A systematic review of gambling-related fi ndings from the National Epidemiologic Survey on Alcohol and Related Conditions
JASMINE M. Y. LOO1,2, SHANE W. KRAUS3and MARC N. POTENZA4,5,6,7*
1School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
2Research Department, The Salvation Army–Sydney Headquarters, Redfern, Sydney, NSW, Australia
3Department of Psychology, University of Nevada, Las Vegas, NV, USA
4Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
5Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
6Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
7The Connecticut Mental Health Center, New Haven, CT, USA
(Received: April 27, 2018; revised manuscript received: October 29, 2019; accepted: November 3, 2019)
Background and aims: This systematic review analyzes and summarizes gambling-related findings from the nationally representative US National Epidemiological Survey on Alcohol and Related Conditions (NESARC) data.Methods:Systematic literature searches in accordance with PRISMA guidelines found 51 eligible studies that met inclusion criteria. Eight studies utilized both Waves 1 and 2 NESARC data, and selection of sample sizes varied from 185 to 43,093 individuals, consistent with specified research objectives of each study.Results:The prevalence of lifetime pathological gambling was 0.42% (0.64% among men, 0.23% among women), while past-year prevalence was 0.16%. Pathological gambling rates were generally higher in populations with substance-use disorders and other psychiatric diagnoses. Rates of adverse childhood experiences and suicidal attempts were higher among individuals with problem or pathological gambling. Early-onset gamblers were more likely to be male, be never married, have incomes below $70,000, belong to younger cohorts and have Cluster B personality disorders, but less likely to be diagnosed with mood disorders. While pathological gambling was related to obesity, increased stress, and poorer physical health among general age groups, recreational gambling was linked with improved physical and mental functioning in older adults.Conclusions:The NESARC has provided important information on the correlates of pathological gambling and subdiagnostic patterns of gambling behaviors. Additional studies should examine these relationships in the current gambling environment and longitudinally with aims of implementing policies to improve the public health.
Keywords:systematic review, NESARC, gambling, pathological gambling, national data sets
INTRODUCTION
Gambling may be de
fined as placing monetary or material items at risk in hopes of gaining money or items of greater material value. Gambling may be viewed along a severity continuum with
“Pathological Gambling
”in DSM-IV and ICD-10 (World Health Organization, 1992) and
“Gambling Disorder
”in DSM-5 referring to gambling behavior that leads to signi
ficant distress and interference with function- ing in major life domains (American Psychiatric Associa- tion, 2013). Meanwhile,
“Problem Gambling
”refers to gambling that negatively affects functioning and relation- ships (Morasco et al., 2006) but may not meet DSM or ICD criteria for pathological gambling/gambling disorder;
that is, the term problem gambling is often used to describe subdiagnostic levels of gambling that are concerning.
Recreational gambling has been operationalized in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) as lifetime gambling of more than
five times per year without meeting more than two DSM
criteria (Desai, Desai, & Potenza, 2007). Other designa- tions such as low-risk and at-risk gambling have been used and de
fined in the context of NESARC data, with designations relating to numbers of inclusionary criteria for pathological gambling acknowledged (Desai &
Potenza, 2008). These de
finitions will guide our discus- sion in this systematic review on gambling-related NESARC
findings.
Nationally representative data provide important descrip- tive and inferential
findings that assist in policy-making, industry compliance assessments, community development, and generation of improved treatment and prevention strategies. For example, data collected from the US National Comorbidity Survey Replication (NCS-R), a nationally
* Corresponding author: Marc N. Potenza, PhD, MD; Department of Psychiatry, Yale University School of Medicine, CMHC Room S-104, 34 Park St, New Haven, CT 06519, USA; Phone: +1 203 737 3553; Fax: +1 203 737 3591; E-mail:marc.potenza@yale.edu This is an open-access article distributed under the terms of theCreative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes–if any–are indicated.
DOI: 10.1556/2006.8.2019.64 First published online December 13, 2019
representative US household survey, assessed 9,282 English-speaking respondents aged 18 years and older and was conducted between February 2001 and April 2003 in a nationally representative multistage clustered area probabil- ity sample of the US household population. Speci
fically, the NCS-R found lifetime prevalence estimates of problem gambling (de
fined as having one or more criteria of patho- logical gambling) at 2.3% and pathological gambling at 0.6% (Kessler et al., 2008). In other countries, the British Gambling Prevalence Survey in 2010
–as a follow-up to the 1999 and 2007 surveys
–was conducted to allow compar- isons pre- and post-implementation of the Gambling Act 2005 (Wardle et al., 2011). Prior to this survey, the 2007 British Gambling Prevalence Survey aimed to examine the nature and extent of gambling in Great Britain before administering the Act. Similarly in Asia, the Singapore National Council on Problem Gambling has conducted gambling participation surveys every 3 years from 2005 to 2014 to guide development of systemic regulatory assess- ment, community engagement activities, prevention programs, and treatment provision (National Council on Problem Gambling, 2014). It is important that national follow-up surveys attempt to achieve maximal comparabili- ty with previous surveys by standardizing methodology and measurement instruments.
Comparing prevalence estimates between countries is often challenging as data-collection protocols, sampling procedures, and gambling assessments are often different, all of which may in
fluence pathological gambling and problem gambling estimates. As such, prevalence estimates in this context may best be considered as an illustration of the range of worldwide approximations, and arguably not as de
finitive comparisons. Overall, national pathological gam- bling prevalence estimates in Western countries range from 0.3% in Sweden (Binde, 2014), 0.7% in Britain (Wardle et al., 2011) to 0.8% in Denmark (Ekholm et al., 2014). In Australia and New Zealand, estimates range from 0.5% in New Zealand (Devlin & Walton, 2012) to 2.1% in Australia (Productivity Commission, 2010). Meanwhile, pathological gambling prevalence estimates in Asia are generally higher with a range from 0.5% in Singapore (National Council on Problem Gambling, 2014), 2.5% in Macau (Fong & Ozorio, 2005; Wu, Lai, & Tong, 2014), 4% in Hong Kong (Wong &
So, 2003) to 4.4% in Malaysia (Loo & Ang, 2013). The prevalence rate observed in the US is like other Western countries, notably Sweden.
The National Institute on Alcohol Abuse and Alcohol- ism
’s NESARC is the largest (N
=43,093 adults) comor- bidity survey conducted in the US that assessed DSM-IV pathological gambling and multiple substance-use, mood, anxiety, and personality disorders (Petry, Stinson, & Grant, 2005). The nationally representative sample with statistical weights has enabled multivariate investigations of preva- lence estimates, gender-related associations, sociodemo- graphic correlates, potential risk factors, and physical and psychiatric comorbidities. Furthermore, NESARC data col- lected from Wave 1 (2001
–2002) and Wave 2 (2004
–2005) provide for a unique opportunity to evaluate longitudinal and prospective research questions, although pathological gambling was only assessed in Wave 1. To date, although 51 articles have reported pathological-gambling-related
fi
ndings based on NESARC data, there have been no systematic reviews synthesizing results from more than a decade of publications. Such a summary could shed light on lessons learned from NESARC as well as inform future research efforts aimed at understanding the correlates and impact of pathological gambling and subdiagnostic levels.
A review of the gambling-related investigations from the NESARC data will help synthesize information gleaned from this data set and lay the foundation for future inves- tigations of these and other data. This systematic review seeks to collect, evaluate, and discuss gambling-related NESARC
findings, as the NESARC-related
findings are important in informing policy makers, governmental bodies, researchers, and treatment providers. In the following sec- tions, we will provide details on the systematic review methodology, evaluate
findings from selected studies, and discuss implications for future directions. These
findings are described and partitioned into relevant sections such as psychometrics, model testing, symptom analysis, preva- lence estimates, gambling subtypes, sociodemographic correlates, potential risk factors, and comorbidities. Finally,
“
Discussion
”section will highlight key
findings, research and practical implications, and future directions.
METHODS
Search strategy
Protocols and strategies employed in this systematic review were in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide- lines (Moher, Liberati, Tetzlaff, Altman, & PRISMA Group, 2009). Electronic Boolean searches of databases (PsycInfo, PubMed, and Web of Science) included all articles from inception to June 2019. The search strategy included a combination of keywords such as
“National Epidemiologic Survey on Alcohol and Related Conditions
”or
“NESARC
”and
“gambling,
” “pathological gambling,
” “problem gam- bling,
”or
“gambling disorder.
”Only articles in English were selected in the three search engines. Reference lists of included articles were checked manually for additional relevant publications.
Inclusion criteria and review process
All citations were managed with Endnote reference manage- ment software. Each reference title and abstract was screened by the authors independently and discussed as a group for eligibility against the inclusion criteria: (a) original empirical publications in English, (b) studies included NESARC Wave 1 and/or Wave 2 data, and (c) studies reported data from the gambling component of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV).
