Primary and Secondary Diagnoses of Gambling Disorder and Psychiatric Comorbidity in the Swedish Health Care System—A Nationwide Register Study

Abstract

Background: Psychiatric comorbidity is common in gambling disorder, a condition with low rates of treatment seeking. There is a paucity of documented nationwide data on gambling disorder and its co-occurring psychiatric comorbidities in the health care system.Methods: This is a nationwide register-based study of all patients aged above 18 years who were diagnosed with gambling disorder (corresponding to pathological gambling, code F63.0, in the ICD-10) in Swedish specialized out-patient health care or in-patient care, from 2005 through 2016. All psychiatric disorders co-occurring with the diagnoses were recorded, along with age, gender and the type of medical specialty.Results: A total of 2,099 patients were included (1,784 in out-patient care and 629 patients in in-patient care), among whom 77 percent were men. Treatment uptake during the study period increased significantly in out-patient care, with an increasing uptake of younger individuals, whereas in-patient treatment uptake remained stable. A co-occurring psychiatric diagnosis was registered in 73 percent of patients, more commonly in females (77 vs. 71 percent, p < 0.01). Several diagnostic subgroups were more common in women, with anxiety and affective disorders being the most common subgroups. Prevalence of substance use disorders did not differ with respect to gender.Conclusions: Despite a large gap between probable population prevalence of gambling disorder and the number of treated patients, the number of patients treated in out-patient health care with a gambling disorder diagnosis increased over time, with an increasing treatment uptake in younger individuals. Psychiatric comorbidity is common in gambling disorder patients in the health care system, with a higher prevalence in women.

Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment

“…Severe psychological distress, indicating severe mental illness, was not found to have a statistically significant association with a history of problem gambling in the final logistic regression model when adjusting for the other comorbidities and sociodemographic factors. Though strong associations between problem gambling and psychiatric disorders have been demonstrated in clinical settings [64], one interpretation of the lacking association in the present study may be the low absolute number of respondents reporting both problem gambling and a high level of psychological distress. In the category combining problem gambling and severe mental illness in the general population sample.…”

Over-Indebtedness and Problem Gambling in a General Population Sample of Online Gamblers

“…One of the clearest findings of the present paper was the lack of association between male gender and problem gambling, or overindebtedness, which otherwise would be expected, based on studies showing that men are overrepresented in problem gambling, both in the general population (19) and in clinical settings (18). In the present study of online gamblers, the large majority of respondents were men, with a male-to-female ratio very similar to what is seen in clinical studies of gambling disorder patients in Sweden (18,42). Despite this male predominance of subjects included because of online gambling, in the unadjusted analyses of the present study, female respondents were markedly more likely to fulfil criteria of problem gambling.…”

“…It can be concluded from the present study that on the online gambling market, with a large market share of online casino, gender distribution may be different from what is typically known in the research are of problem gambling. Psychiatric comorbidity is known to be more common in women with a gambling disorder than among their male counterparts (18,42,45,46), and suicidal ideation among patients seeking treatment for a gambling disorder is more common in women than in men (7). For this reason, the exposure to gambling may affect men and women differently, and it cannot be excluded that the increase in online gambling during the past decade makes high-risk gambling available to groups with a traditionally lower prevalence of problem gambling, particularly women.…”

Internet-delivered cognitive-behavioral therapy for significant others of treatment-refusing problem gamblers: A randomized wait-list controlled trial.

“…Problem gambling is associated with psychological distress (Barry, Stefanovics, Desai, & Potenza, 2011). Psychiatric comorbidity is common, especially substance-related disorder, as well as anxiety and affective disorders (Håkansson, Karlsson, & Widinghoff, 2018;Håkansson, Mårdhed, & Zaar, 2017;Williams, Volberg, & Stevens, 2012).…”