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DSM-IV pathological gambling in the National Comorbidity Survey Replication
Open accessAbstract
Background: Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG). Method: Data from the US National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age of onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and the subsequent risk of secondary disorders. Results: Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age 16.7 v . 23.9 years, z =12.7, p <0.001), with gambling problems typically beginning during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged US$4800. Onset and persistence of PG were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder (PTSD) and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders. Conclusions: DSM-IV PG is a comparatively rare, seriously impairing, and undertreated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.
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In the citing paper
“Epidemiological research indicates that over 50% of PGs have a lifetime mood disorder, over 40% have a lifetime anxiety disorder, and about 23% have ASPD (Kessler et al. 2008; Petry, Stinson & Grant, 2005).”
From Subtyping Pathological Gamblers Based on Impulsivity, Depression, and Anxiety (2010) · cites this paper as Kessler et al. 2008
Experimental — accuracy not yet measuredIn the citing paper
“Gambling disorder often co-occurs with psychiatric disorders, particularly substance use and anxiety disorders (el-Guebaly et al., 2006; Kessler et al., 2008; Lorains, Cowlishaw, & Thomas, 2011; Parhami, Mojtabai, Rosenthal, Afifi, & Fong, 2014).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
In the citing paper
“For gambling disorder and substance use disorders, it appears this relationship is bi-directional, as the presence of one of either of these conditions often predicts the onset of the other (Afifi, Nicholson, Martins, & Sareen, 2016; Kessler et al., 2008).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
In the citing paper
“Approximately 37% (range: 14.0% −60.3%) of subthreshold and clinical gamblers suffer from an anxiety disorder (Kessler et al., 2008; Lorains et al., 2011; Petry et al., 2005)”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
In the citing paper
“Anxiety disorders, however, often precede the onset of gambling disorder or substance use disorders (Blanco et al., 2015; Kausch, Rugle, & Rowland, 2006; Kessler et al., 2008).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Kessler et al., 2008
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“Furthermore, it is well-known that GD is related to personality characteristics (Sáez-Abad & Bertolín-Guillén, 2008; Rogier, Beomonte Zobel, & Velotti, 2020) and mood disorders (Kessler et al., 2008; Petry et al., 2005).”
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“It is estimated that its prevalence is between 0.4-1.5% of global population (Kessler et al., 2008) and 0.5% in Spain (González-Ibáñez & Volberg, 2009; Becoña, 2004).”
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“This finding is not surprising, considering the high co-occurrence between depression and problem gambling (Kessler et al. 2008; Petry et al. 2005).”
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“…the United States (U.S.), both PTSD and problematic gambling behaviors have demonstrated relatively high rates of comorbidity with each other, as well as anxiety, impulse control, mood, personality, and substance use disorders (Hasin & Grant, 2015; Kessler et al., 1995, 2008; Wisco et al., 2017).”
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“Additionally, before applying the survey weights, we found that 73% of all survey respondents from the general population reported lifetime gambling, consistent with previous probability samples (Kessler et al., 2008).”
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Khalil, R. B. (2013) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000426191.64916.72 · Cited by 1
“The prevalence of lifetime pathologic gambling is approximately 1% to 3% in the general population, and co-occurrence of other psychiatric disorders among pathologic gamblers is common.(1,2) Pathologic gambling has been the focus in clinical practice and gambling research over the past decades.”
BackgroundVon Diagnostik über Neurobiologie zur Therapie pathologischen Glücksspiels
Romanczuk‐Seiferth, N., & Fauth‐Bühler, M. (2014) · DNP - Der Neurologe und Psychiater · doi:10.1007/s15202-014-0717-x · Cited by 1
“NCS-R In einer weiteren groß angelegten US-Erhebung zu psychischen Erkrankungen, der „National Comorbidity Survey Replication“, kurz NCS-R [27], konnten die Komorbiditätsraten der NESARC-Studie im Wesentlichen bestätigt werden.”
BackgroundRaghavan, V. (2017) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2017.01.007 · Cited by 1
“It is low when compared with similar studies done in both developed and developing countries which reported a prevalence rate around 20%–30% (Carvalho et al., 2005; Kessler et al., 2008; CunninghamWilliams et al., 2000).”
