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Impulse-Control Disorders

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Research articles:

Barry, D. T., Steinberg, M. A., Wu, R., & Potenza, M. N. (2009). Differences in characteristics of Asian American and White problem gamblers calling a gambling helpline. CNS Spectrums, 14(2), 83-91. Retrieved from EBSCOhost.

Introduction: The characteristics of Asian American and white problem gamblers using a gambling helpline were examined to identify race-related differences. Methods: Logistic regression analyses were conducted on data obtained from callers to a gambling helpline serving southern New England in 2000-2003, inclusive. Results: Of the 144 phone calls used in the analyses, 72 were from Asian American callers and 72 were from white callers who were matched on gender, education, income, marital/cohabitation status, and age. Race-related differences were observed in forms of gambling problems, psychiatric problems secondary to gambling, substance use problems, and family history. Asian American gamblers were more likely to report suicide attempts related to gambling and problems with non-strategic gambling. White gamblers were more likely to report both casino and non-casino gambling problems and personal and familial alcohol use problems. High proportions of both groups reported problems with strategic gambling, gambling-related anxiety, family and financial problems secondary to gambling, financial debt, daily tobacco use, and a family history of problem gambling. Conclusion: Race-related differences should be considered in optimizing prevention and treatment strategies related to problem gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Battersby, M., Tolchard, B., Scurrah, M., & Thomas, L. (2006). Suicide ideation and behaviour in people with pathological gambling attending a treatment service. International Journal of Mental Health and Addiction, 4(3), 233-246. doi:10.1007/s11469-006-9022-z

This study aimed to describe the 12-month period prevalence and risk factors for suicidal ideation and behaviour in a cohort of patients with pathological gambling attending a treatment service. Seventy-nine people with a diagnosis of pathological gambling received a mail out survey that included questions on postulated risk factors for suicidal ideation and behaviour, the modified Suicide Ideation Scale (SIS), the South Oaks Gambling Screen (SOGS), the Beck Depression Inventory (BDI) and the CAGE. A total of .54.4% of the surveys were returned completed. There were 81.4% who showed some suicidal ideation and 30.2% reported one or more suicide attempts in the preceding 12 months. Suicidal ideation and behaviours were positively correlated with the gambling severity (SOGS scores), the presence of debt attributed to gambling, alcohol dependence and depression (BDI). Suicidal ideation/behaviour was not significantly associated with gender and living arrangements, nor a history of receiving treatment for depression during the preceding 12 months. People with pathological gambling attending a treatment service had higher levels of suicidal ideation and behaviour than previous studies. Pathological gambling should be seen as a chronic condition with a similar risk for suicidal ideation and behaviour as other mental illnesses. Counselling services, general practitioners and mental health services should screen for gambling problems when assessing risk after suicide attempts and for suicide risk in patients presenting with gambling problems and co-morbid depression, alcohol abuse and a previous suicide attempt. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Blinn-Pike, L., & Worthy, S. (2008). Undergraduate women who have gambled in casinos: Are they at risk?. Family and Consumer Sciences Research Journal, 37, 71-83. doi:10.1177/1077727X08322861

The aim of this study is to describe female undergraduates who have gambled in casinos compared with their peers who have never participated in casino gambling or gambling in any form. Pathological gambling has been linked to financial problems, marital stress, lost time at work and school, depression, and even suicide. Female students (n = 179, mean age 21.64) from a southeastern university are questioned about their gambling behaviors, sensation-seeking traits, and alcohol consumption. Female college students who have participated in casino gambling have higher sensation-seeking scores, higher scores on a measure of gambling severity, consumed alcohol on more occasions over the past 30 days, and have binge drunk more frequently than their peers. Implications are presented for gambling prevention and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Evelyn J., B., Johan M., H., Nathan, T., Stanislav, K., Roman, K., & Semyon, G. (2007). Suicide ideation, plans and attempts in Ukraine: Findings from the Ukraine world mental health survey. Psychological Medicine, 37(6), 807-819. Retrieved from EBSCOhost.

