Gambling problems in primary care: a systematic review and meta-analysis

Abstract

AimsTo synthesise evidence regarding gambling problems in primary care contexts as evidence suggests that problem gambling may be overrepresented. Objectives were to review all the available evidence regarding the frequency and implications of gambling problems in primary care. The latter were operationalised by covariates relating to physical and mental health that suggest clinical implications, as well as co-occurring addictive behaviours. MethodsPeer reviewed articles published in MEDLINE, Embase, PsycINFO, CINAHL and Sociological Abstracts reporting data relating to gambling and associated problems were screened. Where possible, random effects meta-analysis was used to combine study estimates. FindingsThe search identified 14 articles (based on 11 individual studies) from 1708 deduplicated records.Meta-analyses of data from 10 studies indicated around 3.0% of patients reported significant levels of problem gambling, although there was substantial heterogeneity and rates ranged from around 1% to 15% across studies. In contrast, there were few studies reporting findings relating to gambling problems across a broader continuum of severity, and there is little known about sub-clinical problems (i.e., at-risk gambling) in primary care. There was generally consistent evidence of links between problem gambling and poor mental health and co-occurring substance use problems. In contrast, there was less evidence regarding the physical health implications of problem gambling in primary care. ConclusionsPrimary care may provide an important environment for the detection of gambling problems and should identify patients reporting gambling problems across a continuum, consistent with principles of case finding; thereby targeting investigation on those suspected to be 'at risk'.

Association Between Problem Gambling and Functional Disability: A Nationally Representative Study Conducted in the United Kingdom

“…Findings from the present study support previous research that has shown that problem gambling is associated with several negative health outcomes 6–8 . Moreover, findings from this study add to previous literature by suggesting for the first time that there is a significant association between problem gambling and functional disability.…”

“…6 Other studies have found similar findings. 7,8 It is therefore feasible that problem gambling is associated with functional disability, but to the best of our knowledge, no study has investigated this association to date. Problem gambling may be associated with functional disability through multiple mental and physical health problems.…”

“…For example, 1 study, in a large sample ( N = 10,056) of Canadian women (aged ≥15 years), found that those with problem gambling were more likely to report low general health, poor mental health (eg, decreased psychological well-being, depression, and suicidal attempts) and poor physical health (eg, chronic bronchitis, fibromyalgia, and migraine headaches) 6 . Other studies have found similar findings 7,8 . It is therefore feasible that problem gambling is associated with functional disability, but to the best of our knowledge, no study has investigated this association to date.…”