Current suicidal ideation in treatment-seeking individuals in the United Kingdom with gambling problems

By Silvia Ronzitti, Emiliano Soldini, Neil Smith, Marc N. Potenza, Massimo Clerici, and Henrietta Bowden-Jones.

Background: Studies show higher lifetime prevalence of suicidality in individuals with pathological gambling. However, less is known about the relationship between pathological gambling and current suicidal ideation.

Objectives: We investigated socio-demographic, clinical and gambling-related variables associated with suicidality in treatment-seeking individuals.

Methods: Bivariate analyses and logistic regression models were generated on data from 903 individuals to identify measures associated with aspects of suicidality.

Results: Forty-six percent of patients reported current suicidal ideation. People with current suicidal thoughts were more likely to report greater problem-gambling severity (p < 0.001), depression (p < 0.001) and anxiety (p < 0.001) compared to those without suicidality. Logistic regression models suggested that past suicidal ideation (p < 0.001) and higher anxiety (p < 0.05) may be predictive factors of current suicidality.

Conclusions: Our findings suggest that the severity of anxiety disorder, along with a lifetime history of suicidal ideation, may help to identify treatment-seeking individuals with pathological gambling with a higher risk of suicidality, highlighting the importance of assessing suicidal ideation in clinical settings.

Ronzitti, S., Soldini, E., Smith, N., Potenza, M. N., Clerici, M., & Bowden-Jones, H. (2017). Current suicidal ideation in treatment-seeking individuals in the United Kingdom with gambling problems. Addictive Behaviors, 74, 33–40. https://doi.org/10.1016/j.addbeh.2017.05.032

Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study

K.W. Müller, K. Wölfling, U. Dickenhorst, M.E. Beutel, J. Medenwaldt, A. Koch.

Purpose: Gambling disorder is associated with various adverse effects. While data on the immediate effectiveness of treatment programs are available, follow-up studies examining long-term effects are scarce and factors contributing to a stable therapy outcome versus relapse are under-researched.

Materials and methods: Patients (n = 270) finishing inpatient treatment for gambling disorder regularly participated in a prospective multicenter follow-up study (pre-treatment, post-treatment, 12-month follow-up). Criteria for gambling disorder, psychopathology, functional impairment were defined as endpoints. Changes in personality were defined as an additional parameter.

Results: At follow-up, three groups were identified: subjects maintaining full abstinence (41.6%), patients still meeting criteria for gambling disorder (29.2%), and subjects still participating in gambling without meeting the diagnostic criteria for gambling disorder (29.2%). Every group had improvements in functional impairment, abstinent subjects showed the lowest psychopathology. Significant decreases in neuroticism and increases in both extraversion and conscientiousness were found among abstinent subjects but not in patients still meeting criteria for gambling disorder.

Discussion: One year after treatment, a considerable percentage of patients kept on gambling but not all of them were classified with gambling disorder leading to the question if abstinence is a necessary goal for every patient.

Conclusions: The changes of personality in abstinent patients indicate that after surmounting gambling disorder a subsequent maturing of personality might be a protective factor against relapse.

Müller, K. W., Wölfling, K., Dickenhorst, U., Beutel, M. E., Medenwaldt, J., & Koch, A. (n.d.). Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study. European Psychiatry. https://doi.org/10.1016/j.eurpsy.2017.01.326

The cost of virtual wins: An examination of gambling-related risks in youth who spend money on social casino games (full text)

Methods An online survey was administered to 555 adolescents, including 130 SCG players (78 non-paying and 52 paying users).

Pharmacotherapy and group cognitive behavioral therapy enhance follow-up treatment duration in gambling disorder patients

Choi, S.-W., Shin, Y.-C., Youn, H., Lim, S.-W., & Ha, J.

Background
Longer treatment duration is important for the successful treatment of gambling disorder (GD). This retrospective study investigated the factors and interventions that might enhance treatment duration in GD patients in South Korea.

Methods
A total of 758 outpatients with a primary diagnosis of GD, who were treated in a clinical practice from 2002 to 2011, were assessed by retrospective chart review. We compared the treatment duration according to pharmacotherapy and group cognitive behavioral therapy (CBT).

Results
Pharmacotherapy contributed to a longer duration of treatment maintenance, despite the patients’ gambling severity (p < 0.001). Participation in group CBT (p < 0.001) and antidepressants (p = 0.009) were associated with a longer treatment duration after adjusting for age, depression, and gambling severity. The treatment maintenance duration was the longest in those receiving combined antidepressant pharmacotherapy and group CBT (F = 35.79, p < 0.001).