ResultToneatto, T. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-398336-7.00080-2 · Cited by 1
Return Rates of Online Slot Machines in Trial Mode Influence Players’ Errors of Estimation
Lalande, D. R., Emond, M., & Bélanger, É. (2020) · Journal of Gambling Issues · doi:10.4309/jgi.2020.45.1 · Cited by 1
“0% among those who engage in traditional gambling activities (Dyke, 2009; Gerstein et al., 1999; Kairouz et al., 2011; Kessler et al., 2008; Welte et al., 2001) and is estimated to be between 5% and 18% among online gamblers (Griffiths & Barnes, 2008, Griffiths et al.”
BackgroundInfluentialPrevention and Treatment of Work Addiction
Quiñones, C., & Griffiths, M. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.028 · Cited by 2
Evidence-based pharmacological strategies for gambling disorder
Vasile, D., & Vasiliu, O. (2021) · Psihiatru ro · doi:10.26416/psih.66.3.2021.5370 · Cited by 1
Akerele, E. (2022) · Springer eBooks · doi:10.1007/978-3-030-84834-7_8 · Cited by 1
Sussman, S. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.003 · Cited by 1
Criminogenesi, vittimizzazione familiare e criminalità organizzata nel gioco d'azzardo
Croce, M. T., Fiasco, M., & Sbaragli, S. (2022) · SICUREZZA E SCIENZE SOCIALI · doi:10.3280/siss2022-001007 · Cited by 1
Brazeau, B. W., & Hodgins, D. C. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00232-6 · Cited by 1
Pathological Gambling: Clinical Gender Differences
González–Ortega, I., Echeburúa, E., de Corral, P., & Polo-López, R. (2019) · Springer eBooks · doi:10.1007/978-3-030-15179-9_35 · Cited by 1
Jogo patológico versus transtorno de jogo: o estado de arte
da Costa, L. F., Rodríguez, V. G. D. O., & Marchiori, E. S. (2022) · Ciência et praxis · doi:10.36704/cipraxis.v15i29.5808 · Cited by 1
Association Between Pathological Gambling and Depression in Korean Adults
Yang, S. J., Hong, H., Jung, Y., & Kim, M.-D. (2023) · Mood and Emotion · doi:10.35986/me.2023.21.3.31 · Cited by 1
Kaur, P., Smith, O. R. F., Leino, T. M., Erevik, E. K., Griffiths, M. D., Goudriaan, A. E., & Pallesen, S. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2024.00047 · Cited by 1
“Several other psychiatric disorders, such as anxiety and bipolar disorders are quite often treated with antidepressants, and are also closely linked to the development of problem gambling (Kessler et al., 2008).”
Psychometric Validation of the Chinese Version of Gambling Symptom Assessment Scale (C-GSAS)
Liu, S., Fang, S., Chen, L., Tu, P., Su, H., Huang, W.-C., Liao, P.-C., Chang, H., & Huang, M. (2025) · Journal of Gambling Studies · doi:10.1007/s10899-025-10414-x · Cited by 1
“…2011; Kessler et al., 2008; Kim et al., 2006), substance use disorders (Grant & Chamberlain, 2020; Kessler et al., 2008), impulse control disorders (Kessler et al., 2008), suicide (Moreira et al., 2023), and interpersonal challenges both at home and in the workplace (Lorains et al., 2011), posing…”
InfluentialEffects of Outcome Expectancies on Chinese Adolescents’ Gambling Intention
Wong, S. S.-K. (2016) · Journal of Gambling and Commercial Gaming Research · doi:10.17536/jgcgr.2016.003 · Cited by 1
“There is growing evidence to show that early exposure to gambling may be associated with the development of problem gambling later in life, as well as participation in other problem behaviors (e.g. Felsher et al. 2004; Gupta and Derevensky 1998a, 1998b; Jacobs 2000; Kessler et al. 2008; Lynch et al. 2004; Vitaro et al…”
Proportionality Review in EU Gambling Law
Planzer, S. (2013) · Studies in European economic law and regulation · doi:10.1007/978-3-319-02306-9_9 · Cited by 1
“377 This was at a time when online gambling services had been available already for several years and the volume of offers rapidly growing.”
