Gambling and the Onset of Comorbid Mental Disorders: A Longitudinal Study Evaluating Severity and Specific Symptoms
Abstract
While the association between gambling disorders and comorbid mental disorders has been extensively studied, only a few studies have used longitudinal data or evaluated the association across different levels of gambling behavior and specific gambling-related symptoms. In this study, longitudinal data from waves 1 and 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to determine whether different levels of gambling behavior and gambling-related symptoms were associated with the onset of psychiatric disorders. Although NESARC used DSM-IV diagnoses, for this study, the recently published DSM-5 diagnostic criteria for gambling disorder were used to group the NESARC respondents (N=34,653) into three levels of gambling (gambling disorder, sub-threshold gambling disorder, and recreational gambling) and one non-gambling comparison group. Three years after the initial intake interview, compared to the non-gamblers, those reporting any gambling behavior at baseline were at increased risk to have any mood, anxiety, or substance use disorders (recreational gambling: adjusted odds ratio [AOR]=1.16, 95% confidence interval [CI]=1.10-1.23; sub-threshold gambling disorder: AOR 1.77, 95% CI 1.63-1.92; gambling disorder: AOR 2.51, 95% CI 1.83-3.46). Similar graded relationships were found for a number of specific disorders. In addition, multiple specific gambling-related symptoms were associated with comorbid disorders, possibly suggesting the interaction of different mechanisms linking gambling disorder and the onset of comorbid psychopathology. In conclusion, a graded or dose-response relationship exists between different levels of gambling and the onset of comorbid psychopathology. Among gambling groups, those with a gambling disorder were at the highest risk for the new onset of comorbid conditions and those with recreational gambling were at the lowest risk, while the risk among participants with sub-threshold gambling disorder fell between these two groups.
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Gambling involvement, even at recreational levels, predicts the onset of anxiety or substance use disorders three years later.
“Notably, gambling involvement, even at recreational levels, has been shown to predict the onset of anxiety or substance use disorders three years later (Parhami et al., 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 Parhami et al., 2014
Individuals with gambling disorder demonstrate elevated substance abuse symptoms compared to those without this condition.
“Similarly, individuals with gambling disorder demonstrate elevated substance abuse symptoms compared to those without this condition (K.-L. Chou & Afifi, 2011; el-Guebaly et al., 2006; Parhami et al., 2014; Possemato et al., 2015).”
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 Parhami et al., 2014
The more severe the baseline gambling involvement, the more likely the individual was to experience the onset of either an anxiety or substance use disorder.
“Furthermore, the more severe the baseline gambling involvement, the more likely the individual was to experience the onset of either an anxiety or substance use disorder.”
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 Parhami et al., 2014
The onset of a comorbid anxiety or substance use disorder has been significantly associated with endorsing gambling disorder diagnostic criteria.
“The onset of a comorbid anxiety or substance use disorder has been significantly associated with endorsing gambling disorder diagnostic criteria (e.g. “gambling as an escape from negative affect”), supporting the notion that coping may play a significant role in the comorbidity between anxiety, substance use, and gambling disorders (Lister, Milosevic, & Ledgerwood, 2015; Parhami et al., 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 Parhami et al., 2014
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“…gambling disorder diagnostic criteria (e.g., Bgambling as an escape from negative affect^), supporting the notion that coping may play a significant role in the co-mordidity between anxiety, substance use, and gambling disorders (Lister, Milosevic, & Ledgerwood, 2015; Parhami et al., 2014).”
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- Authors
- PARHAMI, I., MOJTABAI, R., ROSENTHAL, R. J., AFIFI, T. O., & FONG, T. W.
- Affiliations
- Johns Hopkins University (US)
- Venue
- Journal of Psychiatric Practice
- Published
- 2014-05
- Volume
- 20
- Issue
- 3
- Pages
- 207-219
- ISSN
- 1527-4160 (ISSN-L)
- 1538-1145
- OpenAlex
- W2053626209
- Cited by
- 71
- References
- 45
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 3 · 2019: 11 · 2018: 10 · 2017: 6 · 2016: 10 · 2015: 9
- FWCI
- 9.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Keywords
- gambling addiction, comorbidities, recreational gambling, mood disorders, anxiety disorders, substance use disorders, dose-response relationship, NESARC
- MeSH terms
- Adult, Demography, Female, Gambling, Humans, Longitudinal Studies, Male, Middle Aged, Psychiatric Status Rating Scales, Psychopathology, Socioeconomic Factors, United States, Comorbidity, Odds Ratio, Risk Assessment, Mood Disorders, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders
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