial emergence of an association between depressive symptoms and gambling problems in adolescence. However, once emerged, their escalation seems to be better explained by a mutual direct influence between the two sets of disorders.
Depression with fewer symptoms than required for a DSM-IV diagnosis of Major Depressive Disorder (MDD) has consistently been found to be associated with functional impairment. In this study, we aim to define clinically significant depression below the DSM-IV threshold for Major Depressive Disorder (MDD) by means of functional impairment.
Data used are from 2157 respondents of the Netherlands Study of Depression and Anxiety (NESDA). The Composite International Diagnostic Interview (CIDI) and the Inventory for Depressive Symptomatology-Self Report (IDS-SR(30)) were compared in their association with functional impairment as measured by the World Health Organization Disability Assessment Schedule II (WHODAS II). We used ANCOVA, adjusting for gender, age, education and somatic conditions, and ROC analyses.
The IDS-SR(30) (p<.001, eta(2)=.51) was more strongly associated with functional impairment than CIDI symptom count (p<.001, eta(2)=.035). Effect sizes supported four symptoms on the CIDI, and a score within the mild depression range on the IDS-SR(30) as adequate cut-offs for defining subthreshold depression, respectively. ROC analyses showed that these cut-offs identified the top 10% and 8% to 60% most dysfunctional respondents, respectively.
Suggested cut-offs seem reasonable on the basis of converging findings, but in lack of a golden standard they remain somewhat arbitrary. Furthermore, the design of the study is cross-sectional in nature, no causal inferences between depression and functional impairment can be made.
Although both instruments are associated with functional impairment, the IDS-SR(30) seems better suited than the CIDI to define subthreshold depression, with a cut-off in the mild IDS-SR(30) range.
Students from six colleges and universities in five states in the U.S. (New York, New Jersey, Oklahoma, Texas, and Nevada) were surveyed concerning their gambling behavior and the rate of pathological gambling. Type of gambling varied by state, with students in the northeast and Nevada gambling more than students in Oklahoma and Texas. Over 90% of males and 82% of females had gambled. One third of the males and 15% of females gambled once a week or more. Rates of pathological gambling ranged from 8% in New York to 4% in Nevada. The incidence of pathological gambling was high among males, Hispanics, Asians, and Italian-Americans (compared with among other whites), students with non-traffic arrests, those with parents who have gambling problems, and those who abuse alcohol and other drugs. Pathological gambling was only weakly correlated with age, religion, lower grade point average in school, overeating, living in neighborhoods that are "poorer than most," family income, and parental drug use. It was not correlated with academic year in college, marital status, parental occupation, parental alcohol, and bulimic behavior. The implications of the findings for further research and social policy are discussed.
This paper reviews reliability and validity studies of the WHO - Composite International Diagnostic Interview (CIDI). The CIDI is a comprehensive and fully standardized diagnostic interview designed for assessing mental disorders according to the definitions of the Diagnostic Criteria for Research of ICD-10 and DSM-III-R. The instrument contains 276 symptom questions many of which are coupled with probe questions to evaluate symptom severity, as well as questions for assessing help-seeking behavior, psychosocial impairments, and other episode-related questions. Although primarily intended for use in epidemiological studies of mental disorders, it is also being used extensively for clinical and other research purposes. The review documents the wide spread use of the instrument and discusses several test-retest and interrater reliability studies of the CIDI. Both types of studies have confirmed good to excellent Kappa coefficients for most diagnostic sections. In international multicenter studies as well as several smaller center studies the CIDI was judged to be acceptable for most subjects and was found to be appropriate for use in different kinds of settings and countries. There is however still a need for reliability studies in general population samples, the area the CIDI was primary intended for. Only a few selected aspects of validity have been examined so far, mostly in smaller selected clinical samples. The need for further procedural validity studies of the CIDI with clinical instruments such as the SCAN as well as cognitive validation studies is emphasized. The latter should focus on specific aspects, such as the use of standardized questions in the elderly, cognitive probes to improve recall of episodes and their timing, as well as the role of order effects in the presentation of diagnostic sections.
To develop a self-report instrument to assess diagnostic criteria and associated features of pathological gambling in order to learn more about the characteristics of individuals who seek treatment for gambling problems in a Canadian setting.
Fifty-seven adults seeking treatment for gambling problems at the Addictions Foundation of Manitoba were assessed.
There was substantial variation in the endorsement of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptoms. Lying to family members or friends and "chasing" previous gambling losses were frequently reported, while more serious consequences (for example, relationship breakup, job losses) were less frequent. DSM-IV ratings were correlated (r = 0.59) with the South Oaks Gambling Screen. Many individuals reported gambling as a way to alleviate dysphoric mood, and 30% reported receiving mental health services in the past. Approximately 50% reported suicidal ideation, although recent suicide attempts were not common.
These preliminary results of Canadian adults seeking treatment for gambling problems suggest a somewhat different profile from many United States studies, which often rely on older male pathological gamblers. More systematic investigation of the presence of major depression and other psychiatric disorders is warranted. Consistent with demographic data collected at the Addictions Foundation of Manitoba, it appears that video lottery terminals play a major role in the type of problem gambling experience seen in Canadian settings.
To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations.
Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria.
The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p < .05), even after controlling for sociodemographic and socioeconomic characteristics. Male sex, black race, divorced/separated/widowed marital status, middle age, and living in the West and Midwest were associated with increased risk for pathological gambling. Further, associations between alcohol dependence, any drug use disorder, drug abuse, nicotine dependence, major depressive episode, and generalized anxiety disorder and pathological gambling were stronger among women than men (p > .05).
Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.
This article is a critical review of risk factors for pathological gambling categorized by demographics, physiological and biological factors, cognitive distortions, comorbidity and concurrent symptoms, and personality symptoms and characteristics. There is also a varia section (availability, parents playing, sensory characteristics, schedules of reinforcement, age of onset, and playing duration). The review found very few well established risk factors for pathological gambling (i.e. more than two studies to support the conclusions). Well established risk factors included demographic variables (age, gender), cognitive distortions (erroneous perceptions, illusion of control), sensory characteristics, schedules of reinforcement, comorbid disorders (OCD, drug abuse), and delinquency/illegal acts. An understanding of risk factors for pathological gambling should enhance prevention and treatment approaches.
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