Relationship Between Gambling Problems and Depressive Disorders. Problem and pathological gambling became a major public health problem in Canada. Higher levels of psychiatric co morbidity, particularly bipolar disorder and major depressive disorders have been reported in the population problem and pathological a gambler. While it also has shown that a gambler tends to show symptoms of negative mood, the temporal relationship between the two has not been clearly described. This is quote reports of research that published by mooddisorderscanada.ca released at march 2008.
This study confirmed a high prevalence of problem and pathological gambling in clinic based mood disorders patients. The prevalence of past-year problem gambling was equally high in both bipolar (12.5%) and major depressive disorders (12.7%) populations. The rate of gambling was more than twice as high in men with bipolar disorder (18.9%) compared to women with bipolar disorder (8.3%), although men and women did not differ in rates of gambling in the major depressive disorders population. Patterns were similar for lifetime and current pathological gambling, although rates were considerably lower. Community rates for problem gambling in Canada are estimated at less than 5% (Andresen, 2006), while pathological gambling rates are less than 2% (Shaffer & Hall, 2001).
The results of this study document more than twice the prevalence of problem gambling in the mood disorder population. This study found more than two and a half times the prevalence of pathological gambling in the mood disorder population compared to the Canadian community as a whole. Problem gamblers distinguished themselves from non-problem gamblers by having a lower level of educational attainment. Findings from other studies have also shown that problem gamblers are more likely to have lower level of educational attainment (McIntyre et al., 2007) while individuals with post-graduate degrees have the lowest participation rates for gambling.
There were no differences in income, employment status or marital status between gamblers and non-gamblers in either mood disorder population in this study. Two of the three Ontario sites and the Alberta site had the highest prevalence of problem gambling in the past year (Ottawa=19.6%, Toronto=18.0%, Edmonton=16.0%), while Halifax (4.3%) and Providence (4.1%) had the lowest rates with Kingston (10%) in between. This may be in part due to the availability of gambling outlets such as VLTs and permanent casinos in these areas. For instance, Alberta is estimated to have the highest prevalence of pathological gamblers in Canada, and also the highest numbers of VLTs (Alberta Lottery Fund, 2006). This study did not examine the prevalence of gambling behaviour in Manitoba or Saskatchewan, which both have large populations of problem gamblers (Cox, Yu, Afifi & Ladouceur, 2005).
There were also significant differences between gamblers and non-gamblers in several areas of comorbidity. The most consistent distinguishing feature across all three gambling measures was alcohol dependence and this was true in both bipolar disorder and major depressive disorders groups. The gambling populations were also more than twice as likely to display suicidal ideation and had higher rates of OCD and specific phobias compared to non-gamblers. Using the Five-Factor Model of Personality, the study also showed a consistent profile of high Neuroticism, low Openness, low Agreeableness and low Conscientiousness in the gambling populations compared to non-gambling population, although the high level of Neuroticism was largely accounted for by the bipolar disorder population. There is a aucity of data available in the gambling literature quantifying the five-factor model of personality and gambling behaviour. These findings have implications for identifying individuals at high risk for gambling pathology, as well as generating hypotheses regarding the etiology of gambling behaviour.
In this study the temporal relationship between onset of gambling behaviour and onset of depressive disorders was also examined, with 70% of individuals reporting onset of depressive disorders before gambling problems. The onset of gambling behaviour occurred earlier in men with major depressive disorders compared to women but this sex difference was not present in the bipolar disorder population. Individuals in the “mood first” group had higher rates of substance dependence while individuals with “gambling first” had higher rates of anxiety disorders like panic disorder and GAD. Individuals with major depressive disorders in the “mood first” group were also more likely to report suicidal ideation. Individuals with bipolar disorder who reported “gambling first” also had higher scores on the personality measure of Openness in the five-factor personality inventory.
