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Effect of Genes, Environment, and Lifetime Co-occurring Disorders on Health-Related Quality of Life in Problem and Pathological Gamblers
Jeffrey F. Scherrer, PhD;
Hong Xian, PhD;
Kamini R. Shah, MHS;
Rachel Volberg, PhD;
Wendy Slutske, PhD;
Seth A. Eisen, MD, MSc
Arch Gen Psychiatry. 2005;62:677-683.
Background Problem and pathological gambling are associated with many impairments in quality of life, including financial, family, legal, and social problems. Gambling disorders commonly co-occur with other psychiatric disorders, such as alcoholism and depression. Although these consequences and correlates have been reported, little is known about the health-related functional impairment associated with gambling.
Objective To model differences in the health-related quality of life (HRQoL) among non–problem gamblers, problem gamblers, and pathological gamblers after controlling for lifetime co-occurring substance use disorders, psychiatric disorders, sociodemographics, and genetic and family environmental influences.
Design Cohort and co-twin studies.
Setting Nationally distributed community sample.
Patients Male twin members of the Vietnam Era Twin Registry: 53 pathological gamblers, 270 subclinical problem gamblers, and 1346 non–problem gamblers (controls).
Interventions We obtained HRQoL data, via the 8-Item Short-Form Health Survey, from all participants. Data from a subset of twin pairs discordant for gambling behavior was used to control for genetic and family environmental effects on HRQoL and problem gambling.
Main Outcome Measure Health-related quality of life.
Results Results from adjusted logistic regression analyses suggest little difference across groups in the physical domains of the health survey; however, for each mental health domain, pathological gamblers had lower HRQoL scores than problem gamblers (P<.05), who in turn had lower scores than non–problem gamblers (P<.05). After controlling for genes and family environment, no significant differences existed between the non–problem gambling twins and their problem or pathological gambling brothers, but adjusted co-twin analyses resulted in statistically significant differences in 4 of 8 subscales.
Conclusions Pathological and problem gambling are associated with significant decrements in HRQoL. This association is partly explained by genetic and family environmental effects and by lifetime co-occurring substance use disorders. Implications for clinicians, health care utilization, and public health issues are discussed.
Author Affiliations: Research Service (Drs Scherrer, Xian, and Eisen and Ms Shah) and Medical Service (Dr Eisen), St Louis Veterans Affairs Medical Center, St Louis, Mo; Departments of Psychiatry (Drs Scherrer and Eisen) and Internal Medicine (Drs Xian and Eisen and Ms Shah), Washington University School of Medicine, St Louis; Gemini Research Ltd, Northampton, Mass (Dr Volberg); and Department of Psychology, University of Missouri, Columbia (Dr Slutske).
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