The resulting full-text copies of all articles considered to be relevant were retrieved and screened.
Data from included studies were extracted into MS Excel
2013 by the
first author and independently checked by the
other authors. Although the authors agreed upon the manu-
scripts to be included in the
final analyses, data on indepen-
dent evaluation for inclusion were not systematically
collected. The following characteristics of each study were retrieved: (a) general information
–title, authors, and pub- lication year; (b) sample size and other characteristics;
(c) instrument and thresholding for pathological gambling;
(d) other variables investigated in each study; (e) statistical analyses; (f) main
findings or prevalence of pathological gambling; and (g) other
findings.
RESULTS
Study selection
Upon removal of duplicates, the searches identi
fied 67 records that were screened, whereby 51 empirical papers met the inclusion criteria and were included in this system- atic review (see Figure 1 for PRISMA
flow diagram). Nine excluded articles were not written based on NESARC data, while one excluded record was a conference abstract that was eventually published as an article and included in this systematic review. Details extracted from articles (n
=43) that examined pathological gambling as one of the main variables within speci
fied research questions are
summarized in Table 1. Information extracted from the remaining 8 articles (out of the 51 included) that investigat- ed pathological gambling as a peripheral variable in the context of other psychopathology is summarized in Table 2.
Study characteristics
All 51 included studies utilized either Wave 1 (Year 2001
–2002) and/or Wave 2 (2005
–2006) nationally representative NESARC data (Grant, Moore, Shepard, & Kaplan, 2003) and were published between years 2005 and 2019. Ten studies utilized both Wave 1 and 2 data sets for prospective evaluations of associations between pathological gambling at Wave 1 and medical/psychiatric disorders at Wave 2.
Selection of sample
İsizes varied from 185 to 43,093 individuals depending on speci
fied sample selection built upon research objectives.
Instrument
Assessment of pathological-gambling criteria based on the
Diagnostic and Statistical Manual of Mental Disorders, 4thedition (DSM-IV; American Psychiatric Association, 2000)
Records identified through database searching
(n = 124)
ScreeningIncludedEligibilityIdentification
Additional records identified through other sources
(n = 3)
Records after duplicates removed (n = 62)
Records screened (n = 62)
Full-text articles assessed for eligibility
(n = 61)
Full-text articles excluded, with reasons
(n = 10)
Data set used for analysis was not NESARC data
Studies included in Systematic Review
(n = 51)
Records excluded (n = 1)
Figure 1.PRISMAflow diagram of the systematic review phases
Table1.SummarytableofNESARCfindingsongamblingdisorderasthemainconstruct ArticleSample(Nandother characteristics)Instrumentanddiagnostic/ subdiagnosticassessmentsOthervariablesinvestigatedMainfindings Petryetal. (2005)43,093fromWave1 (2001–2002);81%response rate.Aim:topresentnationally representativeprevalencerates forpathologicalgambling, genderdifferencesand comorbidpsychiatricdisorders AUDADIS-IV;pathologicalgambling– 5outof10DSM-IVcriteria(15symptom itemsoperationalizedthe10pathological- gamblingcriteria)
Alcohol,druguse,mood,anxiety, andpersonalitydisordersLifetimeprevalencerates=0.42%(0.64%men,0.23% women).Higherprevalencelinkedwithbeingmale, Black,45–64yearsofage,andwidowed/separated/ divorced.Pathological-gamblingratesforsubstance-use disorder(0.61%–1.83%),mooddisorder(0.85% hypomaniaand2.92%mania),anxietydisorders(0.90% socialphobiaand5.01%panicdisorder),and personalitydisorders(1.53%–3.02%) Blanco,Hasin, Petry, Stinson,and Grant(2006)
43,093fromWave1;non- institutionalpopulation≥18 yearsresidinginhouseholds andgroupquarters;weighted data–socioeconomicvariables (2000DecennialCensus); non-responseadjustment– householdandpersonlevel AUDADIS-IV;pathologicalgambling– 5outof10DSM-IVcriteria;gatekeeping question:“Haveyougambled≥5timesin any1yearofyourlife?”;Subclinical pathologicalgambling–meet1–4 pathological-gamblingcriteria Mentaldisabilityscores–mental componentsummary(MCS) andsocialfunctioning(SF); pathological-gamblinggroup only–onsetage,numberof criteriamet,gamblingvenues, recoveryage,andtreatment- seeking
Lifetimeprevalencerates=0.64%men,0.23%women; Subclinicalpathologicalgambling=6.79%men.3.26% women.Past-yearpathological-gamblingprevalence amonglifetimegamblers=1.92%men,1.05%women; past-yearsubclinicalpathologicalgambling=20.43% men,15.09%women;past-yearnon-gambling=77.65% men,83.86%women.Menmorelikelythanwomento reportpast-yearpathologicalgambling Morascoetal. (2006)43,093fromWave1 (2001–2002);weighteddata– designcharacteristics, oversampling,non-response, demographics;mean age=45.2years(SD=17.6) 52.1%female
AUDADIS-IVandSF-12v2(physicaland emotionalfunctioning);4gambling groups:(1)“low-risk”nevergambled≥5 timesin1year(nevergambledandmay havegambledinlifetime),(2)“At-risk” ≤2criteriametinDSM-IV,(3)“Problem gambling”met3–4criteria,(4)“Patho- logicgambling”met≥5DSM-IVcriteria Physicalandmentalhealth functioning,medicaldiagnoses, medicalutilization,behavioral riskfactors(bodymassindex, lifetimehistoryofalcohol dependence,nicotine dependence,anddiagnosesof mood/anxietydisorder)
Lifetimeprevalenceofpathologicalgambling=0.42%, 0.90%problemgambling,25.84%at-riskgamblingand 72.84%low-riskgamblingindividuals.Increased problem-gamblingseverityassociatedwithcurrentobesity status,alcoholabuse/dependence,nicotinedependence, andmoodandanxietydisorders Slutske(2006)n=185Wave1NESARC (N=43,093)andn=21 GamblingImpactand BehaviorStudy(N=2,417) whometcriteriaoflifetime DSM-IVpathological gambling
AUDADIS-IVforNESARCandNORC DSM-IVforGamblingProblems(NODS) forGamblingImpactandBehaviorStudy. Assessmenttoolchangesmadetomake GamblingImpactandBehaviorStudyand NESARCdiagnosescomparable.Lifetime pathologicalgambling–meet≥5of10 DSM-IVcriteriaatanytimeinlife. Problemgambling–3or4DSM-IV pathological-gamblingcriteria Treatment-seeking(sought professionalhelp),recovery (lifetimehistorybutdidnot endorsepathologicalgambling inthepast12months),natural recovery(recoverybutnever soughttreatment)
GamblingImpactandBehaviorStudy–0.8%lifetime pathological-gamblingprevalence(44.6%females), 1.3%lifetimeproblem-gamblingprevalence(39.7% females).NESARC–0.4%lifetimepathological gambling(29.6%females),0.8%lifetimeproblem gambling(29.8%females).7%(GamblingImpactand BehaviorStudy)and12%(NESARC)treatment- seekingratesamonglifetimepathologicalgambling. 36%(GamblingImpactandBehaviorStudy)and39% (NESARC)“recovery”rates.“Naturalrecovery”was seenamong33%–36%ofindividualswithlifetime pathologicalgambling.Pathologicalgamblingmaynot necessarilyfollowachronicandpersistentcourse
Desaietal. (2007)25,485Wave1NESARC participantsage≥40years. WeightstoadjustSEsforover- sampling,clustersamplingand non-response
