Dr. Shane Kraus and fellow researchers (Kraus et al., 2020) completed a pilot study to assess the prevalence of gambling disorder within a sample of US veterans at a primary care VA hospital. Veterans, as a group, are an often over-looked at-risk group for gambling disorder due to the high prevalence of comorbid mental health issues such as PTSD. These researchers hoped to assess whether a simple screen at a primary care visit could be helpful in finding veterans with gambling problems.
Aim
Researchers set out to evaluate the proportion of veterans meeting full or sub- threshold DSM-5 criteria for gambling disorder (GD). They also aimed to estimate the co-occurrence of other medical or mental health problems with gambling disorder among veterans. The researchers hypothesized that veterans with GD, including those at sub-threshold, would more frequently report psychiatric disorders and medical conditions than those without GD.
Why is this Important?
This study is important because it has been established that GD is associated with many other mental health and substance abuse disorders, including PTSD. PTSD is prevalent in the veteran community, and may be an important risk factor for gambling disorder among veterans. Research done on veterans is scarce despite growing evidence that they may be particularly vulnerable to developing gambling problems. Researchers hope that routine gambling disorder screenings among veterans at VA hospitals will become commonplace.
What did they do?
Researchers retrospectively reviewed medical records for veterans seen for their first appointment in the Bedford VA Hospital between Nov. 1, 2017 and Sept. 15, 2018. Two-hundred and sixty veterans, 88.9% male, 84.6% Caucasian with a median age of 53.7, were screened with the Brief Biosocial Gambling Screen (BBGS) (Gebauer et al., 2010). Information was also collected on sociodemographics, psychiatric history, substance use, PTSD, depression and anxiety disorder. The BBGS was used to evaluate three features of problem gambling: withdrawal, lying, and borrowing money. Patients that endorsed any of the three were considered positive and received further assessment. Further assessment included a 9-question yes/no questionnaire for GD criteria. Researchers then used chi-square and mean comparisons to assess associations.
What did they find?
Researchers found that 32.7% of the sample reported gambling within the last 12 months. They found no significant differences between gambling and non-gambling veterans on demographics, medical, or mental health conditions. Nearly six percent of the veterans screened positive for at risk/problem gambling and 1.9% were categorized as problem gambling after further assessment. Researchers reported that results suggest that self-disclosure of problem gambling and outreach efforts by VA healthcare providers could increase veteran’s participation in treatment services. They also found that adding the screening to routine check-ups was not burdensome and could easily be implemented in all appointments.
Limitations
This pilot study was not without clear limitations. The low endorsement of gambling behaviors does not allow researchers to assess the reliability of the BBGS as a screening tool. This needs to be addressed in future studies by perhaps using busier settings. Additionally, the study was retrospective in behavior, and as a result researchers were unable to pinpoint any specific reasons for the underreporting of gambling issues within the sample.
Gebauer, L., LaBrie, R., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: A brief biosocial screen for detecting current gambling disorders among gamblers in the general household population. Canadian Journal of Psychiatry, 55(2), 82–90.
Kraus, S., Potenza, M., Ngo, T., Pugh, K., Bernice, K., & Shirk, S. (2020). Screening for gambling disorder in VA primary care behavioral health: A pilot study. Issues in Mental Health Nursing. https://doi.org/10.13140/RG.2.2.20813.69601
