Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: a systematic review and meta-analysis

Nicole Andrea Dowling, Sean Cowlishaw, Alun C Jackson, Stephanie Merkouris, Kate Francis, Darren R Christensen

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263 Citations (Scopus)

Abstract

Objective: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. Methods: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis -Rfis1 psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. Results: Results from 36 studies identified high rates of co-morbid current (74.8 , 95 CI 36.5-93.9) and lifetime (75.5 , 95 CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1 , 95 CI 14.9-34.0), alcohol use disorders (21.2 , 95 CI 15.6-28.1), anxiety disorders (17.6 , 95 CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0 , 95 CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4 , 95 CI 35.7-75.2) and major depressive disorder (29.9 , 95 CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2 , 95 CI 13.4-24.2), alcohol dependence (15.2 , 95 CI 10.2-22.0), social phobia (14.9 , 95 CI 2.0-59.8), generalised anxiety disorder (14.4 , 95 CI 3.9-40.8), panic disorder (13.7 , 95 CI 6.7-26.0), post-traumatic stress disorder (12.3 , 95 CI 3.4-35.7), cannabis use disorder (11.5 , 95 CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3 , 95 CI 4.1-19.6), adjustment disorder (9.2 , 95 CI 4.8-17.2), bipolar disorder (8.8 , 95 CI 4.4-17.1) and obsessive-compulsive disorder (8.2 , 95 CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. Conclusions: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates
Original languageEnglish
Pages (from-to)519 - 539
Number of pages21
JournalAustralian and New Zealand Journal of Psychiatry
Volume49
Issue number6
DOIs
Publication statusPublished - 2015

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