Patients with depression and those who drink at risky levels are more than twice as likely to report gambling problems, a UK primary care study has shown.

A total of 1,058 patients attending 11 general practices in the Bristol area were recruited from practice waiting rooms. They were asked to complete anonymous questionnaires that covered mental health problems, addictive behaviours together with the gambling-related questions. Patients reporting gambling were asked to complete the Problem Gambling Severity Index (PGSI). The practices included four from areas of high deprivation, two from areas of low deprivation, three from areas of moderate deprivation, one student health service and one for the homeless.

Overall 0.9% of patients screened were assessed as having significant gambling-related problems (PGSI ≥ 5) while a further 4.3% were found to have low to moderate severity gambling problems. Furthermore, 7.2% of patients surveyed identified gambling problems in a relative.

Patients screening positive for depression on the questionnaire were twice as likely to report gambling problems: odds ratio (OR) 2.08 (95% CI: 1.15-3.94); those with at-risk alcohol use almost three times as likely OR 2.78 (95% CI: 1.60-4.89); and those who used drugs five times more likely OR 5.03 (95% CI: 2.78-8.99).

Overall there were particularly high rates of reported gambling-related problems in young males aged 18-24 years, with a problem gambling rate of 25.4% (95% CI: 15.6-38.2%).

Those patients from high deprivation areas, including the homeless service,  and those attending the student health service appeared to have higher rates of gambling problems compared with practices in moderate or low deprivation areas, but these observations did not reach statistical significance in this small study.

While for many gambling is harmless fun, problematic gambling has been increasingly highlighted as a public health concern in the UK. Harmful gambling for some can become pathological with features of dependent behaviour.

Problem gambling is associated with anxiety disorders and with suicidal thoughts and behaviour. Gamblers are twice as likely to see their GP for mental health symptoms than those who don’t have a gambling problem.

Given that around one in 20 patients routinely attending general practice report some degree of gambling-related problems, GPs and other primary care staff need to be vigilant for gambling problems, particularly among young men and those who are depressed, drink excessively, or who misuse substances. Ideally, they should be able to signpost patients towards resources to support these problems. The authors say that current resources for addressing gambling problems are ‘grossly inadequate’ and need further development. 

Dr Jez Thompson