An Update on Gender Differences in the Characteristics Associated with Problem Gambling: a Systematic Review

To examine sex differences in DSM-IV subclinical and pathological gambling in nationally representative data of the US population. Data come from a large (n = 43093) representative sample of the adult US population. The lifetime prevalence rate of DSM-IV pathological gambling was 0.64% (95% CI 0.50-0.78) for men and 0.23% (95% CI 0.17-0.29) for women, whereas the lifetime prevalence of subclinical pathological gambling was 6.79% (95% CI 6.32-7.26) for men and 3.26% (95% CI 2.93-3.59) for women. For subclinical pathological gambling, men were significantly (p < 0.01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and pathological gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to pathological gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report gambling to relieve depressed mood and to prefer casino gambling. Rates of treatment-seeking for DSM-IV pathological gambling were low for both men and women. There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and pathological gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and pathological gambling.

A random telephone survey was conducted with a representative sample of 2,274 U.S. residents aged 14-21. The prevalence of problem gambling, as measured by the SOGS-RA, was 2.1%. Sixty-eight percent (68%) of the respondents had gambled in the past year, and 11% had gambled more often than twice per week. Males had much higher gambling involvement than females, and gambling involvement increased among older respondents. Blacks were less likely than average to have gambled in the past year, but if they gambled, they were more likely to do so frequently. Low SES respondents were less likely to have gambled in the past year, but if they gambled, they were more likely to be problem gamblers. Life transitions that are associated with assuming adult roles (employment, living independently of parents, non-student status) are also associated with greater gambling involvement. The rates of problem and pathological gambling were lower than those in an adult survey conducted earlier, when measured with the same questionnaire.

The course of pathological gambling (PG) in women has been described as having a later age of initiation but a shorter time to problematic gambling ("telescoped"). This study examined evidence for telescoping and its relationship with comorbidities. Seventy-one treatment-seeking individuals with PG underwent a diagnostic interview to examine gambling behaviors, age at initiation of gambling, and time from initiation to meeting criteria for PG. The women had a higher mean age at gambling initiation compared with that of the men (mean [SD] age, 31.3 [13.0] years, compared with 22.4 [7.9] years; p = 0.0003) and a significantly shorter time from initiation of gambling to meeting the criteria for PG (8.33 [8.7] years compared with 11.97 [9.1] years; p = 0.0476) after controlling for demographic and clinical variables. This study presents evidence for a gender-specific course of PG unrelated to psychiatric comorbidities and suggests a need for greater clinical focus on the gender differences of gambling behavior.