Saturday, September 28, 2013

Behavioural addiction - Gambling - in people living with Disabilities

Behavioural Addiction

In people living with disability: disordered  gambling and health functioning

Sept. 28, 2013

Sandra Cortina, RN, MPH, MD candidate
Nady el-Guebaly, MD 
Department of Psychiatry, University of Calgary

Fascinating Study presented by Sandra Cortina at the Canadian Society of Addiction Medicine Annual Conference, Vancouver, BC 2013.  These are my rough notes of this excellent presentation which included many pertinent slides I can’t reproduce here. I trust this helps someone to appreciate the depth and breadth of information available.

Problem Gambling - gambling behaviour that creates negative consequences for the gambler, their social network, or community
-up to 3.8% of Canadians have symptons of moderate risk or problem gambling

Higher rates of pathological gambling found in US among people with disability

Largest category of Canada Pension Plan disability
-mental illness 22%
-musculoskeletal 21%
-neoplasm 20%

Gambling and Health Function
-direction of association between disability and gambling not known

This association can be especially deterimental to people living with disability who may already suffere from pre existing health deficits related to their disability

problem gamling, disability and health function
-measure prevalence in gambling in people with disability in canadian sample
-association between two

Gambling Prevalence
-Leisure, Lifestyle and Lifecycle Project (W4)
-prospect study

-disability - 18-59 - Canada/Quebec Pension Plan, Worker’s Compensation or both in last 12 months
Canadian Problem Gambling Index (CPGI ) (non,non problem, low risk, moderate-risk, problem)
-Disordered CPGI greater than or equal to 4

Short-Form 8 Health Survy
-Mental Health Burden - vitality, social, emotional, 
-physical health burden - general, physical, function


Gambling prevalence -

Sample 769 participants from Alberta
39 received disability benefits (PRDB)
Characteristics and Behaviours of PRDB
-pretty similiar groups except
-Older participants 66.7% vs 50.6%
Income -less than $50,000  51.3% versus 23 %
Video terminals/slots last 12 months (63 % versus 42.1 %

PRDB found to have a greater proportion of DIsordered Gamblers
15.8 % versus 3.5% 
Gambling and Health Function

Physical burden: Well being
  • gambling status was predictive of decreased health function
  • as gambling status became more severe increased physical burden

People receiving disability have higher prevalence of disordered gambling versus sample remainder and general Canadian population
-small sample - accuracy, confounding, generalizability
-disability definitiion - exclusive, indirect, etiology

Couldn’t differentiate mental or physical disability
And we couldn’t exclude the fact that some disability people don’t receive disability

Increased gambling severity found to significantly predict higher burdens on physical health but couldn’t predict direction

Future Research Directions
-need large sample size
-control confounders
-increase estimate precision, and representation of disordered gambling among people living with disability

Prospective design, monitors health function and problem gambling over time

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