title: Gambling transitions among adult gamblers: A multi-state model using a Markovian approach applied to the JEU cohort.
abstract: BACKGROUND
  The aim of this paper is to study transitions between two states of gambling in adulthood (problem gambling and non-problem gambling) and to identify factors that might influence these transitions.
  
  
  METHODS
  Data for this 2-year long longitudinal study were collected in a French Outpatient Addiction Treatment Center, in gambling establishments and through the press. Both problem gamblers and non-problem gamblers were evaluated using a structured interview and self-report questionnaires. The statistical analysis was carried out using a Markovian approach.
  
  
  RESULTS
  The analyzed cohort consisted of 304 gamblers with 519 observed transitions. Participants with no past-year gambling problems (based on the DSM-IV) had a probability of about 90% of also having no past-year gambling problems at the following assessment, whereas the observed percentage of problem gamblers transitioning to non-problem gambling was of 48%. We reported (i) vulnerability factors of transitioning to problem gambling (such as an anxiety disorder or an Attention Deficit Hyperactivity Disorder (ADHD) during the childhood), (ii) protective factors for non-problem gamblers, (iii) recovery factors (such as ongoing treatment and younger age) and (iv) persistence factors of a gambling problem (such as a persistent ADHD).
  
  
  CONCLUSIONS
  The status of problem gambler is unstable over time, whereas we found stability among non-problem gamblers. Our findings suggest the existence of vulnerability and protective factors in gambling. These results lead to think about preventive actions and adaptive care, such as cognitive-behavioral therapy or researching gambling problems in people with an anxiety disorder or ADHD.
authors.affiliation: BALANCED Clinical Investigation Unit ("BehaviorAL AddictioNs and ComplEx mood Disorders"), Department of Addictology and Psychiatry, University Hospital of Nantes, France; EA 4275 SPHERE "MethodS for Patients-centered outcomes and HEalth REsearch", University of Nantes, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Bruneau
authors.affiliation: BALANCED Clinical Investigation Unit ("BehaviorAL AddictioNs and ComplEx mood Disorders"), Department of Addictology and Psychiatry, University Hospital of Nantes, France; EA 4275 SPHERE "MethodS for Patients-centered outcomes and HEalth REsearch", University of Nantes, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Grall-Bronnec
authors.affiliation: BALANCED Clinical Investigation Unit ("BehaviorAL AddictioNs and ComplEx mood Disorders"), Department of Addictology and Psychiatry, University Hospital of Nantes, France; EA 4275 SPHERE "MethodS for Patients-centered outcomes and HEalth REsearch", University of Nantes, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Vénisse
authors.affiliation: EA 4430 CLIPSYD "CLInique PSYchanalyse Développement", University of Paris Ouest Nanterre La Défense, France; Louis Mourier Hospital of Colombes, Assistance Publique - Hôpitaux de Paris (APHP), France.
authors.forename: Lucia
authors.initials: L
authors.lastname: Romo
authors.affiliation: Marmottan Medical Center, GPS Perray-Vaucluse, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Valleur
authors.affiliation: Department of Adult Psychiatry, Sainte-Marguerite University Hospital of Marseille, France.
authors.forename: David
authors.initials: D
authors.lastname: Magalon
authors.affiliation: Psychiatry Laboratory, Sanpsy CNRS USR 3413, University of Bordeaux and Charles Perrens Hospital, Bordeaux, France.
authors.forename: Mélina
authors.initials: M
authors.lastname: Fatséas
authors.affiliation: Psychiatry Department, University Hospital of Clermont-Ferrand, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chéreau-Boudet
authors.affiliation: Psychiatry and Addictology Department, Paul Brousse University Hospital of Villejuif, Assistance Publique - Hôpitaux de Paris (APHP), France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Luquiens
authors.affiliation: BALANCED Clinical Investigation Unit ("BehaviorAL AddictioNs and ComplEx mood Disorders"), Department of Addictology and Psychiatry, University Hospital of Nantes, France; EA 4275 SPHERE "MethodS for Patients-centered outcomes and HEalth REsearch", University of Nantes, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Challet-Bouju
authors.affiliation: EA 4275 SPHERE "MethodS for Patients-centered outcomes and HEalth REsearch", University of Nantes, France; Unit of Methodology and Biostatistics, University Hospital of Nantes, France.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Hardouin
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology; D001294:Attitude to Health; D004812:Epidemiologic Methods; D005260:Female; D005715:Gambling / Q000523:psychology* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: Gambling; Longitudinal study; Markov process; Prevalence; Risk factors; Transitions