Based on the DSM-IV operational definition, people who endorsed 5 or more symptoms were regarded as “pathological gamblers.” A total of 201 participants who met the criteria of pathological gambling were included in the present study, with a mean clinically rated DSM-IV score of 7.3. Among them, 128 participants (63.7%) had comorbid psychiatric disorders in their lifetime, whereas 90 participants (44.8%) had at least one comorbid psychiatric disorder at the time of evaluation.
showed that about nine-tenths of 201 participants were men. Most of them were in the stages of early and middle adulthood, and reached secondary school level of educational attainment. Around 60% of the participants were married or cohabitating. Compared with those without current comorbid psychiatric disorder, results of chi-square test showed that a greater proportion of participants with current comorbid psychiatric disorder were divorced, separated, or widowed. Regarding the living arrangement, most of them lived with family members and there were a greater proportion of participants with current comorbid psychiatric disorder living alone than those without current comorbid psychiatric disorder.
Differences between pathological gamblers with and without lifetime and current psychiatric disorders in demographic characteristics.
In terms of economic status and personal income, most of the participants were employed on either a full-time or part-time basis, and earned within the range of HK$5,001 and HK$15,000 per month. Generally speaking, greater proportions of participants with both lifetime and current diagnosis of comorbid psychiatric disorders were unemployed than those without the psychiatric disorders. Moreover, greater proportions of participants with lifetime comorbid psychiatric disorder had no income than those without psychiatric comorbidities, but the difference was not found to be statistically significant in current diagnosis.
showed the results for gambling behavior on both the lifetime and current diagnoses between participants with and without comorbid psychiatric disorders. It was found that most participants started gambling involving money in their early twenties, with the average age of 19.9. More than 80% of participants with both lifetime and current comorbid psychiatric disorders reported that they had debts at the time of study, compared to about 75% of participants without comorbid psychiatric disorders. t-tests analysis showed that there were significantly more participants with current psychiatric comorbidities with debt (86.7%) than those without current psychiatric comorbidities (74.8%), while comparison for lifetime diagnosis did not reach statistically significant level. On the other hand, severity of gambling problems assessed by ASI composite scores (which ranged from 0 to 1) with higher scores reflecting more severe gambling problems showed a mean ASI gambling scale composite score for participants was 0.38. For both lifetime and current diagnosis, the mean scores for participants with comorbid psychiatric disorders were significantly higher than those without the disorders, and reflecting greater severity of gambling problems ().
Differences between pathological gamblers with and without lifetime and current psychiatric disorders in gambling and clinical characteristics.
Psychiatric symptoms experienced by the participants in the past week were examined by the BSI. Participants with comorbid psychiatric disorders in general scored significantly higher than those without the disorders in all nine psychiatric symptom dimensions including depression, somatization, obsessive-compulsive, anxiety, psychoticism, hostility, phobic anxiety, interpersonal sensitivity, and paranoid ideation. Moreover, there were significant differences in the overall level of psychological distress, number of symptoms endorsed and the average intensity of distress experienced between participants with and without lifetime comorbid psychiatric disorders in general ().
The LIFE-RIFT was developed specifically to assess functional impairment with a range from 4 to 20. A higher score indicates more severe psychosocial dysfunction. Since 11 participants reported “not applicable” or “no information” for a particular domain of LIFE-RIFT, no total score could be calculated for these participants and they were coded as missing. Of the remaining 190 participants, results showed that participants with comorbid psychiatric disorders in general had significantly higher LIFE-RIFT score than those without the disorders (). Regarding nicotine problems, 104 (51.7%) participants reported that they ever smoked in their lifetime. Nine of them reported they were former smokers whereas 95 reported to be current regular tobacco users. Participants with comorbid psychiatric disorders in general had significantly higher FTND score than those without comorbid psychiatric disorders ().
summarizes the prevalence rates for lifetime and current comorbidity of DSM-IV Axis I psychiatric disorders, including mood disorders, schizophrenia spectrum disorders, substance use disorders, anxiety disorders, and adjustment disorders, whereas shows the number of comorbid psychiatric disorders possessed by pathological gamblers. All disorders were screened by detailed and structured interview of SCID by trained social workers or clinical psychologists. In , lifetime comorbid psychiatric disorders included mood disorders (n = 59; 29.4%), schizophrenia spectrum disorders (n = 5; 2.5%), substance use disorders (n = 62; 30.8%), anxiety disorders (n = 19; 9.5%), and adjustment disorders (n = 42; 20.9%). The most common comorbid psychiatric disorders for lifetime diagnosis were nicotine dependency (n = 49; 24.4%), major depressive disorder (n = 43; 21.4%), adjustment disorders (n = 42; 20.9%), and alcohol abuse or dependency (n = 23; 11.4%).
Prevalence rates of lifetime and current comorbid psychiatric disorders in 201 pathological gamblers.
Number of lifetime and current comorbid psychiatric disorders for pathological gamblers seeking treatment.
Similarly, current comorbid psychiatric diagnoses included mood disorders (n = 43; 21.4%), schizophrenia spectrum disorders (n = 3; 1.5%), substance use disorders (n = 46; 22.9%), anxiety disorders (n = 17; 8.5%), and adjustment disorders (n = 28; 13.9%). Similar to the results for lifetime diagnosis, the most common current psychiatric comorbidities were major depressive disorders (n = 30; 14.9%), nicotine dependency (n = 41; 20.4%), adjustment disorders (n = 28; 13.9%), and alcohol abuse or dependency (n = 16; 8.0%).
In , for those 128 participants with lifetime comorbid psychiatric disorders, 55.8% of them reported that the onset of psychiatric disorder was prior to the onset of pathological gambling. With respect to specific disorders, most of them reported the onset of any substance use disorders (74.6%) and anxiety disorders (57.9%) prior to the onset of pathological gambling, whereas the onset of mood disorders (62.7%) and adjustment disorders (64.3%) was later than the onset of pathological gambling.
As shown in , about two-thirds of participants (N = 128, 63.7%) had at least one lifetime Axis I disorder other than pathological gambling. Among them, 73 participants had one lifetime comorbid disorder, 33 participants had at least two disorders, and 22 participants had three disorders or more in their lifetime. For those participants who had lifetime comorbid psychiatric disorders, the average number of psychiatric comorbidity was 1.7. On the other hand, 90 participants (44.8%) had at least one current Axis I disorder other than pathological gambling. Among them, 69 participants had only one current comorbid psychiatric disorder, 12 of them had two disorders, and 9 of them had three disorders or more. For those participants who had current comorbid psychiatric disorders, the average number of psychiatric comorbidity was 1.36 ().
Previous research findings showed that participants with comorbid psychiatric disorders had significantly greater severity in gambling problems and psychiatric symptoms, level of impairment in psychosocial functioning as well as nicotine problems. Further analysis of the relationship between these clinical correlates and the presence of comorbid psychiatric disorder was conducted. Multiple regression analyses were then performed to investigate whether comorbid psychiatric disorders were predictive of severity of gambling problems (). The ASI was treated as the outcome variable, and presence of any comorbid psychiatric disorder, gender, education, and income were regarded as predictors. For both lifetime and current diagnosis, results of multiple regression analyses showed that the association between psychiatric comorbidity and gambling severity (ASI composite score) remained significant after adjusting for other demographic variables (lifetime morbidity: beta = 0.239, P < 0.001; current morbidity: beta = 0.300, P < 0.001).
Lifetime and current psychiatric disorder and demographic predictors of gambling severity.