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Gambling and the Onset of Comorbid Mental Disorders: A Longitudinal Study Evaluating Severity and Specific Symptoms


Journal of Psychiatric Practice®: May 2014 - Volume 20 - Issue 3 - p 207–219
doi: 10.1097/01.pra.0000450320.98988.7c
Winner of Resident Paper Award 2013

While the association between gambling disorders and comorbid mental disorders has been extensively studied, only a few studies have used longitudinal data or evaluated the association across different levels of gambling behavior and specific gambling-related symptoms. In this study, longitudinal data from waves 1 and 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to determine whether different levels of gambling behavior and gambling-related symptoms were associated with the onset of psychiatric disorders. Although NESARC used DSM-IV diagnoses, for this study, the recently published DSM-5 diagnostic criteria for gambling disorder were used to group the NESARC respondents (N=34,653) into three levels of gambling (gambling disorder, sub-threshold gambling disorder, and recreational gambling) and one non-gambling comparison group. Three years after the initial intake interview, compared to the non-gamblers, those reporting any gambling behavior at baseline were at increased risk to have any mood, anxiety, or substance use disorders (recreational gambling: adjusted odds ratio [AOR]=1.16, 95% confidence interval [CI]=1.10–1.23; sub-threshold gambling disorder: AOR 1.77, 95% CI 1.63–1.92; gambling disorder: AOR 2.51, 95% CI 1.83–3.46). Similar graded relationships were found for a number of specific disorders. In addition, multiple specific gambling-related symptoms were associated with comorbid disorders, possibly suggesting the interaction of different mechanisms linking gambling disorder and the onset of comorbid psychopathology. In conclusion, a graded or dose-response relationship exists between different levels of gambling and the onset of comorbid psychopathology. Among gambling groups, those with a gambling disorder were at the highest risk for the new onset of comorbid conditions and those with recreational gambling were at the lowest risk, while the risk among participants with sub-threshold gambling disorder fell between these two groups. (Journal of Psychiatric Practice 2014;20:207–219)

PARHAMI: Delaware Division of Substance Abuse and Mental Health, New Castle, DE; MOJTABAI: John Hopkins University School of Medicine; ROSENTHAL and FONG: University of California, Los Angeles; AFIFI: University of Manitoba, Winnipeg, Canada.

Funded by a travel award from the National Center for Responsible Gaming, results from this study were presented at the American Academy of Addiction Psychiatry’s Annual Meeting (December 2013: Scottsdale, Arizona). This study was also awarded the 2014 APA/Lilly Resident Research Award.

Dr. Mojtabai has received consulting fees from the pharmaceutical company H. Lundbeck A/S; the other authors declare no conflicts of interests.

Please send correspondence to: Iman Parhami, MD, MPH, Delaware Psychiatry Residency Program; Delaware Division of Substance Abuse and Mental Health; 1901 North Dupont Highway, Springer Building, New Castle, DE 19702.

© 2014 by Lippincott Williams & Wilkins, Inc.