Socio-demographic Profile and Psychiatric Co-morbidity of Subjects with Pathological Gambling

1. Socio-demographic Profile and Psychiatric Co-morbidity of Subjects with Pathological Gambling Dr R. M. Winslow Head, CAMP Community Addictions Management Programme Institute of Mental Health

2. Study Goal • This is a case-controlled descriptive study of 40 subjects with PG on their socio-demographic profile, co-morbidity and personality profile

3. Method • Matched Case-Control Design • Subjects were screened using the South Oaks Gambling Screen (SOGS) • Participants scored more than 5 on SOGS • Participants diagnosed to have PG using DSM-IV • Control Group • Matching criteria • Age (+/- 1 year) • Gender

4. Method • Instruments • Structured Questionnaire on Sociodemographic Data • Composite International Diagnostic Interview (CIDI-Auto) • Personality Diagnostic Questionnaire (PDQ) • Axis II Diagnoses • Eysenck Personality Inventory • Impulsivity

5. Results & Discussion

9. Discussion • Typical profile of our sample’s pathological gambler • 38 year old married man • Tertiary education & employed • Started gambling at age 20 • Lottery (4D) as most preferred form of gambling

11. Discussion • High rates of comorbid substance use & mood disorders were confirmed in this sample • Controls • Only 22.5% were diagnosed with a DSM-IV criteria for a lifetime disorder

12. Discussion • Most common lifetime disorders • Mood disorders • Substance Use Disorders • Anxiety Disorders • Similar to Black & Moyer (1998) and Petry et al (2005) • Black and Moyer reported that 90% of their sample of pathological gamblers suffered from a lifetime disorder • Petry et al found 49.6% and 41.3% of pathological gamblers with mood and anxiety disorders respectively • However, our study found higher rates of anxiety disorders whereas the above 2 studies found higher rates of mood disorders

13. Discussion • Rates of anxiety, depression & substance use were significantly higher in pathological gamblers compared to controls • Rate of substance abuse disorders is low in Singapore among pathological gamblers compared to the West

14. Discussion • Onset of gambling predated onset of substance abuse in all cases • Onset of gambling preceded onset of depression in most cases • Implication • 2 types of gamblers • Gambling leading to depression • Gambling as a means of coping with depression

16. Discussion • Most common Personality Disorders in our study • Obsessive-compulsive • Avoidant • Paranoid

17. Discussion • Impulsivity • Pathological gamblers scored significantly higher than the controls on the impulsivity questionnaire (16.8 ± 4.7 and 11.3 ± 4.2 respectively) • Range of Impulsivity – 0 to 31

19. Limitations • Self-selected group of participants • Cross-sectional Design • Aetiological implications are unclear

20. Thank You

21. Introduction • Definition of Gambling • A wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome (Bolen & Boyd, 1968)

22. Pathological Gambling • Characterized by • Failure to resist impulse to gamble despite disruption to personal, family & vocational life • Associated with • Adverse consequences for the person & family & society at large

23. Pathological Gambling • Pathological Gambling as an addiction (Potenza, 2001) • Pathological Gambling as an obsessive-compulsive spectrum disorder (Blaszczynski, 1999)

24. Prevalence of Pathological Gambling • United States & Canada • 0.4% - 2.0% • (Welte et al, 2002; Cunningham-Williams & Cottler, 2001) • Asian Countries • 1.0% - 2.0% • (Lee et al, 1990; Wong & So, 2003) • Singapore (MCYS, 2005) • 58% of Singapore residents aged 18 & above have taken part in some form of gambling activity over a 1-year period • 2.1% reported symptoms that suggest probable pathological gambling • Comparable to results of similar studies in HKG & Macau

25. Co-morbidity with Pathological Gambling • Affective Disorders • 33.3% of pathological gamblers have an affective disorder compared to 14.2% in non-gamblers (Bland et al, 1993) • Major depression significantly more prevalent in problem gamblers (8.8%) than non-gamblers (5.2%) • Among patients who engage in gambling, secondary depressive symptoms are very common (Thorson et al, 1994; Becona et al, 1996)

26. Co-morbidity with Pathological Gambling • Anxiety Disorders • Pathological gamblers significantly more likely than non-gamblers to have any anxiety disorder and agoraphobia (Bland et al, 1993) • High rates of prevalence of anxiety disorders among respondents with pathological gambling (Petry et al, 2005)

27. Co-morbidity with Pathological Gambling • Impulse Control Disorders • 22.9% of study subjects (pathological gambling) displayed compulsive shopping or compulsive sexual activity • Patients also reported more severe gambling symptoms Grant & Kim, 2003

28. Co-morbidity with Pathological Gambling • Personality Disorders • Positive association between PG & ASPD (Slutske et al, 2001; Cunningham-Williams et al, 1998) • 87% of subjects with PG met criteria for at least one PD • Most frequent – obsessive-compulsive, avoidant, & schizoid PD • Number of PD positively related to the South Oaks Gambling Screen (SOGS) score (Blaszczynski & Steel, 1998)

29. Co-morbidity with Pathological Gambling • Substance Use Disorders • Toneatto et al (2002) in a study of gamblers • 55.4% using alcohol • 10.1% using drugs • Welte et al (2001) • Extremely strong relationship between current alcohol dependence & current PG (OR = 23.1) • Drinking increased with gambling severity • Petry et al (2005) • Alcohol dependence, drug use disorder & tobacco dependence are significantly related to PG