When Problem Gambling is the Primary Reason for Seeking Addiction Treatment

An existing database was used to compare problem gamblers (N = 138) who presented for treatment of their gambling problem to two other groups: alcohol and/or drug addiction clients who also had a gambling problem (N = 280) or who did not have a gambling problem (N = 2178). Clients with gambling as their primary problem were more likely to be female; employed or retired; more highly educated; married, divorced, or widowed; without legal problems; and older than the other groups. They also had different patterns of recent mental health diagnoses and problematic substance use. The other problem gambling clients were more similar to the substance only clients. These findings indicate that those who present for treatment of problem gambling are a distinct subset of addiction clients who have gambling problems, and emphasize the importance of considering the reasons for seeking treatment, not just the presence of a gambling problem.     

Internet Gambling, Health, Smoking and Alcohol Use: Findings from the 2007 British Gambling Prevalence Survey

This study provides analysis of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9003 adults aged 16 years and over), all participants who had gambled online, bet online, and/or who had used a betting exchange in the last 12 months (6% of the total sample) were compared with all other gamblers who had not gambled via the Internet (62% of the sample). Results showed that Internet gambling and non-Internet gambling had a significant association with smoking (nicotine) and drinking (alcohol). Self-reported general health status was not significantly associated with Internet gambling but was significantly associated with offline gambling. Analysis of DSM-IV scores showed that problem gambling prevalence rate was significantly higher among Internet gamblers than non-Internet gamblers (5% versus 0.5%) and that Internet gamblers were significantly more likely to endorse individual DSM-IV items compared to non-Internet gamblers.     

Differences in Addiction Severity Between Social and Probable Pathological Gamblers Among Substance Abusers in Treatment in Rio de Janeiro

There is a strong association between pathological gambling and substance abuse. The objective of this study is to identify the differences between substance abusers with and without gambling problems. A cross sectional study was conducted interviewing with Addition Severity Index (ASI) and South Oaks Gambling Screen (SOGS), alcohol and drug abusers (N = 147) who sought treatment in specialized treatment facilities. SOGS was used to access and classify individuals into two groups: social gamblers (n = 96) and probable pathological gamblers (n = 32). Scores on ASI provided data about severity on seven areas. Several differences were found between the two groups. Cocaine was the major reason for treatment among drug abusers with gambling problems. This group had more severity problems in the areas of drug use, psychiatric, legal and family-social. Furthermore, they had more suicidal ideas, parents with gambling problems and started to play earlier than the social gamblers group. These results indicate the need to improve the services that provide treatment to alcohol and drug abusers, including routines for screening to early identification and professional education on specific treatment to substance abusers with pathological gambling.     

Abstinence Versus Harm Reduction: Considering Follow-up and Aftercare in First Nations Addictions Treatment

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential ‘Namgis Treatment Centre (NTC) program in Alert Bay, British Columbia. Intake files (n = 218) were reviewed for clients who participated in 17 different 6-week sessions over a period of two and a half years. The assessment included a telephone follow-up survey, developed in conjunction with all of the NTC staff, for clients who had been out of treatment for 3–37 months (n = 91, 52.7% male and 47.3% female participants). In total, 24 clients (26.37%) were abstinent at the time of the interview, and 67 clients (73.6%) had had a relapse on average 155.29 (SD = 167.77) days after completing treatment. Cox regression univariate and bivariate analysis revealed that pre-treatment variables were not associated with time to relapse or what happened after relapse (abstinence again, harm reduction or resuming pre-treatment consumption levels). However, the greater number of supports the client had, the more likely they were to be completely abstinent, and the less supports the client had, the more likely they were to completely relapse. NTC staff and community members were consulted on the implications of the data, and recommendations were shared with NTC policy makers. Based on the findings of this project, it is apparent, that in this context, follow-up and aftercare are critical for effective treatment.     

Factors Associated with the Severity of Gambling Problems in a Community Gambling Treatment Agency

Factors (demographics, gambling behaviors and comorbid problems) that may be related to the severity of gambling problems were investigated among 440 problem gamblers seeking treatment in an Australian outpatient treatment agency. The participants were divided into sub-threshold pathological gamblers (SPGs; N = 104) and pathological gamblers (PGs; N = 336) using Diagnostic Statistical Manual (DSM) IV diagnosis of pathological gambling. SPGs were more likely to be separated/divorced, while PGs were more likely to be single. PGs tended to be younger than SPGs. Participation in lottery games was the only form of gambling that could distinguish between the two severity groups. No significant differences were found in participation in more than one gambling session per week and average amount spent per session on various gambling activities between the two groups. PGs were more likely to report financial, relationship, employment, physical, intrapersonal, other excessive behaviors (e.g., substance problems), leisure (e.g., loneliness, boredom) and legal problems than SPGs. Implications and limitations of these findings are discussed.     

