Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.
Level 4 - case-series / case-control
Cross-sectional epidemiological survey (Oxford CEBM level 4 by design analogy)
PubMed 15889941 · doi:10.4088/jcp.v66n0504
What was done
Data were analyzed from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 US residents aged 18 and older. Lifetime pathological gambling (operationalized using 15 symptom items for 10 DSM-IV criteria) and other psychiatric disorders were evaluated using the structured NIAAA AUDADIS-DSM-IV interview. Associations were assessed while adjusting for sociodemographic characteristics, and sex differences in comorbid associations were evaluated.
What was found
The lifetime prevalence of pathological gambling was 0.42%. Pathological gamblers had high rates of co-occurring lifetime disorders: alcohol use disorder (73.2%), personality disorder (60.8%), nicotine dependence (60.4%), mood disorder (49.6%), anxiety disorder (41.3%), and drug use disorder (38.1%). Most associations remained positive and statistically significant after sociodemographic adjustment (p < .05). Male sex, Black race, middle age, divorced/separated/widowed status, and residence in the West or Midwest were associated with increased risk. Associations with alcohol dependence, drug use disorders, nicotine dependence, major depressive episode, and generalized anxiety disorder were stronger among women than men (reported as p > .05 in the abstract text).
Why it matters
These findings establish in a broad national cohort that pathological gambling infrequently occurs as an isolated disorder, emphasizing the need for comprehensive psychiatric assessment and integrated treatment planning.
Limits
The study is cross-sectional, preventing causal or temporal inference. Diagnoses rely on retrospective self-report via structured interview, which may introduce recall or reporting bias. The abstract lists p > .05 for the sex difference comparisons despite describing them as stronger in women.
Cited by
- supports A large proportion of problem gamblers are also problem drinkers and addicted to cigarettes.