AUDADIS-IV-gamblingproblemsinthree groups:(a)Non-gamblers–never gambled>5timesinayearfortheir lifetime,(b)Recreationalgamblers– gambled>5times/yearbut≤2criteriaof pathologicalgamblinginpreviousyear, and(c)Problem/pathologicalgamblers with≥3criteriaofpathologicalgambling inpreviousyear Healthstatus–obesity,body massindex,self-ratedhealth; nicotinedependenceand alcoholabuse/dependence; chronicmedicalconditions; sociodemographics;SF-12 score–physicalandmental
Participantsaged40–64years(youngergroup):weighted prevalenceestimateswerecalculatedfornon-gambling (68.70%),recreationalgambling(30.80%)and problem/pathologicalgambling(0.30%). Participants>64years(oldergroup):prevalence estimateswere71.10%fornon-gambling,28.70% recreationalgambling,and0.30%problem/pathological gambling Pietrzak, Morasco, Blanco, Grant,and Petry(2007)
10,563Wave1NESARColder adultsage≥60years. Cronbach’sαforsymptom itemsandpathological gamblingforfullsamplewere .92and.80,respectively. Cronbach’sαforsymptom itemsandpathological gamblingforolderadults samplewere0.85and0.71, respectively AUDADIS-IVtoassesspathological gambling(meetatleast5of10DSM-IV criteria).Gatekeepingquestion:“Have yougambled≥5timesinany1yearof yourlife?”–Thosewhoanswered“NO”: Non-gambling(70.41%).Recreational gambling:ThosewhoansweredYESand met0–2ofthe10DSM-IVcriteria. Disorderedgambling:≥3criteria, includedthosewithproblemgambling andpathologicalgambling Alcohol-anddrug-use,mood, anxiety,andpersonality disorders.Medicaldiagnosesof past-yearprevalenceof11 medicalconditions
28.74%lifetimerecreationalgamblingand0.85% lifetimeproblem/pathologicalgamblingwith0.29% meetingdiagnosticcriteriaforpathologicalgambling and0.56%reportingsubdiagnosticsymptoms. Recreationalgamblingrelativelycommonamongolder adults(30%lifetimegambling≥5timesinayear). Pathologicalgamblingrareas0.3%olderadultsmet lifetimepathological-gamblingdiagnosesand0.1%met past-yearpathological-gamblingcriteria Strongand Kahler (2007)
11,153Wave1participants (46.1%females)whoanswered “yes”to“Haveyouever gambledatleast5timesinany oneyearofyourlife?”Aim:to assessunidimensionality, symptomseverityandrelative patterns AUDADIS-IV–pathologicalgambling represents5outof10DSM-IVcriteria; included12-monthclusteringcriterion– whethermultiplesymptomsoccurred withinthepastyear
Sociodemographics–age, gender,race,andincomelevelGamblerswere76.8%White,20.1%Black,14.2% Hispanic.Meanagewas45.75years(SD=18.51). Genderandagedifferences:womenmorelikelythan mentoreportgamblingtoimprovemoodandforget problems,whileyoungergamblersreportedchasing lossesatlowerlevelsofproblem-gamblingseverity Desaiand Potenza (2008)
43,093fromWave1;non- institutionalpopulation≥18 yearsresidinginhouseholds andgroupquarters;weighted data–socioeconomicvariables (2000DecennialCensus);non- responseadjustment– householdandpersonlevel
AUDADIS-IVtoassesspathological gambling,usedpast-yeardiagnoseswith illnessandsubstanceexclusions-primary/ independentDSMdiagnoses.Four groups:(1)Non-gambling/lowfrequency gambling–nevergambled>5times/year inlifetime,(2)Low-riskgambling– gambled>5times/yearinlifetimebutno pathological-gamblingcriteriainpast year,(3)At-riskgambling–reported1–2 pathological-gamblingcriteriainpast year,and(4)Problem/pathological gambling–≥3pathological-gambling criteriainpastyear Substanceabuseand7AxisII personalitydisorders(notime periodsapplied).Socio- demographics(covariates):age, race/ethnicity,education, employment,maritalstatus,and householdincome
Problem/pathologicalgamblingrates:0.7%inmenand 0.4%inwomen.Bothmenandwomenmayengagein low-frequencygamblingwithoutexperiencingproblem/ pathologicalgambling.Highratesofco-occurrence betweenAxis-Ipsychiatricdisordersandproblem/ pathologicalgambling.Strongassociationbetween antisocialpersonalitydisorderandproblem/ pathologicalgambling.Malesmorelikelythanfemales togambleanddevelopproblem/pathologicalgambling, butstrongerassociationsbetweenat-riskorproblem/ pathologicalgamblingandpsychopathologyamong femalesthanmales (Continued)
Table1.(Continued) ArticleSample(Nandother characteristics)Instrumentanddiagnostic/ subdiagnosticassessmentsOthervariablesinvestigatedMainfindings Alegriaetal. (2009)43,093fromWave1 (2001–2002);11,153for subgroup–prevalenceof problem/pathologicalgambling amongthosewhohadengaged ingambling(lifetime conditionalprevalenceof disorderedgambling)
AUDADIS-IV;Combinedproblem gambling(problemgambling–i.e.,met 3or4DSM-IVcriteriaforpathological gambling)withpathologicalgamblingand labeledthisgroupas“disordered gambling”
Medicalconditions,stressfullife events(SocialReadjustment RatingScale),psychosocial functioninganddisability
Prevalenceofproblem/pathologicalgamblingamong black(2.2%),NativeAmerican/Asian(2.3%),and White(1.2%)groups.Lifetimeconditionalprevalence ofproblem/pathologicalgamblingamongblack(9.0%), NativeAmerican/Asian(8.2%),andwhite(4.0%) groups.Potentialriskfactorsforpathologicalgambling: socioeconomicstatus,alcohol-usedisorders,psychiatric disorders Boudreau, Labrie,and Shaffer (2009)
43,093fromWave1(2001– 2002);11,153forgambling subgroup.Aim:toinvestigate shadowsyndromesandco- occurringsymptomswithin individualswithpathological- gamblingfeaturesand individualswhogamblebutno evidenceofpathological- gamblingfeatures AUDADIS-IV;selected658outoftotal 3,008questionsfortestingprior1-year symptompresence.2groups:past-year pathologicalgambling(n=121)and gamblerswithoutpathological-gambling features(n=9,930).Shadowsyndromes– clinicalsymptomsthatareinsufficiently clusteredtosatisfycriteriafordiagnoses 29DSMdiagnosticcategories withgambling-relevant symptoms(alcohol,drug dependence,mooddisorders, andpersonalitydisorder)
25%ofindividualswithpathologicalgamblingreported enoughsymptomstomeetcriteriaforatleastoneofthe fourpathological-gambling-relevantsymptomclusters (dysthymia,generalizedanxiety,anxietyrelatedtoother factors,specificphobias).Factoranalysisreduced symptomsto13clusters Grant,Desai, andPotenza (2009)
43,093fromWave1multi-stage stratifiedsample;non- institutionalpopulation≥18 yearsresidinginhouseholds andgroupquarters;weighted data.Aim:toinvestigate associationsbetweennicotine dependence,problem/ pathologicalgamblingand psychopathology AUDADIS-IV–4groups:(1)Non- gambling/low-frequencygambling– nevergambled>5times/yearinlifetime, (2)Low-riskgambling–gambled>5 times/yearinlifetimebutnopathological- gamblingcriteriainpastyear,(3)At-risk gambling–gambled>5times/yearin lifetimeandreported1–2pathological- gamblingcriteriainpastyear,and(4) problem/pathologicalgambling–reported ≥3pathological-gamblingcriteriainpast year Past-yearmeasuresformood disorders,anxietydisorders, drugabuseanddependence, alcoholabuseanddependence, nicotinedependence;lifetime measuresforAxisIIpersonality disorders;sociodemographic variables
Outof43,093,12.8%nicotinedependentand71.7%non- gambling,23.1%low-riskgambling,2.2%at-risk gamblingand0.5%problem/pathologicalgambling. Amongindividualswhowerenicotinedependent, prevalenceestimatesfor4problem-gambling-severity groupswere59.7%,31.6%,4.9%and1.9%, respectively Nelsonetal. (2009)11,153(26%of43,093) individualswhoreported gambling≥5times/yearin lifetime.Aim:toexaminehow specificpathological-gambling criteriarelatetosymptom patternsandstability (severityandcourse)
