Phenotypes in gambling disorder using sociodemographic and clinical clustering analysis: An unidentified new subtype?

Background: Gambling disorder (GD) is a heterogeneous disorder which has clinical manifestations that vary according to variables in each individual. Considering the importance of the application of specific therapeutic interventions, it is essential to obtain clinical classifications based on differentiated phenotypes for patients diagnosed with GD

Objectives: To identify gambling profiles in a large clinical sample of n = 2,570 patients seeking treatment for GD.

Methods: An agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used, considering a large set of variables including sociodemographic, gambling, psychopathological, and personality measures as indicators.

Results: Three-mutually-exclusive groups were obtained. Cluster 1 (n = 908 participants, 35.5%), labeled as “high emotional distress,” included the oldest patients with the longest illness duration, the highest GD severity, and the most severe levels of psychopathology. Cluster 2 (n = 1,555, 60.5%), labeled as “mild emotional distress,” included patients with the lowest levels of GD severity and the lowest levels of psychopathology. Cluster 3 (n = 107, 4.2%), labeled as “moderate emotional distress,” included the youngest patients with the shortest illness duration, the highest level of education and moderate levels of psychopathology.

Conclusion: In this study, the general psychopathological state obtained the highest importance for clustering. Link to the article

Citation: Jiménez-Murcia, S., Granero, R., Fernández-Aranda, F., Stinchfield, R., Tremblay, J., Steward, T., Mestre-Bach, G., Lozano-Madrid, M., Mena-Moreno, T., Mallorquí-Bagué, N., Perales, J.C., Navas, J.F., Soriano-Mas, C., Aymamí, N., Gómez-Peña, M., Agüera, Z., del Pino-Gutiérrez, A., Martín-Romera, V., & Menchón, J.M. (2019). Phenotypes in Gambling Disorder Using Sociodemographic and Clinical Clustering Analysis: An Unidentified New Subtype? Frontiers in Psychiatry, 10(173). doi: 10.3389/fpsyt.2019.00173

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.

Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income – open access

Sanacora, R. L., Whiting, S. W., Pilver, C. E., Hoff, R. A., & Potenza, M. N.

Background and aims: Problem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups.MethodsData from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups.ResultsGreater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents.Discussion and conclusionsThe findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more “disposable income,” may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use.

Sanacora, R. L., Whiting, S. W., Pilver, C. E., Hoff, R. A., & Potenza, M. N. (2016). Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income. Journal of Behavioral Addictions, 1–10.

The intergenerational transmission of problem gambling: The mediating role of parental psychopathology

The present study investigated the intergenerational transmission of problem gambling and the potential mediating role of parental psychopathology (problem drinking, drug use problems, and mental health issues). The study comprised 3953 participants (1938 males, 2015 females) recruited from a large-scale Australian community telephone survey of adults retrospectively reporting on parental problem gambling and psychopathology during their childhood. Overall, 4.0% [95%CI 3.0, 5.0] (n = 157) of participants reported paternal problem gambling and 1.7% [95%CI 1.0, 2.0] (n = 68) reported maternal problem gambling. Compared to their peers, participants reporting paternal problem gambling were 5.1 times more likely to be moderate risk gamblers and 10.7 times more likely to be problem gamblers. Participants reporting maternal problem gambling were 1.7 times more likely to be moderate risk gamblers and 10.6 times more likely to be problem gamblers. The results revealed that the relationships between paternal-and-participant and maternal-and-participant problem gambling were significant, but that only the relationship between paternal-and-participant problem gambling remained statistically significant after controlling for maternal problem gambling and sociodemographic factors. Paternal problem drinking and maternal drug use problems partially mediated the relationship between paternal-and-participant problem gambling, and fully mediated the relationship between maternal-and-participant problem gambling. In contrast, parental mental health issues failed to significantly mediate the transmission of gambling problems by either parent. When parental problem gambling was the mediator, there was full mediation of the effect between parental psychopathology and offspring problem gambling for fathers but not mothers. Overall, the study highlights the vulnerability of children from problem gambling households and suggests that it would be of value to target prevention and intervention efforts towards this cohort.