title: Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys.
abstract: OBJECTIVE
  This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers.
  
  
  METHODS
  A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies.
  
  
  RESULTS
  Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution.
  
  
  CONCLUSIONS
  Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.
authors.affiliation: Problem Gambling Research and Treatment Centre, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia. felicity.lorains@monash.edu
authors.forename: Felicity K
authors.initials: FK
authors.lastname: Lorains
authors.forename: Sean
authors.initials: S
authors.lastname: Cowlishaw
authors.forename: Shane A
authors.initials: SA
authors.lastname: Thomas
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D005715:Gambling / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*