AUDADIS-IV–pathologicalgambling represents5outof10DSM-IVcriteriaPast-yearpathologicalgambling andpriortopast-year pathologicalgambling Preoccupationwasthemostendorsedsymptomat12.1%, followedbychasing(7.1%),tolerance(6.4%),escape (6%),lying(3.3%),lossofcontrol(2.9%),relianceon others(1.3%),withdrawal(1.2%),jeopardizingother experiences(1%),andillegalacts(0.4%)
Brewer, Potenza,and Desai(2010)
43,093fromWave1(2001– 2002);81%responserateAUDADIS-IV–4groups:(a)Non- gambling/lowfrequencygambling–never gambled>5times/yearinlifetime, (b)Low-riskgambling–gambled >5times/yearinlifetimebutno pathological-gamblingdiagnosesinpast year,(c)At-riskgambling–1or2 pathological-gamblingsymptomsinpast year,(d)problem/pathologicalgambling– ≥3pathological-gamblingsymptomsin pastyear Alcoholdependenceand/or abuse;sociodemographics; Alcoholusegroups(final): alcohol-usedisorderandnon- alcohol-usedisorder
2.3%problem/pathologicalgamblingamongnon- alcohol-use-disordergroupand8.3%problem/ pathologicalgamblingamongalcohol-use-disorder group.Complexrelationshipbetweenproblem/ pathologicalgambling,alcohol-usedisorderand psychopathology.Amongnon-alcohol-use-disorder group,problem/pathologicalgamblingwasassociated withelevatedoddsformostAxisIandIIdisorders. Amongalcohol-use-disordergroup,thesamepattern wasnotevident.Datasuggestthatalcohol-usedisorders accountforsomeofthevarianceintherelationship betweenproblem-gamblingseverityand psychopathology Gebaueretal. (2010)43,093fromWave1;non- institutionalpopulation≥18 yearsresidinginhouseholds andgroupquarters.Aim:to developabriefbiosocial gamblingscreenforthegeneral population
AUDADIS-IV–pathologicalgambling represents≥5outof10DSM-IVcriteriain pastyearandutilizedtheMappedLie/Bet scale
Lie/BetQuestionnairesasa referencepointDevelopedapsychometricallysound3-item questionnaireasanalternativetotheLie/Bet Questionnaire.Thequestionnaireisconsistentwiththe syndromemodelofaddiction Barryetal. (2011b)31,830adults(13%Hispanic, 87%white),48%menand 52%women.Aim:toexamine associationsbetweenrace/ ethnicity,sociodemographics, psychopathologyandproblem/ pathologicalgambling
AUDADIS-IV–3groups:(a)Non- gambling/lowfrequencygambling–never gambled>5times/yearinlifetime, (b)Low-riskorat-riskgambling– gambled>5times/yearinlifetimewith 0–2inclusionarypathological-gambling criteriainpreviousyear,and(c)problem/ pathologicalgambling–≥3past-year pathological-gamblingcriteria Past-yearmeasuresformood disorders,drugabuse,alcohol abuseanddependence,nicotine dependence(asperGrantetal., 2009).Lifetimemeasuresfor AxisIIpersonalitydisorders. Sociodemographicvariables included
Whiterespondents(0.5%)morelikelytoexhibitproblem/ pathologicalgamblingascomparedtoHispanic respondents(0.4%).Ratesofpsychiatricdisorders significantlyrelatedtopast-yearproblem-gambling severityinbothHispanicandWhiteparticipants Barryetal. (2011a)32,316adults(12.98%Black, 87.12%White),42%menand 58%women.Aim:toexamine associationsbetween sociodemographics, psychiatricdisorders,andpast- yearproblem-gambling severityamongBlackand Whiterespondents
AUDADIS-IV–3groups:(a)Non- gambling/lowfrequencygambling–never gambled>5times/yearinlifetime, (b)Low-riskorat-riskgamblers-gambled >5times/yearinlifetimewith0–2 inclusionarypathological-gambling criteriainpreviousyear,and(c)problem/ pathologicalgambling–≥3past-year pathological-gamblingcriteria Past-yearmeasuresformood disorders,drugabuse,alcohol abuseanddependence,nicotine dependence.Lifetimemeasures forDSM-IVAxisIIpersonality disorders.Sociodemographic variablesincluded
65.7%Blackand63.9%Whiterespondentshadnon- gambling/low-frequencygambling.Prevalenceratesof problem/pathologicalgamblingwerehigherforBlack (0.96%)thanWhite(0.45%).respondents.Ratesof psychiatricdisorderswereassociatedwithpast-year problem-gamblingseverityforbothBlackandWhite participants (Continued)
Table1.(Continued) ArticleSample(Nandother characteristics)Instrumentanddiagnostic/ subdiagnosticassessmentsOthervariablesinvestigatedMainfindings Carragherand McWilliams (2011)
11,104adultswhoreported havinggambled≥5timesin lifetimeandprovidedcomplete dataon15past-yearDSM-IV pathological-gamblingcriteria items.Aim:latentclass analysistoderiveandvalidate typologyofgamblinggroups usingepidemiologicaldata AUDADIS-IV–pathologicalgambling represents5outof10DSM-IVcriteria. “Chasing”behaviorisrepresented differentlyinDSM-IV(long-term chasing)andAUDADIS-IV(bothshort- andlong-termchasing) Demographicvariables, psychiatric,andsubstanceuse disorders.Includedlifetime measuresformooddisorders, anxietydisordersand personalitydisorders. Compositevariablesofpast- yearalcoholuseanddrug-use disorders
93.3%respondentsgroupedintheclass,without gamblingproblemswhile6.1%inthemoderate-and 0.6%inthepervasive-gambling-problemsclasses, respectively.Intheclasswithoutgamblingproblems, therewereverylowendorsementprobabilitiesofall10 DSM-IVpathological-gamblingcriteria.Moderate- gambling-problemsclassendorsedprimarilythe preoccupation,toleranceandchasingcriteria. Pervasive-gambling-problemsclassendorsedmost criteria ChouandAfifi (2011)33,231Waves1and2NESARC reflectingfollow-up completionsandcompletedata (Respondentswithmissing itemsremoved).Aim:to examineassociationbetween past-yearproblem/pathological gamblingwithAxis1 psychiatricdisorders3years later(longitudinaland prospectivestudydesign)
AUDADIS-IV–past-yearproblem/ pathologicalgamblingrepresents respondentshavingmet≥3criteriainthe pastyear.Non-disorderedgambling–all participantsnotclassifiedunderproblem/ pathologicalgambling,includinglifetime non-gamblers Sociodemographics(covariate- 1);Axis1disorders–mood, anxietyandsubstanceuse;11 medicalconditions(covariate- 2);SF-12physicalandmental healthcomponentsummary scores(covariate-3);12stressful lifeevents(covariate-4)
Overallprevalenceofproblem/pathologicalgambling was0.6%with0.82%prevalenceamongmalesand 0.4%amongfemales.Past-yearproblem/pathological gamblinglinkedwithincreasedoddsoftheincidenceof someAxis1disordersat3-yearfollow-up,andthese relationshipsremainedsignificantafteradjustingforthe effectsofpotentialconfounds Oleskietal. (2011)43,093fromWave1.Aim: confirmatoryfactoranalysisto investigatehowpathological gamblingloadsonKrueger’s (1999)3-factormodelof commonmentaldisorders (internalizing,externalizing, andanxious-miseryfactors)
AUDADIS-IVtoassesspathological gambling(meetatleast5of10DSM-IV criteria).Gatekeepingquestion:“Have yougambled≥5timesinany1yearof yourlife?”
10mentaldisorders:major depression,dysthymia, generalizedanxietydisorder, panicdisorder,agoraphobia, socialphobia,specificphobia, alcoholdependence,and antisocialpersonalitydisorder
ConfirmatoryfactoranalysisshowedKrueger’s3-factor modelfittedNESARCdata.DSM-IVpathological gamblingshowshighestloadingontoexternalizing factorcomprisedofpathologicalgambling,drugand alcoholdependence,andantisocialpersonalitydisorder forbothmenandwomen Saccoetal. (2011)43,093fromWave1.Aim:to examinedifferentialitem functioninginDSM-IV pathologicalgamblingcriteria basedonethnicity,ageand gender
AUDADIS-IV–pathologicalgambling represents5outof10DSM-IVcriteriain any1yearoftheirlives.Past-yearand lifetimeprevalenceobtained.
