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      Investigating Veterans’ Pre-, Peri-, and Post-Deployment Experiences as Potential Risk Factors for Problem Gambling

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          Abstract

          Background and aims

          Gambling disorder and its comorbid diagnoses are observed at higher rates in military veterans than in the general population. A significant research gap exists regarding the relationships of veterans’ life and service experiences to problematic gambling. The present study explored pre-, peri-, and post-deployment factors associated with problem gambling in veterans.

          Methods

          Veterans of Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn ( n = 738; 463 males, and 275 females) completed questionnaires via structured telephone interview. We conducted bivariate and multinomial logistic regression analyses exploring associations among problem-gambling severity and socio-demographic variables, psychiatric comorbidities, and 10 scales of the Deployment Risk and Resilience Inventory measuring experiences pre-, peri-, and post-deployment.

          Results

          Approximately 4.2% of veterans indicated at-risk or probable pathological gambling (ARPG) post-deployment (two or more DSM-IV criteria for pathological gambling). Bivariate analyses found more severe gambling in males, higher frequencies of post-traumatic stress disorder, substance dependence, traumatic brain injury, panic disorder, and depression in veterans with ARPG, and higher general harassment during deployment, and lower social support and more stressful life events post-deployment in those with ARPG. In multivariable models, both post-deployment factors remained significantly associated with ARPG.

          Discussion

          The study suggests that problem gambling among veterans is related to service experiences, and particularly to life experiences post-deployment.

          Conclusions

          Adverse service and life experiences and lack of social support may contribute to the risk of problem gambling in military veterans. Investigation of how Veterans Affairs clinical settings may serve veterans following deployment to prevent behavioral addictions is warranted.

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          Most cited references 43

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          The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample.

          the purpose of this study was to assess the test-retest reliability of newly introduced or revised modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV), including alcohol consumption, tobacco use, family history of depression, and selected DSM-IV axis I and II psychiatric disorders. kappa and intraclass correlation coefficients were calculated for the AUDADIS-IV modules using a test-retest design among a total of 2657 respondents, in subsets of approximately 400, randomly drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). reliabilities for alcohol consumption, tobacco use and family history of major depression measures were good to excellent, while reliabilities for selected DSM-IV axis I and II disorders were fair to good. The reliabilities of dimensional symptom scales of DSM-IV axis I and axis II disorders exceeded those of their dichotomous diagnostic counterparts and were generally in the good to excellent range. the high reliability of alcohol consumption, tobacco use, family history of depression and psychiatric disorder modules found in this study suggests that the AUDADIS-IV can be a useful tool in various research settings, particularly in studies of the general population, the target population for which it was designed.
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            Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.

            Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for 2 years of free military service-related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. Of 103 788 OEF/OIF veterans seen at VA health care facilities, 25 658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32 010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older. Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.
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              Gambling disorders.

              Gambling disorders, including pathological gambling and problem gambling, have received increased attention from clinicians and researchers over the past three decades since gambling opportunities have expanded around the world. This Seminar reviews prevalence, causes and associated features, screening and diagnosis, and treatment approaches. Gambling disorders affect 0·2-5·3% of adults worldwide, although measurement and prevalence varies according to the screening instruments and methods used, and availability and accessibility of gambling opportunities. Several distinct treatment approaches have been favourably evaluated, such as cognitive behavioural and brief treatment models and pharmacological interventions. Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported. Gambling disorders are highly comorbid with other mental health and substance use disorders, and a further understanding is needed of both the causes and treatment implications of this disorder. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                jba
                JBA
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                09 May 2016
                June 2016
                : 5
                : 2
                : 213-220
                Affiliations
                [1 ]Department of Veterans Affairs, VISN 1 Mental Illness Research Education and Clinical Center (MIRECC) , West Haven, CT, USA
                [2 ]Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
                [3 ]Department of Neurobiology, Yale University School of Medicine , New Haven, CT, USA
                [4 ]Child Study Center, Yale University School of Medicine , New Haven, CT, USA
                [5 ]Department of Psychology, University of Connecticut , Storrs, CT, USA
                Author notes
                [* ]Corresponding author: Rani A. Hoff; NEPEC/182, 950 Campbell Ave., West Haven, CT 06416, USA; Phone: +1 203 937 3850; Fax: +1 203 937 3433; E-mail: Rani.hoff@ 123456va.gov
                Article
                10.1556/2006.5.2016.027
                5387772
                27156377
                © 2016 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 40, Pages: 8
                Funding
                Funding sources: This study was funded by the U.S. Department of Veteran Affairs Office of Research and Development, Clinical Science Research and Development (ZDA 1, PI: Hoff). MNP’s involvement supported by a Center of Excellence grant from the National Center for Responsible Gaming and CASAColumbia. The views presented in the manuscript are not necessarily those of the funding agencies and the funding agencies did not have input into the content of the manuscript beyond provision of funding.
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