Conclusions
Group CBT and antidepressants seem to enhance treatment follow-up duration in GD patients. Additional studies are needed to advance GD prevention and treatment strategies.

Unpacking the public stigma of problem gambling: The process of stigma creation and predictors of social distancing

Hing, N., Russell, A. M. T., & Gainsbury, S. M.

Background and aims
Public stigma diminishes the health of stigmatized populations, so it is critical to understand how and why stigma occurs to inform stigma reduction measures. This study aimed to examine stigmatizing attitudes held toward people experiencing problem gambling, to examine whether specific elements co-occur to create this public stigma, and to model explanatory variables of this public stigma.

Methods
An online panel of adults from Victoria, Australia (N = 2,000) was surveyed. Measures were based on a vignette for problem gambling and included demographics, gambling behavior, perceived dimensions of problem gambling, stereotyping, social distancing, emotional reactions, and perceived devaluation and discrimination. A hierarchical linear regression was conducted.

Results
People with gambling problems attracted substantial negative stereotypes, social distancing, emotional reactions, and status loss/discrimination. These elements were associated with desired social distance, as was perceived that problem gambling is caused by bad character, and is perilous, non-recoverable, and disruptive. Level of contact with problem gambling, gambling involvement, and some demographic variables was significantly associated with social distance, but they explained little additional variance.

Discussion and conclusions
This study contributes to the understanding of how and why people experiencing gambling problems are stigmatized. Results suggest the need to increase public contact with such people, avoid perpetuation of stereotypes in media and public health communications, and reduce devaluing and discriminating attitudes and behaviors.

Hing, N., Russell, A. M. T., & Gainsbury, S. M. (2016). Unpacking the public stigma of problem gambling: The process of stigma creation and predictors of social distancing. Journal of Behavioral Addictions, 1–9. http://doi.org/10.1556/2006.5.2016.057

Gambling Disorder in the DSM-5: Opportunities to Improve Diagnosis and Treatment Especially in Substance Use and Homeless Populations – Open Access

Rash, C. J., & Petry, N. M.

Purpose of review: This paper reviews recent research related to the revisions of the gambling disorder (GD) criteria, including the elimination of the illegal acts criterion and the lowered diagnostic threshold. Recent findings: Studies suggest that the removal of the illegal acts criterion has little impact in terms of prevalence or loss of diagnostic status among gamblers, especially when considered in combination with the lowered diagnostic threshold. Overall, prevalence rates will increase modestly with the lowered threshold in community samples of gamblers. However, increases in GD prevalence rates may be more notable in settings that serve individuals at higher risk for gambling problems (e.g., substance abuse treatment clinics and homeless persons). Summary: Changes to the GD diagnostic criteria may lead to increased recognition of gambling problems, particularly in settings that serve high-risk populations. These changes also may necessitate the training of more clinicians in the delivery of efficacious gambling treatments.

Rash, C. J., & Petry, N. M. (2016). Gambling Disorder in the DSM-5: Opportunities to Improve Diagnosis and Treatment Especially in Substance Use and Homeless Populations. Current Addiction Reports, 1–5. http://doi.org/10.1007/s40429-016-0112-0

Gambling Disorder and Minority Populations: Prevalence and Risk Factors

Okuda, M., Liu, W., Cisewski, J. A., Segura, L., Storr, C. L., & Martins, S. S.

Previous studies demonstrate disparities in health and health services including gambling disorders (GD) among ethnic and racial minority groups. In this review, we summarize studies examining the prevalence of GD across different ethnic and racial minorities. We describe the sociodemographic subgroup variations at heightened risk for GD and factors associated with GD in racial and ethnic minority groups including gambling availability, comorbid substance use, psychiatric conditions, stress, acculturation, and differences in cultural values and cognitions. We found that research of GD among minority groups is scant, and the prevalence of GD among these groups is at a magnitude of concern. Racial and ethnic minority status in it of itself is not a risk factor for GD but may be a proxy for underlying potential risk factors. The need for prevention and treatment programs for different cultural group remains unmet.

Okuda, M., Liu, W., Cisewski, J. A., Segura, L., Storr, C. L., & Martins, S. S. (2016). Gambling Disorder and Minority Populations: Prevalence and Risk Factors. Current Addiction Reports, 1–13. http://doi.org/10.1007/s40429-016-0108-9