title: Problem-gambling severity and psychiatric disorders among American-Indian/Alaska native adults.
abstract: BACKGROUND
  Little is known about the association between problem-gambling severity and psychiatric disorders among American-Indian/Alaska-Native (AI/AN) individuals. Thus, we examined these factors among a nationally representative sample of AI/AN and other American adults in the USA.
  
  
  METHODS
  Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data, we conducted separate Wald tests and multinomial logistic regression analyses comparing AI/AN to black/African American, white/Caucasian, and all other racial/ethnic groups, respectively.
  
  
  RESULTS
  Relative to other American adults, AI/AN adults were least likely to report non-/low-frequency gambling (NG: AI/AN 66.5%, white/Caucasian 70.5%, black/African American 72.8%, other racial/ethnic group 72.3%) and most likely to report low-risk gambling (LRG: AI/AN 30.1%, white/Caucasian 26.5%, black/African American 23.4%, other racial/ethnic group 24.7%). The association between at-risk/problem-gambling (ARPG) and any past-year Axis-I disorder was stronger among AI/AN versus other American adults. Although ARPG and LRG were associated with multiple past-year Axis-I and lifetime Axis-II psychiatric disorders in both AI/AN and other American adults, LRG was more strongly associated with both Axis-I disorders (particularly major depression, generalized anxiety disorder and nicotine dependence) and Cluster-B Axis-II (particularly antisocial personality disorder) disorders in AI/AN versus other American adults.
  
  
  CONCLUSIONS
  A stronger association between problem-gambling severity and past-year psychiatric disorders among AI/AN relative to other American adults suggests the importance of enhancing mental health and problem-gambling prevention and treatment strategies that may help AI/AN individuals.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States. Electronic address: Grace.Kong@yale.edu.
authors.forename: Grace
authors.initials: G
authors.lastname: Kong
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Smith
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, United States.
authors.forename: Corey
authors.initials: C
authors.lastname: Pilver
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Rani
authors.initials: R
authors.lastname: Hoff
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, United States; Child Study Center, Yale University, School of Medicine, New Haven, CT, United States; CASA Columbia, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Potenza
mesh_terms: D000328:Adult; D000413:Alaska / Q000208:ethnology; D015897:Comorbidity; D005260:Female; D005715:Gambling / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D004930:Inuit / Q000208:ethnology*; D008297:Male; D001523:Mental Disorders / Q000208:ethnology*; D008875:Middle Aged; D012720:Severity of Illness Index; D014481:United States / Q000208:ethnology
keywords: American Indian/Alaska native; Comorbidity; Gambling; Psychiatric disorders