Sociodemographics–age, gender,race,employment,and incomelevel
Differentialitemfunctioningevidencedforgender, ethnicityandage.WomenandAsiansindividualsless likelytoendorsepreoccupation(Criterion1)than referencegroups(male,Caucasianandages25-59 years).Femalesmorelikelytoendorsegamblingto escape(Criterion5),whileyoungadultswerelesslikely toendorsegamblingtoescape
Giddensetal. (2012)43,093fromWave1(2001– 2002).Aim:toinvestigatethe impactofpast-yearanxiety disordersontherelationships betweenpast-yearproblem/ pathologicalgamblingand non-anxietypsychopathology
AUDADIS-IV–fourgroups:(a)Non- gambling/lowfrequencygambling– gambled<5times/yearinlifetime, (b)Low-riskgambling–gambled>5 times/yearinlifetimebutnopathological- gamblingcriteriainpastyear,(c)At-risk gambling–gambled>5times/yearin lifetimeandreported1–2pathological- gamblingcriteriainpastyear,and(d) problem/pathologicalgambling–reported ≥3pathological-gamblingcriteriain previousyear Samplestratifiedintotwogroups: (a)individualswhometpast- yearanxiety-disordercriteria (personalitydisorder, generalizedanxietydisorder, socialphobia,orsimple phobia),and(b)individuals whodidnotmeetpast-year anxiety-disordercriteria
Higherproblem-gamblingseverityassociatedwithAxisI andIIpsychiatricdisordersinbothanxiety-disorderand non-anxiety-disordergroups.Significantinteractions (anxiety-by-gambling),especiallyformoodand personalitydisorders.Anxiety-by-gamblinginteractions indicatestrongerassociationsbetweenproblem- gamblingseverityandpsychiatricdisordersamong individualswithoutanxietydisorderthanthosewith anxietydisorders Barryetal. (2013)41,987adults(Wave1)with completeinformationonpain interferenceandproblem- gamblingseverity
AUDADIS-IV–3groups:(a)Non- gambling/lowfrequencygambling–never gambled>5times/yearinlifetime,(b) Low-riskorat-riskgambling–gambled >5times/yearinlifetimewith0-2 inclusionarypathological-gambling criteriainpastyear,and(c)problem/ pathologicalgambling–≥3past-year pathological-gamblingcriteria Past-yearmeasuresformood, anxiety,substance-usedisorders andlifetimemeasuresforDSM- IVAxisIIpersonalitydisorders; socio-demographicvariables. Paininterference–measuredby SF-12subscaleanddividedinto 2groups:no/lowpain interferenceandmoderate/ severepaininterference
Prevalenceofproblem/pathologicalgamblinghigherfor moderate/severepaininterferencegroup(0.79%)than forno/lowpaininterference(0.48%).Associations betweenproblem-gamblingseverityandpsychiatric disordersarelargelynotmodifiedbypaininterference. Paininterferencemoderatestherelationshipsbetween problem-gamblingseverityand4psychiatricdisorders: dysthymia,panicdisorder,dependentpersonality disorder,specificphobia Nower, Martins,Lin, andBlanco (2013)
581problem/pathological gamblingparticipantsfrom Wave1NESARC.Aim:to deriveempiricalsubtypes relatingtoproblem/ pathologicalgamblingbased onetiologicalandclinical characteristicsinthePathways Model AUDADIS-IV;pathologicalgambling–5 outof10DSM-IVcriteria;gatekeeping question:“Haveyougambled≥5timesin any1yearofyourlife?”;Problem/ pathologicalgambling–≥3DSM-IV pathological-gamblingcriteria
Otherpsychiatricdisorders; generalhealth,physical functioning,bodilypainand mentalhealthscoresofthe SF12v2;familyhistoryofdrug/ alcoholproblemsandantisocial personalitydisorder;current events(separation,divorce, deathoflovedones,problems withthelaw);demographics
1.36%problem/pathologicalgamblingoutof43,093 participants.Latentclassanalysesshoweda3-class solutionasbest-fittingmodel.50.76%inClass1 reportedlowestoverallpsychiatricdisordersincluding problem-gamblingseverityandmooddisorders. 20.06%inClass2reportedhighprobabilityof endorsingpast-yearsubstance-usedisorders,moderate probabilityofhavingpersonalitydisorderandhaving parentswithalcohol-/drug-useproblemsandhighest probabilityforpast-yearmooddisorders.29%inClass 3hadthehighestprobabilitiesofpersonalityandprior- to-pastyearmooddisorders,substance-usedisorders, separation/divorce,drinking-relatedphysicalfights,and parentswithalcohol/drugproblemsand/orahistoryof antisocialpersonalitydisorder Pilver,Libby, Hoff,and Potenza (2013a)
34,653participantswho completedbothWave1and Wave2data(87%response rate)
AUDADIS-IV–at-risk/problem/ pathologicalgambling–gambled>5times ayearandacknowledgedonetoten inclusionarycriteriaforpathological gambling) –Non-at-risk/problem/pathological gambling–noinclusionarycriteriafor pathologicalgambling 3-yearincidence(fromWave1to Wave2)ofalcohol-use disorders,nicotinedependence, drug-usedisorders(both prescribedandnon-prescribed) andillicitdrug-usedisorders
At-risk/problem/pathologicalgambling(incomparison withnon-at-risk/problem/pathologicalgambling) showed:(a)positiveassociationwithincidentnicotine dependenceamongwomen,(b)negativeassociation withincidentprescriptiondrug-usedisordersamong men,(c)positiveassociationwithincidentalcohol-use disordersamongmen (Continued)
Table1.(Continued) ArticleSample(Nandother characteristics)Instrumentanddiagnostic/ subdiagnosticassessmentsOthervariablesinvestigatedMainfindings Pilver,Libby, Hoff,and Potenza (2013b)
10,231participantsaged55 yearsoroldertoexamine incidentcasesofAxis1 disorders.Aim:toevaluate past-yearproblemgambling severityatWave1andincident AxisIpsychopathologyat Wave2 AUDADIS-IV–at-risk/problem/ pathologicalgambling–gambled>5times ayearandacknowledgedonetoten inclusionarycriteriaforpathological gambling) –Non-at-risk/problem/pathological gambling–noinclusionarycriteriafor pathologicalgambling Binary(presenceorabsence); combinedcategoryofAxis1, mood,anxietyandany substance-usedisorder. Covariates–assessedatWave1
67.3%non-gambling/low-frequencygambling,29.9% low-riskgambling,and2.8%at-risk/problemand pathologicalgambling(84.7%1–2featuresof pathologicalgambling,13.3%3–4featuresof pathologicalgambling,2.0%endorsed≥5featuresof pathologicalgambling).At-risk/problem/pathological- gamblinggroupwasmorelikelytoreportincidenceof mentalillnessascomparedtonon-gambling/low- frequency-gamblinggroup Pilverand Potenza (2013)
10,231participantsaged55 yearsorolder.Aim:toevaluate prospectiveassociations betweenat-risk/problem/ pathologicalgambling(Wave 1)andincidentmedical conditionsamongolderadults (Wave2) IV–At-risk/problem/pathological gamblingassessedatWave1. –Onlyindividualswithoutalifetime historyofoutcomeofinterestinWave1 wereincludedineachanalyticalsample Incidentphysicalhealth conditions(binaryoutcomes)at Wave2.Othervariables– socio-demographiccovariatesat Wave1,baselinepsychiatric comorbidity,substanceuse, bodymassindex
67.3%non-gambling/low-frequencygambling,28.8% low-riskgambling,and2.4%at-risk/problem/ pathologicalgambling.Atbaseline(Wave1),at-risk/ problem/pathological-gamblinggroupwasyounger, morelikelytobemale,havepast-yearhistoryofmood disorderandAxisIIdisorder,andreportusingalcohol, tobacco,anddrugs.At-risk/problem/pathological gamblingwasassociatedwithincidentarteriosclerosis andheartconditions Parhamietal. (2014)34,653Wave1(81%response rates)andWave2(87% responserates)NESARC participants.Aim:touse longitudinaldatatodetermine whetherproblem-gambling severityisrelatedtotheonset ofpsychiatricdisorders
AUDADIS-IV–non-gambling/low- frequency-gamblingcomparisongroup (individualswhogambled<5times/yearin lifetime)and3gamblinggroups: (1)Recreationalgambling–gambled>5 times/yearinlifetimewithoutmeetingany past-yeargambling-disordercriteria, (2)Subthresholdgamblingdisorder– gambled>5times/yearinlifetimewith1–3 inclusionarypast-yeargambling-disorder criteria,and(3)Gamblingdisorder– met4-9past-yeargambling-disorder criteria DSM-IVAxisIdisorders groupedintothreecategories: mood,anxietyandsubstance- usedisorders.Posttraumatic stressdisorderassessedinWave 2andsociodemographics
Non-weightedbaselineprevalenceofrecreational gambling(23%),subthresholdgamblingdisorder (2.6%)andgamblingdisorder(0.33%)with73.2%non- gambling.At3yearsafterinitialintakeinterview, individualswithhigherproblem-gamblingseverityat baselinedemonstratedgreateroddsofexperiencing incidentmood,anxietyorsubstance-usedisorders,with agradedrelationshipobserved Vizcainoetal. (2014)43,093fromWave1.Aim:to investigatedifferencesbetween early-vs.later-onset pathologicalgamblingin sociodemographics,AxisIand IIpsychopathology,preferred gamblingandtreatment- seekingrates