Suicide attempts by psychiatric patients in acute inpatient, long-stay inpatient and community care

Background: This study examined rates of and risk factors associated with suicide attempts by psychiatric patients under active care. It was especially focussed on the relative rates across three standard treatment settings: acute inpatient care, long-stay inpatient care and community-based care. Methods: A total of 12,229 patients in 13,632 episodes of care were rated on the Health of the Nation Outcome Scales (HoNOS) Item 2. For the purposes of the current investigation, a score of 4 was deemed to indicate a suicide attempt. Results: Incidence densities per 1000 episode days were 5.4 (95% CI = 4.8–6.1) for patients under care in acute inpatient settings, 0.6 (95% CI = 0.5–0.8) for patients under care in long-stay inpatient settings, and 0.5 (95% CI = 0.5–0.6) for patients under care in community-based arrangements. Predictors varied by treatment setting. Risk was elevated for personality disorders across all settings: 22.7 attempts per 1000 episode days (95% CI = 17.2–30.0) in acute inpatient care; 2.1 (95% CI = 1.0–4.5) in long-stay inpatient care; and 2.3 (95% CI = 1.7–3.0) in community-based care. This effect remained after adjustment for demographics. Conclusion: Rates of suicide attempts among psychiatric patients are a major issue facing contemporary mental health care systems, and risk factors vary across different treatment settings. Accepted: 8 October 1999     

Suicide rates, life satisfaction and happiness as markers for population mental health

Objective To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe. Design Ecological study correlating (Spearman’s rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group). Results An inverse association exists between suicide rates and life satisfaction (r=−0.44; 95% CI: −0.68, −0.11) and happiness (r=−0.42; 95% CI: −0.67, −0.08). Similar though weaker associations were seen with hospital discharge data and MHI−5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15–44 year olds (r=−0.31; 95% CI: −0.59, 0.04) than amongst 45–64 year olds (r=−0.47; 95% CI: −0.70, −0.14). It was strongest in the 65+ age group (r=−0.54; 95% CI: −0.75, −0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=−0.35) but a positive association was seen in Western Europe (r=0.47). Conclusions Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health.     

Problem Video Game Use and Dimensions of Psychopathology

The objective of this study was to examine associations between problem video game use and psychopathology. The Video Game Use Questionnaire (VGUQ) and the Symptom Checklist 90 (SCL-90) were administered in an international anonymous online survey. The VGUQ was used to identify problem video game users and SCL-90 assessed dimensions of psychopathology. In comparison with other video game players (n = 1789), those with problem video game use (n = 156) had significantly elevated scores on all SCL-90 subscales. When compared to the U.S. male nonpatients, a significantly greater proportion of male video game players exhibited higher levels of all psychopathology. These findings suggest that there is a non-specific relationship between various domains of psychopathology and video game use in general and problem video game use in particular.     

Estimating the Prevalence of Anxiety and Mood Disorders in an Adolescent General Population: An Evaluation of the GHQ12

Anxiety and mood disorders (AMD) may be more common among adolescents than previously thought, and epidemiological research would benefit from an easily-administered measure of AMD. We assessed the ability of the GHQ12 to estimate the prevalence of AMD in a representative sample of Ontario adolescents. Data were based on self-administered questionnaires from 3,311 students in grades 7 through 12 derived from the 2007 Ontario Student Drug Use and Health Survey. The GHQ12 showed good ability to identify probable AMD (AUC = 0.80). A threshold value of 5 appeared optimal, and based on this threshold value, the estimated prevalence of AMD in Ontario students in grades 7–12 may be 19%. Observations that individuals with a self-reported history of family disruption, substance use, gambling problems, bullying victimization, and who reported seeking professional help for a mental health problem were significantly more likely to experience probable AMD provided additional validity.     

Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy

Background: Adverse life events have been associated with increased risk of suicide. Mental disorders are also major risk factors for suicide. Matching cases and controls for mental disorder is thus appropriate in studies of suicide. This procedure was used to study the degree to which excess adversity was more common in cases who committed suicide as opposed to living controls matched for mental disorder. Methods: The study formed part of a retrospective case-control comparison of cases of suicide/undetermined death with living controls using psychological autopsy in south-east Scotland. Cases and controls were matched for age, sex and mental disorder. Informants were those closest to cases and controls. Cases and controls were assessed for life events using the Interview for Life Events. The subjects were 45 cases of suicide/undetermined death and 40 living controls. Results: Cases and controls did not differ significantly in severity of mental disorder. Adverse interpersonal events within the family (P=0.01) with an odds ratio (OR) of 9.0 (95% CI, 1.3–399) and adverse physical health-related events (OR 5.0, 95% CI 1.1–47, P=0.04) were significantly more common in cases than controls. Conclusions: Cases had significantly more adverse life events than controls overall. The categories accounting for these differences were interpersonal family adversity and physical ill-health. There were no significant differences in either the number or severity of ongoing difficulties between cases and controls. Recent adverse life events contribute to the increased risk of suicide even when age, sex and mental disorder are controlled for. Future research should examine interactions between social support and acute and chronic adversity. Accepted: 6 September 1999     

MAG Gene Variation and Cortical Gray Matter Volume in First Episode Schizophrenia

Evidence implicating myelin related genes in the pathophysiology of schizophrenia is accumulating. Abnormalities of brain structure at the onset of psychosis may be related to variation in genes such as myelin associated glycoprotein (MAG). Subjects with first episode schizophrenia (n = 30) or schizoaffective disorder (n = 11), and healthy comparison subjects (n = 43) participated in an MRI scan. Two single nucleotide polymorphisms (rs720309, rs720308) in the MAG gene were genotyped. MAG genotype variation predicted cortical gray matter volume in first episode schizophrenia patients (p = 0.039), but not in controls (p = 0.827). Cortical gray matter, total gray matter, total white matter, and ventricular cerebrospinal fluid volumes did not differ between groups. Genetic variation in the MAG gene may predict cortical gray matter volume differences in patients in the first episode of schizophrenia or schizoaffective disorder.     

A national survey of violence experienced by community mental health researchers

  Background: In recent years there has been a vigorous debate concerning the relationship between violence and mental illness. Psychiatric hospital staff are especially likely to experience violence. `Detached staff ' working in the community appear to be at greatest risk. The present study examines reported aggression towards field-based community mental health researchers (CMHRs). It aimed to investigate the nature and extent of violence experienced by CMHRs, to establish which CMHR characteristics act as precipitators of violent incidents and to identify training needs. Methods: This national survey, conducted between December 1997 and March 1998 at the Department of Mental Health, University of Exeter, used a postal questionnaire circulated among CMHRs working in England, Scotland and Wales. Results: Whilst this study did not achieve comprehensive coverage of all eligible CMHRs, it indicates that, even allowing for response bias, occupational violence is not uncommon among CMHRs: 51% (n=33) ever experienced at least one verbally violent incident, 9% (n=6) a mildly violent incident and 2% (n=1) a severely violent incident. In the 12 months preceding the study, 45% of CMHRs (n=29) had experienced at least one verbally violent incident and 8% (n=5) a mildly violent incident. Male CMHRs are more likely (P < 0.05) to experience violence than their female counterparts. Conclusions: The findings indicate a need to improve existing safety training, procedures and awareness among this occupational group. Additional comparative research among other community-based groups is, however, required. Accepted: 19 December 2000     

Threshold Assessment Grid (TAG): the development of a valid and brief scale to assess the severity of mental illness

  Background: Lack of consensus about the meaning of severe mental illness makes it difficult to prioritise the severely mentally ill for specialist mental health care. The goal of this study was to develop a valid and brief assessment of severity of mental illness. Method: Six search workshops (n = 57) using consensus techniques developed a draft assessment acceptable to users, carers, practitioners and policy makers. A two-round Delphi consultation (n = 58) was held to identify consensus on this instrument. Results: Search workshops agreed seven domains relevant to identifying the severely mentally ill: intentional and unintentional self-harm, risk from and to others, and survival, psychological, and social needs and disabilities. The Delphi consultation indicated at least agreement with all aspects in both rounds. Conclusions: The Threshold Assessment Grid (TAG) is a brief method of identifying the severely mentally ill, which has adequate face, concurrent, construct and content validity. Accepted: 10 November 1999     

Internet Gambling: An Online Empirical Study Among Student Gamblers

It has been noted that the introduction of the Internet to gambling activities may change some of the fundamental situational and structural characteristics and make them potentially more addictive and/or problematic. This study examined some of the differences between Internet gamblers and non-Internet gamblers. Based on past literature it was hypothesised that (1) males would be significantly more likely to be Internet gamblers than females, (2) Internet gamblers would be significantly more likely to be problem gamblers than non-Internet gamblers, and (3) males would be significantly more likely to be problem Internet gamblers than females. A self-selected sample of 473 student respondents (213 males; 260 females) aged between 18 and 52 years (mean age  = 22 years; SD = 5.7 years) participated in an online survey. All three hypotheses were confirmed. The results suggest the structural and situational characteristics of Internet gambling may be having a negative psychosocial impact on Internet gambling. This is most notably because of increased number of gambling opportunities, convenience, 24-h access and flexibility, increased event frequencies, smaller intervals between gambles, instant reinforcements, and the ability to forget gambling losses by gambling again immediately. It is suggested that further research needs to be carried out into the effects that the Internet has in facilitating gambling behaviour.     

