Lexa W Lee

October 18, 2007

October 18, 2007 (New Orleans) — Pathological gambling (PG) is more prevalent among military veterans than in the US general population and may be associated with combat-related posttraumatic stress disorder (PTSD), results of a new study suggest.

The findings were presented here at the American Psychiatric Association 59th Institute on Psychiatric Services.

PG, which is classified as an impulse-control disorder (persistent and recurrent behavior), is estimated nationally at 1% to 2% of the population, the researchers, with lead author Robert Hierholzer, MD, a psychiatrist at Veterans Administration (VA)–Central California, in Fresno, write. Problem gambling, defined as the urge to gamble despite harmful consequences, affects an additional 2% to 4% of the population.

Potential risk factors for gambling problems have been proposed; different studies of veterans undergoing treatment for PTSD have shown their current rate of problem gambling to range from 0 to as high as 17%, with a lifetime prevalence of 29%.

However, most large surveys of mental disorders among combat veterans do not include problem gambling, Dr. Hierholzer said. The goals of this pilot study were to obtain an estimate of PG within the past year among combat veterans seen in a clinical setting and assess the feasibility of conducting research on such "sensitive issues" among veterans, specifically examining the time required to complete questionnaires and participant distress level while completing them.

Pathologic Gamblers

All subjects were seen between June and September 2006. They completed the South Oaks Gambling Screen (SOGS) and a demographic questionnaire. All responses were anonymous. Data for 120 subjects were analyzed. Sex was 100% male, 75% were 56 to 60 years old, 92% were combat veterans, 80% were Vietnam vets, 71% were married or in committed relationships, and 75% had a VA diagnosis of PTSD.

The authors found that 85% of the participants had gambled sometime in the past year, and 20% of the total were classified as "probable pathologic gamblers" based on SOGS. Another 4.2% were classified as "problem gamblers."

Among the subjects, 87% found that completing the questions was "not distressing." Those with gambling problems were more likely to find this "a little" or "fairly" distressing. Gambling status was not significantly associated with period of service, combat exposure, relationship status, or age.

Study Limitations

The study was limited by its specific setting of a veterans' hospital, which does not include all combat veterans; its age range; and the proximity of the area to gambling venues, which, the authors note, is not typical of every setting. The influence of depression and substance use was not investigated, nor was causation of PG.

The researchers conclude that the rate of current PG as assessed by the SOGS was much higher for these veterans than for the general US population. While PTSD or combat exposure could not be specifically linked to PG, the findings suggest the importance of further investigating possible connections in clinical populations of veterans, they write. Study participation was not perceived as distressing by most participants, but it was moderately distressing to those with gambling problems.

"Pathological gambling in a clinical sample of US combat veterans is very high compared with its prevalence in the general population," Dr. Hierholzer told Medscape Psychiatry. "One next step would be to look at the broader veteran population."

Tara Strine, an epidemiologist at the Centers for Disease Control and Prevention, in Atlanta, Georgia, said, "This study is interesting because it shows that a high percentage — 20% — of these folks [veterans] are classified as having problematic gambling.

"This warrants a lot larger sample size and further research, especially as the prevalence of PTSD [in this population] is also high," she said.


This study received no funding. Dr. Hierholzer and Ms. Strine report they have no relevant financial relationships.


American Psychiatric Association 59th Institute on Psychiatric Services: Poster 155. Presented October 13, 2007.


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