AUDADIS-IVtoassesspathological gambling(meetatleast5of10DSM-IV criteria).Gatekeepingquestion:“Have yougambled≥5timesinany1yearof yourlife?”Ageofpathological-gambling onsetwasdividedas≤25years(earlier onset)and≥26years(later-onset) Strategic(blackjack,poker,sports betting,etc)vs.non-strategic (keno,bingo,pull-tabs,slot machines)gambling; Aggregatedalcohol-use disordersanddrug-use disorders;moodandanxiety disorders;7DSM-IV personalitydisorders Early-onsetpathologicalgamblingwasassociatedwith beingmale,beingnevermarried,havingincomesbelow $70,000,belongingtoyoungercohortsandhaving ClusterBpersonalitydisordersandinverselyassociated withmooddisorders.Genderdifferencesmayrelateto telescopingeffects
Blancoetal. (2015)43,093fromWave1.Aim:to developetiologicalmodelof pathologicalgamblingfor malesandfemalesbasedon Kendler’sdevelopmental modelformajordepression AUDADIS-IV–stratifiedintothree samples:(a)Lifetimegambling–gambled atleast5timesperyearinanyoneyear, (b)Lifetimehistoryofpathological gambling–individualswhometDSM-IV pathological-gamblingcriteriainanyone yearoftheirlife,(c)Past-yearpathological gambling–individualsmeeting5outof 10DSM-IVcriteriaintheprioryear Variablesselectedwererelatedto fivedevelopmentalperiods: childhood,earlyadolescence, lateadolescence,adulthoodand pastyear
12-monthpathological-gamblingprevalencewas0.16%. ModifiedKendler’smodelprovidesafoundationfora comprehensivedevelopmentalmodelofpathological gambling.Lifetimeand12-monthpathological gamblingcanbestatisticallypredictedbyfactorsin severaldevelopmentallevelswithcarry-overeffects fromprecedingtosubsequentlevels Cowlishaw andHakes (2015)
402patientswhoreportedpast- yeartreatmentofsubstance-use problemsfromWave1and Wave2(n=308).Aim:to estimateprevalenceof pathologicalgamblingand problemgamblingacross treatmentsettingsand associationswithconstructsin mentalandphysicalhealth, healthcareutilizationand psychosocialproblems AUDADIS-IV–pathologicalgambling represents5outof10DSM-IVcriteriain any1year.Past-yearandlifetime prevalenceobtained.Problem/ pathologicalgamblingrepresentsmeeting 3ormoreDSM-IVcriteria.4groups: recreational(0criteria),at-riskgambling (1–2criteria),problemgambling (3–4criteria)andpathologicalgambling (≥5criteria) Past-yearAxisIandlifetimeAxis IIdisorders,SF-12measuresof past-yearmentalandphysical health,andpast-year occurrencesoflifeevents (representingpsychosocial problems)suchaswork relationships,terminationof steadyrelationship,financial issuesandlegaldifficulties
4.3%lifetimepathological-gamblingprevalence (5+DSM-IVcriteria)and7.2%problem/pathological gambling(3+DSM-IVcriteria). Lifetimepathological-gamblingcriteriaassociatedwith AxisIIdisordersbutnotAxisIdiagnoses Moghaddam etal.(2015)13,578individualswho providedinformationon gamblingbehavior,lifetime suicidalideationand/or attempts.Aim:toexamine suicidalandgamblingbehavior withaderivedsubgroupofa nationallyrepresentative sample
AUDADIS-IV–5gamblinggroups:non- gambling(nevergambled≥5timesinany oneyear),low-riskgambling(gambled ≥5timesinanyoneyearbuthavenotmet anyDSM-IVpathological-gambling criteria),at-riskgambling(met12 pathological-gamblingcriteria),problem gambling(met3–4criteria),and pathologicalgambling(met5–10criteria) Lifetimesuicidalbehaviors, lifetimesuicidalideation,and lifetimesuicidalattempts
Non-gambling(25.8%),low-risk(24.5%)andat-risk gambling(28.4%)hadsimilarprevalenceratesof suicidalideation.36.7%rateofsuicidalideationamong problem-gamblinggroupand49.2%among pathological-gamblinggroup.Forsuicideattempts, rateswereasfollows:7.9%non-gambling,6.6%low- risk,and7.9%at-riskgambling.Problemgambling (17.2%)andpathologicalgambling(18.3%)associated withhigherratesofsuicideattempts Sharmaand Sacco(2015)34,653participantswho completedbothWave1and Wave2data.Aim:toexamine associationsbetween pathologicalgamblingand adversechildhoodexperiences
AUDADIS-IV–4groups:0=non- gambling,nevergambled>5timesperyear inlifetime;1=non-problemgambling, endorsed<2pathological-gambling criteria;2=problemgambling,endorsed 2–4DSM-IVpathological-gambling criteria;3=pathological-gambling endorsed≥5pathological-gamblingcriteria Adversechildhoodexperiences: physical,sexual,emotional abuse,physicalneglectand familyviolence.Covariates: sociodemographics,lifetime substance-use,andmoodand anxietydisorders
Adversechildhoodexperiencesrateswerehigheramong problem-gamblingandpathological-gamblinggroups thannon-gamblinggroup.Physicalabuse:4.40% amongnon-gamblinggroup,4.84%amongnon- problem-gamblinggroup,6.95%amongproblem- gamblinggroup,12.21%amongpathological-gambling group.Sexualabuse:10.41%amongnon-gambling group,9.56%amongnon-pathological-gamblinggroup, 15.50%amongproblem-gamblinggroup,15.44% amongpathological-gamblinggroup (Continued)
Table1.(Continued) ArticleSample(Nandother characteristics)Instrumentanddiagnostic/ subdiagnosticassessmentsOthervariablesinvestigatedMainfindings Wilson,Salas- Wright, Vaughn,and Maynard (2015)
11,153Wave1participantswho answered“yes”to“Haveyou evergambledatleast5timesin anyoneyearofyourlife?” Aim:toutilizedatafromWave 1and2toexaminegambling prevalenceratesacrossgender andworldregions AUDADIS-IV;Onlyitemswithprevalence ofgreaterthan1.5%wereincludedin statisticalanalyses
–Wave2Immigrantstatus:first- generation,second-generation, third-generationandnon- immigrant –Socio-demographiccontrols: age,gender,ethnicity/race, householdincome,education level,maritalstatus,regionof theU.S.,urbanicity
Gamblingprevalenceloweramongfirst-generation immigrants(19.05%)relativetonative-bornAmericans (29%),second-generation(29.93%)andthird- generation(33.22%)immigrants.Pathological- gamblingprevalenceloweramongfirst-generation immigrants(2.79%)relativetonative-bornAmericans (4.73%),second-generation(4.71%)andthird- generation(5.18%)immigrants.Second-generation immigrantsandnon-immigrantswithhigherlikelihood ofmeetingcriteriaforproblem/pathologicalgambling Kong,Smith, Pilver,Hoff, andPotenza (2016)
43,093fromWave1 (2001–2002);Aim:to investigateassociation betweenproblem-gambling severityandpsychiatric disordersamongAmerican- Indian/Alaska-Native individuals AUDADIS-IV–3groups:Non-gambling/ lowfrequency,low-riskgambling,and at-risk/problem/pathologicalgambling (seeBarryetal.,2011b)
Sociodemographics–age, gender,race,educationlevel, maritalstatus,employment status;AxisIandAxisII diagnoses
American-Indian/Alaska-Nativeascomparedwithother respondentswereleastlikelytoreportnon-gambling/ low-frequencygambling(American-Indian/Alaska- Native66.5%,white70.5%,black72.8%,otherrace 72.3%)andmostlikelytoreportlow-riskgambling (American-Indian/Alaska-Native30.1%,white26.5%, black23.4%,otherrace24.7%).Strongerassociations betweenat-risk/problem/pathologicalgamblingand past-yearAxisIdisordersamongAmerican-Indian/ Alaska-Nativethanothergroups Cowlishaw, Hakes,and Dowling (2016)
3,007adultsreportingtreatment formood/anxietydisorders. Predominantlyfemale (73.2%),white/non-Hispanic (65.5%).Aim:toevaluate prevalenceandclinical correlatesofproblem/ pathologicalgamblingamong asampleofindividualsseeking treatmentforaffective disorders AUDADIS-IVtoderiveestimatesofat-risk gambling(1–2criteria)andproblem/ pathologicalgambling(3+criteria)
Past-yearsubstanceusage (i.e.,drinkingfrequency,heavy drinking,marijuanaandother drugsuse);mentalandphysical health(SF-12);health-service utilization;occurrencesof psychosocialdifficulties
Amongindividualsseekingtreatmentforaffective disorders,ratesoflifetimeandpast-yearproblem/ pathologicalgamblingwere3.1%and1.4%, respectively.Meanwhile,8.9%showedat-risk gamblingfeatures.Lifetimepathologicalgambling statisticallypredictedhigherinterpersonalandfinancial difficulties,marijuanause(notalcoholuse)and healthcareutilization;andpoorermentalorphysical health Sanacoraetal. (2016)43,093fromWave1(2001– 2002).Aim:toinvestigate potentialmoderationeffectof incomeonrelationship betweenpathologicalgambling andpsychopathology
AUDADIS-IVtoderive4problem- gambling-severitygroups–Non- gambling/lowfrequency,low-risk gambling,at-riskgamblingandproblem/ pathologicalgambling(seeDesai& Potenza,2008) Independentorprimarypast-year psychopathologydiagnoses (Desai&Potenza,2008). Annualincome(moderator)in2 groups–lower(annual householdincome<$24,000) andmiddle/higher(>$24,000) income Greaterproblem-gamblingseveritystatisticallypredicted increasedoddsofmultiplepsychiatricdisordersforboth incomegroups.Strongerassociationbetweenproblem/ pathologicalgamblingandalcoholabuse/dependence formiddle/higherincomethanlower-incomegroup