People meeting criteria for problem or pathological gambling also had lower selfreported quality of life. The three gambling scales were significantly negatively correlated with scores on the Q-LES-Q. These results corroborate a lower quality of life in gambling sufferers reported by Grant and Kim (2005). The Banff Consensus (Walker, Toneatto, Potenza, Petry, Ladouceur, et al, 2006), an expert panel invited by the Alberta Gambling Research Institute, confirmed quality of life as an important element to measure problems caused by gambling. Ultimately, it is quality of life that determines whether gambling behaviour is pathological for the individual partaking in gambling activities. This study confirms that quality of life is indeed an issue that needs to be addressed by clinicians for individuals with problem and pathological gambling.
Individuals with problem or pathological gambling had higher self-reported anxiety (behavioural, cognitive, and somatic) than non-problem or non-pathological gamblers. The scores on the three gambling measures were significantly negatively correlated with scores on the self-reported anxiety measure, the TAQ. These results substantiate the evidence from a previous report (Zimmerman, Chelminski & Young, 2006) that anxiety is often an important component of problem and pathological gambling behaviour.
Individuals meeting criteria for problem or pathological gambling also had higher levels of clinician-rated depressive disorders, as quantified with the HAM-D-7 and self-reported levels of depressive disorders as measured by the QIDS. Particularly relevant is the inference that as gambling difficulties mount, so do symptoms of depressive disorders. This indicates the importance of exploring potential gambling behaviour in individuals with depressive disorders and in addition, to address the level of depressive disorders in individuals with problem or pathological gambling.
The total score on the clinician-rated DSM-IV-TR checklist of current pathological gambling behaviour was significantly correlated with the clinician-rated manic symptoms in individuals with bipolar disorder. This may be indicative of higher mood and greater impulsivity in this group, as shown elsewhere in the gambling literature (Steel & Blaszczynski, 1998). There were a number of strengths to this study including the large sample size, administration of in-person interviews and the use of reliable diagnostic instruments and symptom scales. The results of this study lend support to the argument that problem and pathological gambling share features with addictions, as well as personality traits of impulsivity. The question remains, why does the mood disorder population have higher incidences of problem and pathological gambling? It is possible that individuals with depressive disorders use gambling to quell symptoms of low mood.
Some individuals with problem or pathological gambling become depressed due to decreased quality of life and financial ruin Results from this study indicate that in most cases (ie. approximately 70%), participants had experienced a depressive disorders episode prior to a problematic gambling episode. However, men with major depressive disorders had significantly lower age of onset of gambling pathology than women. This corroborates results found elsewhere that document an earlier age of onset of gambling in males (Martins, Tavares,da Silva Lobo, Galetti & Gentil, 2004).
There are many features of gambling behavior that are commonly encountered in individuals with bipolar disorder. For example, impulsivity is a frequent symptom in states of hypomania and often represents an enduring feature in remitted bipolar populations. Gambling may represent a feature of impulsivity and may reflect a more fundamental abnormality in aberrant reward behaviours (e.g. substance use disorders and compulsive overeating) (McIntyreet al., 2007b). This study has public policy implications. Lessons in healthy public policy development can be learned from successful tobacco control strategies. Given the high comorbidity of gambling and alcohol and substance dependence, consideration should be given to limiting the availability of alcohol in gambling outlets such as casinos. Also, the number of video lottery terminals (VLTs) should be decreased, and they should be removed from premises licensed to serve alcohol. Just as the tobacco industry is prevented from advertising their products, so too should the gambling industry.
Educating the public about the effects of gambling on individual gamblers, their families, and communities will help promote the idea of gambling as an important health issue facing Canadians today. Therefore, an increase in funding to research groups concerned with examining the effects of problem gambling should be allocated. Mainly deal with the impact of gambling that led to the development of major depressive disorders morever if this impact to increasing incidence of suicide. Early identify of depressive disorders in individual gamblers must be done in order to suicide can be prevented. There needs to be strong advocacy by health care professionals on behalf of gambling sufferers to address this significant issue and push the government to make the recommended changes.
No comments:
Post a Comment