Background. Because the suicide rates in Eastern Europe have increased, the epidemiology of suicide behaviors in this part of the world is in urgent need of study. Using data from the Ukraine site of the World Mental Health (WMH) Survey Initiative, we present the first population-based findings from a former Soviet country on the descriptive epidemiology of suicide ideation, plans and attempts, and their links to current functioning and service utilization.Method. In 2002, a nationally representative sample of 4725 adults in Ukraine was interviewed with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Risk factors included demographic characteristics, trauma, smoking, and parental and personal psychiatric disorders. Current functional impairments and recent service utilization were assessed.Results. The lifetime prevalence of suicide ideation was 8·2%. The average age of onset was 31. The key risk factors were female sex, younger age, trauma, parental depression, and prior alcohol, depressive and intermittent explosive disorders, especially the presence of co-morbidity. Ideators had poorer functioning and greater use of health services. One-third of ideators had a plan, and one-fifth made an attempt. Among ideators, young age, smoking and prior psychiatric disorders were risk factors for these behaviors.Conclusions. Together with the increasing suicide rate, these results suggest that suicide intervention programs in Ukraine should focus on the generation of young adults under 30. The associations with co-morbidity, impairments in current functioning and greater service use indicate that a physician education program on suicidality should be comprehensive in scope and a public health priority in Ukraine. [ABSTRACT FROM AUTHOR]

Hodgins, D., Mansley, C., & Thygesen, K. (2006). Risk factors for suicide ideation and attempts among pathological gamblers. American Journal on Addictions, 15(4), 303-310. doi:10.1080/10550490600754366

The link between pathological gambling and suicide is poorly understood. The current study has two major goals: to provide descriptive information about suicide ideation and attempts among pathological gamblers trying to quit, and to identify predictors of suicidal ideation and attempts, with a particular emphasis on mood and substance use disorders. A community sample of 101 individuals with gambling problems who had made a recent quit attempt was assessed using structured instruments. Of these, 28.7% reported no history of suicide ideation or attempts, 38.6% reported having only thoughts of suicide, and 32.7% reported a suicide attempt. Ideation predated the onset of gambling problems by an average of greater than ten years. History of ideation was increasingly likely with a greater severity of gambling problem as determined by DSM criteria. Those experiencing ideation were also more likely to over gamble on gambling days and five times more likely to have a history of depression. Substance abuse history was the only factor that distinguished between individuals who had a history of suicide attempts versus ideation only. Having a drug history was related to a more than six times greater likelihood of having made a suicide attempt. Gambling-related suicide attempts were relatively rare—21.2% of attempters, or 7% of the total sample. These findings are consistent with the common factor model of etiology in which the suicidality of gambling is related to prior mental health disorders. More research on the relationship between alcohol and other drug disorders and their complex relationship to pathological gambling and suicide is crucial. (Am J Addict 2006;15:297–302) [ABSTRACT FROM AUTHOR]

Kausch, O. (2005). Suicidality among pathological gamblers. Directions in Psychiatry, 25(4), 291-300. Retrieved from EBSCOhost.

Pathological gambling is an important public health problem. Pathological gamblers frequently suffer from comorbid psychiatric conditions and are at risk for suicidal behavior, including completed suicide. Little is known about completed suicide among pathological gamblers. This lesson presents data from two studies of completed suicide and one study of suicide attempts among pathological gamblers. Two case reports are also presented. Issues discussed include demographic factors of gamblers who complete suicide, suicidal communications, the role of comorbidity and childhood trauma, and the relationship between suicide attempts and completed suicide. The limitations of studies in clinical decision-making and the development of a risk reduction plan are discussed. After completing this lesson, it is hoped that the clinician will have a greater understanding of the factors that may increase the risk of suicidal behavior among pathological gamblers and will further be able to utilize this understanding more generally in assessing suicidal risk in other patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Lejoyeux, M., Arbaretaz, M., McLoughlin, M., & Ades, J. (2002). Impulse control disorders and depression. Journal of Nervous & Mental Disease, 190(5), 310-314. Retrieved from EBSCOhost.

This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).

McCloskey, M. S., Ben-Zeev, D., Lee, R., & Coccaro, E. F. (2008). Prevalence of suicidal and self-injurious behavior among subjects with intermittent explosive disorder. Psychiatry Research, 158(2), 248-250. doi:10.1016/j.psychres.2007.09.011

Abstract: The prevalence of suicidal attempts and self-injurious behavior among 376 subjects diagnosed with Intermittent Explosive Disorder (IED) was assessed via structured interviews. Results showed 16% of IED subjects reported self-aggression, with 12.5% reporting suicide attempts and 7.4% reporting non-lethal self-injurious behaviors. Additional risk factors were identified. [Copyright &y& Elsevier]

Newman, S. C., & Thompson, A. H. (2007). The association between pathological gambling and attempted suicide: Findings from a national survey in Canada. Canadian Journal of Psychiatry, 52(9), 605-612. Retrieved from EBSCOhost.