Ronzitti, Kraus,Hoff, Clerici,and Potenza (2018) 43,093fromWave1(2001– 2002).Aim:toexaminethe extenttowhichstress moderatedtherelationships betweenproblem-gambling severityandpsychopathologies
AUDADIS-IV;Problem-gambling gamblingmeasuredatWave1.The samplewasdividedintofourproblem- gamblingseveritygroupswithfive episodesofgamblinginasingleyearin theirlifetime;low-riskgamblingwith<5 episodesofgamblinginasingleyearand nocriteriaforpathologicalgamblinginthe pastyear;at-riskgamblingwithoneortwo criteriaforpathologicalgamblinginthe pastyear;andproblem/pathological gamblingwith>threecriteriafor pathologicalgamblinginthepastyear AUDADIS-IVassessedgambling andotherpsychiatricdisorders intheNESARC.Fromthe12 itemsontheAUDADIS-IV relatedtopast-12-month stressfulevents,amediansplit wasusedtocreatetwo categories:alowpast-year stressgroup(i.e.,0or1event), andahighpast-yearstress group(i.e.,twoormoreevents)
Stressmoderatedproblem-gambling-severity relationshipswithClusterBdisorders.Astronger relationshipwasobservedbetweenproblem-gambling severityandpsychopathologyinthelow-stressversus high-stressgroups Ronzittietal. (2018)13,543fromWave1 (2001–2002)withmood symptomatology.Aim:to examinerelationshipsbetween problem-gamblingseverityand personalitydisordersamong individualswithdiffering levelsofsuicidality
AUDADIS-IV;Problem-gambling gamblingmeasuredatWave1.The samplewasdividedintofourproblem- gamblingseveritygroupswithfive episodesofgamblinginasingleyearin theirlifetime;low-riskgambling with<fiveepisodesofgamblingina singleyearandnocriteriaforpathological gamblinginthepastyear;at-risk gamblingwithoneortwocriteriafor pathologicalgamblinginthepastyear; andproblem/pathologicalgambling with>threecriteriaforpathological gamblinginthepastyear NESARCwave-1survey investigatedfeaturesof antisocial,avoidant,dependent, histrionic,obsessive– compulsive,paranoid,and schizoidpersonality.Two questionswereusedtoassess lifetimemajordepressive episode(yes/no).Basedonthree questionsthesamplewas classifiedintothreesuicidality groups:(a)historyofsuicide attempt;(b)historyofsuicide ideation,withoutanyhistoryof suicideattempt;and(c)no historyofsuicidalbehaviors
At-riskorproblem/pathologicalgamblinggroupsshowed higherratesofawiderangeofpersonalitydisorders comparedtonon-gamblinggroup.At-riskandproblem/ pathologicalgamblinggroupshadhigheroddsforany personalitydisorderthanthegroupwithnohistoryof suicidality,particularlyforcluster-Bpersonality disorders Nicholson, Mackenzie, Afifi, Keough,and Sareen (2019)
43,093fromWave1(2001– 2002).34,635fromWave2 (2004and2005).Aim:to examinewhetherchangesin gambling-relateddiagnostic criteriafromDSM-IVtoDSM- 5correspondtochangesin prevalenceofcomorbid psychiatricdisorders AUDADIS-IV;Pathologicalgambling assessedatWave1accordingtoDSM-IV criteriainthepastyear
AUDADIS-IVassessedgambling andotherpsychiatricdisorders intheNESARC
Prevalenceforanycomorbiddisorderamonggambling- relateddiagnoseswassimilarfromDSM-IV(56.7%)to DSM-5(53.7%).Comorbiditybetweengambling disorderusingDSM-5criteriaandalcohol-use(25.3%) andcannabis-use(37.7%)disordersremainedhigh Robertsetal. (2018)Waves1and2(N=25,631)of theNESARC.Aim:to investigatetheassociations betweenintimatepartner violenceandgambling problemsandAxisIandII disorders
AUDADIS-IV;Pathological-gambling- relatedmeasuresatWave1accordingto DSM-IVcriteriainthepastyear.Problem/ pathologicalgamblingwasdefinedby havingthreeormoreDSM-IVcriteriaand at-riskgamblingwith1–2criteriaof pathologicalgambling Physicalintimatepartnerviolence victimizationandperpetration inthepast12monthswere assessedatWave2usingitems fromtheConflictTacticsScale (CTS-R) Problem/pathologicalgamblingwasassociatedwith increasedoddsofbothintimatepartnerviolence perpetrationformales(OR=2.62)andfemales (OR=2.87),andwithintimatepartnerviolence victimizationforfemalesonly(OR=2.97) (Continued)
Table1.(Continued) ArticleSample(Nandother characteristics)Instrumentanddiagnostic/ subdiagnosticassessmentsOthervariablesinvestigatedMainfindings Bernardietal. (2019)43,093fromWave1 (2001–2002).Aim:toexamine predictorsofpathological gamblingremissionstatus duringthepast12months
AUDADIS-IV;Pathological-gambling- relatedmeasuresatWave1accordingto DSM-IVcriteriainthepastyear.Problem/ pathologicalgamblingwasdefinedby havingthreeormoreDSM-IVsymptoms. Gamblingremissionwasdefinedas havingalifetimehistoryofproblematic gamblingorpathologicalgamblingbut notendorsinganypathologicalgambling DSM-IVcriteria AUDADIS-IVassessed psychiatricdisordersinthe NESARC.Familyhistoryof depression,substance-use disorders,andantisocial personalitydisorderwere included
Ratesofpast12-monthremissionwere45.24%for problemgambling(3–4DSM-IVcriteria)and36.72% forpathologicalgambling(>5DSM-IVcriteria). Survivalanalysesestimatedan85.6%cumulative probabilityofremissionfrompathologicalgambling, withamediantimeof19years Ronzitti, Kraus,Hoff, Clerici,and Potenza (2019)
13,543fromWave1(2001– 2002)withmood symptomatology.Aim:to examinetherelationship betweendifferentlevelsof problem-gamblingseverityand DSM-IVAxisIpsychiatric disordersaccordingto suicidalitylevel
AUDADIS-IV;Pathological-gambling- relatedmeasuresatWave1accordingto DSM-IVcriteriainthepastyear. Thesamplewasdividedintofourproblem- gamblingseveritygroupswithfive episodesofgamblinginasingleyearin theirlifetime;low-riskgambling with<fiveepisodesofgamblingina singleyearandnocriteriaforpathological gamblinginthepastyear;at-risk gamblingwithoneortwocriteriafor pathologicalgamblinginthepastyear; andproblem/pathologicalgambling with>threecriteriaforpathological gamblinginthepastyear AUDADIS-IVassessed psychiatricdisordersinthe NESARC. Twoquestionswereusedto assesslifetimemajordepressive episode(yes/no).Basedonthree questionsthesamplewas classifiedintothreesuicidality historygroups:(a)historyof suicideattempt;(b)historyof suicideideation,withoutany historyofsuicideattempt;and (c)nohistoryofsuicidal behaviors
TherelationshipsbetweenAxisIpsychiatricdisorders andproblem-gamblingseverityweremostlynot moderatedbysuicidalideationorattemptexceptfor panicdisorderinwhichastrongerrelationshipwas observedintherelationshipbetweenlow-riskgambling (vslow-frequency/non-gambling)inthegroupwith suicideattemptsascomparedwiththatwithoutattempt orideation Hammond etal.(2019)43,093fromWave1(2001– 2002).Aim:toexaminehow cannabisusemoderated associationsbetweenproblem- gamblingseverityand psychopathology
AUDADIS-IV;Pathological-gambling- relatedmeasuresatWave1accordingto DSM-IVcriteriainthepastyear. Thesamplewasdividedintofourproblem- gamblingseveritygroupswithfive episodesofgamblinginasingleyearin theirlifetime;low-riskgambling with<fiveepisodesofgamblingina singleyearandnocriteriaforpathological gamblinginthepastyear;at-risk gamblingwithoneortwocriteriafor pathologicalgamblinginthepastyear; andproblem/pathologicalgambling with>threecriteriaforpathological gamblinginthepastyear AUDADIS-IVassessed psychiatricdisordersinthe NESARC
Amongboththegroupwithlifetimecannabisuseandthat whichneverusedcannabis,greaterproblem-gambling severitywasassociatedwithmorepsychopathology acrossmood,anxiety,substance-useandAxisII disorders.Cannabisusemoderatedtherelationships betweenproblem-gamblingseverityandpsychiatric disorders,withcannabisuseappearingtoaccountfor someofthevarianceintheassociationsbetweengreater problem-gamblingseverityandspecificformsofmental illness
Table2.Summarytableof(eight)studiesthatinvestigatedproblem-gamblingseverityinthecontextofothermainpsychopathologyvariables ArticleSample(Nandothercharacteristics)MainvariablesinvestigatedMainfindings Blancoetal. (2008)43,093fromWave1(2001–2002);81% responserate.Aim:topresentnationally representativelifetimeprevalence correlatedandcomorbidityofshoplifting amongUSadults Mainvariable:shoplifting(embeddedinthe sectiononantisocialpersonalitydisorder). Diagnosesofmood,anxiety,and disorders,andpersonalitydisorders
0.56%past-yearpathologicalgamblingprevalenceamongshopliftersand0.11% pathologicalgamblingprevalenceamongnon-shoplifters.Strongestlinkswith shopliftingbehaviorweredeficitsinimpulsecontrolsuchaspathological gambling,antisocialpersonalitydisorder,substance-usedisorders,andbipolar disorder Pulayetal. (2008)43,093fromWave1(2001–2002);81% responserate.Aim:topresentlifetime prevalenceandpopulationestimatesof violentbehavioramongindividualswith psychopathology
