Effect of genes, environment, and lifetime co-occurring disorders on health-related quality of life in problem and pathological gamblers.
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.
Scherrer
Jeffrey F
JF
Research Service, St Louis Veterans Affairs Medical Center, St Louis, Missouri 63106, USA. scherrej@msnotes.wustl.edu
Xian
Hong
H
Shah
Kamini R
KR
Volberg
Rachel
R
Slutske
Wendy
W
Eisen
Seth A
SA
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