Objective : To examine the association between pathological gambling (PG) and attempted suicide in a nationally representative sample of Canadians. Methods : Data came from the Canadian Community Health Survey, Cycle 1.2, conducted in 2002, in which 36 984 subjects, aged 15 years or older, were interviewed. Logistic regression was performed with attempted suicide (in the past year) as the dependent variable. The independent variables were PG, major depression, alcohol dependence, drug dependence, and mental health care (in the past year), as well as a range of sociodemographic variables. Survey weights and bootstrap methods were used to account for the complex survey design. Results : In the final logistic regression model, which included terms for PG, major depression, alcohol dependence, and mental health care, as well as age, sex, education, and income, the odds ratio for PG and attempted suicide was 3.43 (95% confidence interval, 1.37 to 8.60). Conclusions : PG (in the past year) and attempted suicide (in the past year) are associated in a nationally representative sample of Canadians. However, it is not possible to say from these data whether this represents a causal relation. [ABSTRACT FROM AUTHOR]

Nower, L., Gupta, R., Blaszczynski, A., & Derevensky, J. (2004). Suicidality and depression among youth gamblers: A preliminary examination of three studies. International Gambling Studies, 4, 69-80. doi:10.1080/1445979042000224412

Both suicide and problem gambling among youth are two growing areas of public health concern, though studies have yet to characterise the relationship between these issues. Youth report higher prevalence rates of problem gambling than adults, but no studies to date have investigated whether they are likewise prone to higher risks of gambling-related suicidality. This article explores the relationship of depression, suicidality, and problem gambling in youth in three studies of middle and high-school students (total N = 3,941; males n = 1,937, females n = 2,004) conducted in 1996, 2000, and 2001 in Quebec and Ontario. All studies reported significantly higher rates of suicidality among problem and pathological gamblers as compared to non-gamblers and social gamblers, irrespective of gender, grade, or level of depression. The implications for future investigations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Wong, P. C., Chan, W. C., Conwell, Y., Conner, K. R., & Yip, P. F. (2010). A psychological autopsy study of pathological gamblers who died by suicide. Journal of Affective Disorders, 120(1-3), 213-216. doi:10.1016/j.jad.2009.04.001

Abstract: Background: Pathological gambling is associated with suicidal ideation and attempt. There is no known report on pathological gambling preceding suicide. By examining a series of 17 suicide cases with evidence of pathological gambling prior to death, we sought to generate hypotheses for further study of this under-researched but rapidly-increasing worldwide public health problem. Method: Psychological autopsy interviews using a semi-structured format were conducted with proxy respondents for suicide and control subjects aged 15–59 years in Hong Kong SAR, China. Results: Of the 150 suicides and 150 controls examined, 17 suicides (11.3%) and one control case (0.6%) met criteria for the diagnosis of pathological gambling at the time of death or interview. All 17 suicide cases with pathological gambling had unmanageable debt at the time of death. Fourteen cases (82.4%) had other associated psychiatric disorders, most often major depressive disorders (n =10, 58.9%) and substance-use disorders (n =3, 17.6%). None had ever received psychiatric treatment. Limitations: Descriptive, retrospective case series with a small sample size. Conclusions: Along with unmanageable debt, a high proportion of the suicide cases with pathological gambling also experienced other psychiatric illnesses, most often depression, at the time of death. None sought treatment for their addictive behavior or psychiatric illness prior to death. Pathological gambling is a modifiable risk factor for suicide for which means to enhance case identification and engagement in treatment are urgently needed. Clinicians treating depression should explore the presence of pathological gambling behavior or unmanageable debts among their patients. Addressing pathological gambling should be one important component of a comprehensive suicide prevention strategy especially in countries where gambling activities are legalized and expanding. [Copyright &y& Elsevier]

Zangeneh, M., & Hason, T. (2006). Suicide and gambling. International Journal of Mental Health and Addiction, 4(3), 191-193. doi:10.1007/s11469-006-9030-z

Problem gambling is a recent issue that has received some negligible attention as a factor playing a role in suicidal ideation and/ or behavior. There are a host of factors that are suggested to play a direct or indirect role in suicidal ideation and/or suicidal behavior. It has been suggested that problem gamblers have high rates of both suicidal ideation and suicide attempts. Turning to this issue, three articles present their findings in relation to suicide and problem gambling. One of the articles describe the 12 month period prevalence and risk factors for suicidal ideation and behavior in patients with pathological gambling who attended a treatment service. The other article reported that suicidal ideation and behaviors were positively correlated with several factors including the gambling severity and the presence of debt attributed to gambling. In the final article, patients were tested positive for problem gambling, with half having attempted suicide in the past. It was concluded that problem gambling amongst those who had attempted suicide could be considered as an important factor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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