Informationonviolentbehaviorcollected beforeage15andsinceage15years. Diagnosesofmood,anxiety,substance- use,andpersonalitydisorders
28.78%prevalenceofviolentbehavioramongpathological-gamblinggroupwith comorbiddisorders,but0%prevalenceofviolentbehavioramongindividualswith solelypathological-gamblingdiagnoses.Oddsofviolentbehaviorincreaseswith pathologicalgambling,substance-usedisorders,majordepressivedisorder,anxiety disorders,andpersonalitydisorders Vaughnetal. (2009)43,093fromWave1(2001–2002);81% responserate.Aim:toinvestigate sociodemographic,psychiatric,and behavioralcorrelatesofcrueltytoanimals
Crueltytoanimalsassessedasanembedded iteminthesectiononantisocial personalitydisorder.Diagnosesofmood, anxiety,substance-use,andpersonality disorders
3.02%lifetimepathologicalgamblingprevalenceamongindividualswithhistoryof crueltytoanimalsand0.39%pathological-gamblingprevalenceamongindividuals withouthistoryofcrueltytoanimals.Strongassociationsbetweencrueltyto animalsandlifetimealcohol-usedisorders,pathologicalgambling,conduct disorder,specificpersonalitydisordersandfamilyhistoryofantisocialbehavior, andcrueltytoanimals Blancoetal. (2010)43,093fromWave1(2001–2002).Aim:to examinenationalprevalence, sociodemographic,psychiatriccorrelates andmentalhealthserviceutilizationrates ofindividualswithfire-settingbehaviors
Fire-settingbehaviorassessedinthesection onantisocialpersonalitydisorder,mental healthserviceutilization,mooddisorders, anxietydisorders,substance-usedisorders, andpersonalitydisorders
1.6%lifetimeprevalenceofpathologicalgamblingamongfire-settingindividualsas comparedto0.1%prevalenceofpathologicalgamblingamongnon-fire-setting individuals.Strongestlinkswithfiresettingweredisordersrelatedtoimpulse- controldeficitssuchaspathologicalgambling,antisocialpersonalitydisorder,drug dependenceandbipolardisorder Schneier etal.(2010)43,093fromWave1(2001–2002).Aim:to estimatenationalprevalenceandclinical impactofcomorbidsocialanxiety disorder,andalcohol-usedisorders (alcoholabuseanddependence)
Diagnosesofsocialanxietydisorder, alcohol-usedisorders,otherpsychiatric disorders,andsociodemographics
1.4%pathological-gamblingprevalenceamongcomorbidsocialanxietydisorderand alcohol-usedisordergroupascomparedto0.1%pathological-gamblingprevalence amonggroupwithneithersocialanxietydisordernoralcohol-usedisorders.Among respondentswithsocialanxietydisorder,alcohol-usedisorderpresencewas stronglyassociatedwithmoresubstance-usedisorders,pathologicalgambling,and antisocialpersonalitydisorder Wuetal. (2011)43,093fromWave1(2001–2002).Aim:to investigatepatternsofsubstanceuseand psychiatriccorrelatesamongindividuals withprescriptionopioid,heroinand non-opioiddruguseinanationally representativesample
Substanceuse(heroin,opioidanalgesics), psychiatricdisorders(mood,anxietyand personalitydisorders),substanceabuse treatmentutilization,qualityoflife,and sociodemographics
Prevalenceofpathologicalgamblingwas5.4%amongindividualswithheroin-other- opioiduse,2.2%amongthosewithother-opioiduseonly,0%amongthosewith heroinuseonlyand0.7%amongthosewithnon-opioiddruguse.Non-opioiddrug useassociatedwithreducedoddsofsubstance-usedisordersandother psychopathology(mood,anxiety,pathologicalgambling,andpersonalitydisorder) ascomparedwiththosewithother-opioiduseonly Chouand Cheung (2013)
8,205respondents65yearsorolderfrom Wave1NESARCdata.Aim:toestimate prevalenceofDSM-IVmajordepressive disorder,itsclinicalcharacteristics(onset, courseandtreatment)andevaluate comorbidpsychopathology Diagnosesofmajordepressivedisorder, anxietydisorders,substance-usedisorders, andsociodemographics
0.12%pathological-gamblingprevalenceamongrespondentswithpast-yearmajor depressivedisorderwithinthissampleofindividualsaged65yearsorolder. Pathologicalgambling,anxietydisordersandsubstance-usedisorderswere stronglyassociatedwithmajordepressivedisorder Moghaddam etal.(2014)701AmericanIndiansandAlaskaNatives fromWave1NESARC.Aim:toexamine comorbidityoflifetimenicotine dependencewithbothcurrentandlifetime psychiatricandsubstance-usedisorders
Lifetimepresence/absenceofnicotine dependence,substance-usedisorders, mooddisorders,anxietydisorders, personalitydisorders,andpathological gambling 0.6%lifetimepathologicalgamblingprevalenceratesoveralland1.9%pathological gamblingprevalenceamongindividualswithnicotinedependencebut0% prevalenceamongindividualswithoutnicotinedependence
was conducted at Wave 1 with the psychometrically validated AUDADIS-IV instrument, which is an extensive semi-structured diagnostic interview conducted by trained lay interviewers to assess lifetime and past-year psychiatric disorders and related measures (Grant & Dawson, 2006).
Other psychiatric disorders assessed in the AUDADIS-IV included: (a)
five mood disorders/features
–major depressive disorder, bipolar I and II disorders, dysthymia, and hypomania; (b) four/
five anxiety disorders
–panic disorder with and without agoraphobia, social phobia, speci
fic phobia, and generalized anxiety; and (c) seven personality disorders
–avoidant, dependent, obsessive
–compulsive, paranoid, schizoid, histrionic, and antisocial disorders.
There are several distinctions between Waves 1 and 2 estimates
–Wave 1 data captured respondents
’lifetime and past-year experiences, whereas Wave 2 focused on prior- to-past-year (since Wave 1) and past-year psychopathology experiences. Additional assessments in Wave 2 included:
(a) classi
fications for several psychiatric disorders
–posttraumatic stress disorder, attention-de
ficit hyperactivity disorder, and narcissistic, borderline, and schizotypal personality disorders; (b) psychosocial indicators
–sexual orientation, adverse childhood events, childhood and partner abuse, social integration, and acculturation; and (c) perceived experiences of discrimination.
De
finitions of problem-gambling-related behaviors have changed over time in accordance with empirical
findings and progression of DSM and non-DSM efforts like the Research Domain Criteria movement
–with both categori- cal and continuum conceptualizations of problem-gambling severity (from non-gambling/low frequency gambling to pathological gambling). Although several different thresh- olds and de
finitions have been utilized (see Table 1), pathological gambling in DSM-IV was de
fined by meeting 5 or more of 10 criteria, whereby 15 symptom items operationalized the 10 pathological-gambling criteria in the assessment used in the NESARC (Blanco et al., 2006; Petry et al., 2005). Meanwhile, meeting three to four criteria has been termed by some authors as experiencing problem gambling
–de
fined by some as excessive gambling linked with impaired inter- and intra-personal functioning but not meeting the minimum threshold of pathological-gambling criteria in DSM-IV (Loo, Raylu, & Oei, 2008). The gate- keeping question in the AUDADIS-IV was
“Have you gambled 5 or more times in any one year of your life?
”and respondents who answered
“No
”to this question were classi
fied as
low-frequency/non-gambling, while past-year recreational gamblinginvolved answering
“Yes
”but met no more than two pathological-gambling criteria in the previous year (Desai et al., 2007; Pietrzak et al., 2007).
Some authors have further separated recreational gambling into low-risk and at-risk groups, with the former meeting no criteria and the latter 1
–2 criteria for pathological gambling (Desai & Potenza, 2008; Grant, Desai, & Potenza, 2009).
Some studies combined problem gambling and pathological gambling into a single group to increase statistical power and labeled it as problem/pathological gambling, where respon- dents met three or more pathological-gambling criteria (Barry, Pilver, Hoff, & Potenza, 2013; Barry, Stefanovics, Desai, & Potenza, 2011a, 2011b; Desai & Potenza, 2008;
Giddens, Stefanovics, Pilver, Desai, & Potenza, 2012;
Grant et al., 2009). Most studies distinguished between lifetime gambling and past-year pathological gambling, and presented weighted prevalence estimates for the population of interest.
Psychometric developments and measurement analyses with NESARC data
