title: Effect of genes, environment, and lifetime co-occurring disorders on health-related quality of life in problem and pathological gamblers.
abstract: 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.
  
  
  METHODS
  Cohort and co-twin studies.
  
  
  METHODS
  Nationally distributed community sample.
  
  
  METHODS
  Male twin members of the Vietnam Era Twin Registry: 53 pathological gamblers, 270 subclinical problem gamblers, and 1346 non-problem gamblers (controls).
  
  
  METHODS
  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.
authors.affiliation: Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri 63106, USA. scherrej@msnotes.wustl.edu
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Hong
authors.initials: H
authors.lastname: Xian
authors.forename: Kamini R
authors.initials: KR
authors.lastname: Shah
authors.forename: Rachel
authors.initials: R
authors.lastname: Volberg
authors.forename: Wendy
authors.initials: W
authors.lastname: Slutske
authors.forename: Seth A
authors.initials: SA
authors.lastname: Eisen
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D004200:Diseases in Twins / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005192:Family Health; D005260:Female; D005715:Gambling / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012042:Registries; D012931:Social Environment; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000235:genetics; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data