title: Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues.
abstract: BACKGROUND
  Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues.
  
  
  METHODS
  This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536) who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger). Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis.
  
  
  RESULTS
  Approximately 3/100 (3%) answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1). Increasing age reduced likelihood of gambling concerns - logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99) p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p < 0.0001) to have concerns about their smoking, use of recreational drugs, and alcohol. Similarly there were more likely to indicate problems with depression, anxiety and anger control. No significant relationship with gambling worries was found for abuse, physical inactivity or weight concerns. Patients expressing concerns about gambling were significantly more likely to want help with smoking, other drug use, depression and anxiety.
  
  
  CONCLUSIONS
  Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.
authors.affiliation: Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Auckland, New Zealand. f.goodyear-smith@auckland.ac.nz
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.forename: Sean
authors.initials: S
authors.lastname: Sullivan
authors.forename: Nicole
authors.initials: N
authors.lastname: Coupe
authors.forename: Samson
authors.initials: S
authors.lastname: Tse
authors.forename: Robin
authors.initials: R
authors.lastname: Shepherd
authors.forename: Fiona
authors.initials: F
authors.lastname: Rossen
authors.forename: Lana
authors.initials: L
authors.lastname: Perese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression; D017831:Diagnosis, Dual (Psychiatry); D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009520:New Zealand; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011594:Psychometrics; D012307:Risk Factors; D012309:Risk-Taking; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population