BackgroundRelationship of Behavioral Addictions to Eating Disorders and Substance Use Disorders
Weintraub, P., Dunn, T. M., & Yager, J. (2014) · Springer eBooks · doi:10.1007/978-3-642-45378-6_18 · Cited by 2
An Examination of the Near Miss in Gambling-Like Behavior of Children
Dixon, M. R., Whiting, S. W., & King, A. M. (2015) · The Psychological Record · doi:10.1007/s40732-015-0155-y · Cited by 1
Problem współwystępowania zaburzeń hazardowych z zaburzeniami psychicznymi. Przegląd literatury
Dąbrowska, K., & Wieczorek, Ł. (2016) · Alcoholism and Drug Addiction · doi:10.1016/j.alkona.2016.03.002 · Cited by 1
Assessment and Treatment of Pathological Gambling
Tavares, H. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195389715.013.0091 · Cited by 1
Gambling Disorder: Future Perspectives in Research and Treatment
Romanczuk‐Seiferth, N., Potenza, M. N., & Heinz, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-03060-5_15 · Cited by 1
Comorbid Smoking and Gambling Disorder: Potential Underlying Mechanisms and Future Explorations
Ritchie, E. V., Hodgins, D. C., & McGrath, D. S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813035-3.00048-4 · Cited by 1
Adult ADHD and Non-Substance-Related Disorders
Pallanti, S., & Salerno, L. (2020) · Springer eBooks · doi:10.1007/978-3-030-39051-8_17 · Cited by 1
Stark, R. M., & Müller, A. (2020) · Psychotherapeut · doi:10.1007/s00278-020-00477-z · Cited by 1
Adolescent Drug Misuse Prevention: Challenges in School-Based Programming
Scheier, L. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.021 · Cited by 1
Measurement, Prevention, and Treatment of Exercise Addiction
Hausenblas, H. A., Mann, D. T. Y., & Downs, D. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.036 · Cited by 2
Fron, M., Billieux, J., Leboucher, J., Dubuy, Y., Hardouin, J.-B., Challet‐Bouju, G., & Grall‐Bronnec, M. (2022) · Journal of Gambling Issues · doi:10.4309/jgi.2022.49.10 · Cited by 1
Verhaltensprävention von pathologischem Glücksspielen
Braun, B., Kräplin, A., & Bühringer, G. (2014) · Springer eBooks · doi:10.1007/978-3-642-38364-9_12
Metadata
- Authors
- Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J.
- Affiliations
- Harvard University (US)
- Cambridge Health Alliance (US)
- University of Minnesota (US)
- Corresponding author
- Kessler, R. C.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-02-07
- Volume
- 38
- Issue
- 9
- Pages
- 1351-1360
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC2293303
- OpenAlex
- W2121784510
- Cited by
- 928
- References
- 29
- Citations by year
- 2026: 26 · 2025: 27 · 2024: 28 · 2023: 34 · 2022: 40 · 2021: 49 · 2020: 89 · 2019: 76 · 2018: 67 · 2017: 51 · 2016: 66 · 2015: 62 · 2014: 75 · 2013: 64 · 2012: 65
- FWCI
- 40.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Robert Wood Johnson Foundation
- John D. and Catherine T. MacArthur Foundation
- John W. Alden Trust
- World Health Organization
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- Johnson and Johnson
- Pan American Health Organization
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, U13MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R01-TW006481, R03TW006481)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- gambling addiction, problem gambling, prevalence, age of onset, comorbidities, anxiety disorders, mood disorders, impulse control disorders, substance use disorders, generalized anxiety disorder, post-traumatic stress disorder, substance dependence, gambling losses, treatment utilization, DSM-IV diagnostic criteria
- MeSH terms
- Adolescent, Adult, Mental Disorders, Data Collection, Ethnicity, Female, Gambling, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Predictive Value of Tests, Retrospective Studies, Socioeconomic Factors, United States, Comorbidity, Prevalence, Odds Ratio, Age of Onset, Age Distribution, Sex Distribution, Diagnostic and Statistical Manual of Mental Disorders
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