Academic journal article International Journal of Child Health and Human Development

Associations between Pathological Gambling and Psychiatric Comorbidity among Help-Seeking Populations in Hong Kong

Academic journal article International Journal of Child Health and Human Development

Associations between Pathological Gambling and Psychiatric Comorbidity among Help-Seeking Populations in Hong Kong

Article excerpt

Introduction

Pathological gambling can have a wide range of adverse effects on individuals, families, and society. The negative consequences include financial and debt problems, marital conflict, criminal behavior, family violence and breakdown, as well as severe emotional and mental health problems (1-3). In Hong Kong, a study conducted in 2008 showed that the prevalence of probable problem gambling and pathological gambling was 2.2% and 1.8% respectively (4). These figures were comparable with other cities such as Macau (2.5% probable problem gambling and 1.8% pathological gambling (5)) and Singapore (2% probable problem gambling and 1.8% pathological problems (6)).

In Hong Kong, the development of pathological gambling treatment and research is still at an early stage. One of the neglected areas in the literature is the comorbid conditions of pathological gambling. International studies have reported that pathological gambling was highly comorbid with mental health disorders such as anxiety disorders, depression and affective disorders, and substance use disorders (7- 10). There are research findings showing that patients with multiple diagnoses were more impaired and less responsive to treatment than those with a single diagnosis (11). A number of epidemiological studies have been carried out to investigate the prevalence of comorbid mood disorders, anxiety disorders, substance use disorders and other psychiatric disorders among pathological gamblers. Although comparisons between studies are difficult due to differences in samples, inclusion criteria, and assessment tools used, these studies generally showed a high psychiatric comorbidity among pathological gamblers identified from the general population sample (9, 12, 13).

Kessler and colleagues (12) reported a significant prevalence rate of 55.6% of mood disorders among pathological gamblers whereas Petry, Stinson and Grant (9) reported a prevalence rate of 49.6%. Regarding anxiety disorders, Petry and colleagues (9) found a prevalence rate of 41.3% among problem gamblers whereas Kessler et al. (12) reported an even higher rate of 60.3%. Besides, the risk of experiencing moderate/high severity gambling was shown to be 1.7 times higher for people with anxiety disorder. Regarding substance use disorders, Petry and colleagues (9) found alcohol use disorder among almost three quarters (73.2%) of pathological gamblers, whereas drug use disorder and nicotine dependence were found among 38.1% and 60.4% of pathological gamblers respectively. El-Guevaly et al. (13) also reported that people with substance or alcohol dependence had 2.9 times higher risk having gambling problems compared to people without the disorder. Unfortunately, there is no data on comorbid schizophrenia spectrum disorders from existing epidemiological studies on pathological gamblers.

Several studies have also reported a high prevalence of comorbid psychiatric disorders among pathological gamblers seeking treatment (8, 14, 15). Ibanez et al. (8) and Kausch (15) reported that 50% of treatment seeking pathological gamblers had a clinical diagnosis of mood disorders in their lifetime. Anxiety disorders are also common, with the lifetime prevalence estimated to range between 4.3% and 8.5% (8, 14, 15). Kausch (15) reported a prevalence rate of 66.4% of substance abuse or dependence among treatment- seeking gamblers. The reported rate of comorbid alcohol abuse or dependence was 8.5% and 23.2% across studies (14, 15). As for schizophrenia spectrum disorders, the prevalence rate reported was 4.3% to 6% (14, 15). Based on these findings, it can be conjectured that psychiatric comorbidity has a high rate among pathological gamblers identified both in the community sample and treatment seeking sample.

Some researchers argued that the high comorbidity of psychiatric disorders among pathological gamblers suggested an association between these conditions (8, 9, 12, 13). However, studies on their temporal relationships are limited. …

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