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# Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income

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### Abstract

##### 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.

##### Methods

Data 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.

##### Results

Greater 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 conclusions

The 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.

### Most cited references30

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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.

(2003)
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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### Taking chances: problem gamblers and mental health disorders--results from the St. Louis Epidemiologic Catchment Area Study.

(1998)
This study determined prevalence estimates of problem gambling and relationships to other psychiatric and substance use disorders. In 1981, the Diagnostic Interview Schedule was used to collect epidemiological information on problem gambling and other disorders from 3004 adults in St. Louis, Mo. The lifetime prevalence of pathological gambling was 0.9%; 46% of those surveyed gambled recreationally. Problem gamblers (those reporting at least one gambling-related problem) were 9.2% of the sample and were predominately White (69%), male (78.2%), and young than nongamblers. They were at increased risk for several psychiatric diagnoses, especially for antisocial personality disorder, alcoholism, and tobacco dependence. Clinicians treating alcoholism and tobacco dependence may need to screen for problem gambling. Additional research in the context of increased gambling opportunities is needed.
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### Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication.

(2008)
The purpose of this report was to update previous estimates of the association between mental disorders and earnings. Current estimates for 2002 are based on data from the National Comorbidity Survey Replication (NCS-R). The NCS-R is a nationally representative survey of the U.S. household population that was administered from 2001 to 2003. Following the same basic approach as prior studies, with some modifications to improve model fitting, the authors predicted personal earnings in the 12 months before interview from information about 12-month and lifetime DSM-IV mental disorders among respondents ages 18-64, controlling for sociodemographic variables and substance use disorders. The authors used conventional demographic rate standardization methods to distinguish predictive effects of mental disorders on amount earned by persons with earnings from predictive effects on probability of having any earnings. A DSM-IV serious mental illness in the preceding 12 months significantly predicted reduced earnings. Other 12-month and lifetime DSM-IV/CIDI mental disorders did not. Respondents with serious mental illness had 12-month earnings averaging $16,306 less than other respondents with the same values for control variables ($26,435 among men, $9,302 among women), for a societal-level total of$193.2 billion. Of this total, 75.4% was due to reduced earnings among mentally ill persons with any earnings (79.6% men, 69.6% women). The remaining 24.6% was due to reduced probability of having any earnings. These results add to a growing body of evidence that mental disorders are associated with substantial societal-level impairments that should be taken into consideration when making decisions about the allocation of treatment and research resources.
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### Author and article information

###### Journal
jba
JBA
Journal of Behavioral Addictions
2062-5871
2063-5303
20 July 2016
September 2016
: 5
: 3
: 429-438
###### Affiliations
[ 1 ]Yale Child Study Center, Yale University School of Medicine , New Haven, CT, USA
[ 2 ] University of Connecticut , Storrs, CT, USA
[ 3 ]Department of Veterans Affairs, VISN 1 Mental Illness Research Education and Clinical Center , West Haven, CT, USA
[ 4 ]Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
[ 5 ]Department of Biostatistics, Yale School of Public Health , New Haven, CT, USA
[ 6 ]Department of Neuroscience and the National Center on Addiction and Substance Abuse (CASAColumbia), Yale University School of Medicine , New Haven, CT, USA
[ 7 ]Connecticut Mental Health Center, Yale University School of Medicine , New Haven, CT, USA
###### Author notes
[* ]Corresponding author: Marc N. Potenza, MD, PhD; Yale University School of Medicine, Room 726, 1 Church St., New Haven, CT 06510, USA; Phone: +1 203 974 7356; Fax: +1 203 974 7366; E-mail: marc.potenza@ 123456yale.edu
###### Article
10.1556/2006.5.2016.045
5264410
27440475
© 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: 2, Tables: 4, Equations: 0, References: 29, Pages: xx
###### Funding
Funding sources: This work was supported in part by the Veterans Administration, the National Center for Responsible Gaming, the National Center on Addiction and Substance Abuse (CASAColumbia), the Connecticut Department of Mental Health and Addiction Services, and the NIH under Grant T32 MH014235. The funding agencies did not provide input into the content of the manuscript beyond the grant funding.
###### Categories
Full-Length Report