Don’t Let an Opportunity Go by: Validation of the EIGHT Gambling Screen

The EIGHT Screen is a brief problem gambling screen originally designed for use by family doctors. Its wider use indicated the need for further validation. A triangulated approach used a range of measures in different settings in both the current study and findings from a number of earlier projects, and reviewed current use. The EIGHT Screen had acceptable correlations with the SOGS (r = 74–90%) and with the NODS-12 months Screen (r = 62.4%). Measurements remained relatively constant amongst a range of cultures, settings, age and gender, while few false positives were produced by the screen. The EIGHT Screen appears to be a valid tool for untrained users to identify Level 2 and 3 problem gambling in a wide range of cultures and settings.     

Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective

  Background Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. Method: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. Results: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (β-coefficient 0.257, P=0.000), a house destroyed (β-coefficient 0.148, P=0.001), female sex (β-coefficient 0.139, P=0.001), previous mental health problems (β-coefficient 0.109, P=0.009) and illiteracy (β-coefficient 0.110, P=0.009). Those with previous mental health problems (OR=4.84; 95% CI=3.04–7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR=0.38; 95% CI=0.21–0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI=1.12–4.37) and those with previous mental health problems (OR 2.84; 95% CI=1.12–4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. Conclusion: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention. Accepted: 4 December 2000     

Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1)

Background: Most definitions of severe mental illness (SMI) are categorical and assign the patient to either SMI or not-SMI status. While this is useful for some purposes, it is a rather limited approach. The purpose of the present study is to develop a new method of addressing the issue of ‘severity’, and to develop a dimensional rather than a categorical approach. The paper reports on the acceptability, reliability and validity of a method developed to collect a standard set of data covering the majority of items specified in the academic and policy literature as characterising SMI. Method: A single page form, Matching Resources to Care (MARC-1), containing most of the items used in definitions of SMI was used to collect data from community mental health staff about their current open caseload, in four co-terminous health and social services settings during a census week (n = 2139). In addition to the data from the four pilot sites, we conducted a sub-study (n = 91), in which two raters rated the same cases during the same week. Results: The MARC-1 scores were able to distinguish between patients in receipt, and those not in receipt, of specific types of community care (level of care, eligibility for care and statutory aftercare) (P < 0.001). The MARC-1 score was modestly but significantly correlated (r = 0.28) with the Global Assessment Scale (P < 0.001). The mean percentage inter-rater agreement for the MARC-1 score items was 87%. Conclusion: It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community. Accepted: 7 March 2000     

Posterior fossa tumors in children: how long does it take to establish the diagnosis?

Objective The aim of this study is to evaluate, for our patient population, the time interval from the first chart-documented symptom to the radiological diagnosis in children and infants with posterior fossa tumors. Materials and methods We retrospectively analyzed 50 consecutive children (36 men, 14 women) with posterior fossa tumor treated at our department between January 1999 and December 2003. The mean age at time of diagnosis was 98 months (6 months–16 years). The mean follow up was 27 months (6–61 months). The diagnoses included astrocytoma (n = 17), medulloblastoma (n = 15), ependymoma (n = 6), and other tumors (n = 12). Results The mean time interval between onset of symptoms and radiographic diagnosis was 142 days (5–535 days), the median was 59 days. The mean time for Grade I and II tumors was 238 days (n = 19) and for tumors Grade III and IV 117 days (n = 31). The most common presenting symptoms were headache, nausea, vomiting, ataxia, and oculomotor deficits. Approximately half of the patients were initially diagnosed and treated for other diseases (gastrointestinal infection, appendicitis, psychological behavioral problems, cervical spine strains, different ophthalmologic entities). Specialists (ophthalmologists, orthopedics) tended to diagnose and treat their specific diagnoses (e.g., strabism, torticollis). Parents play a significant role in the process of establishing the correct diagnosis. Conclusion We conclude that further information and education regarding symptomatology and diagnosis of posterior fossa tumors in children is necessary. Communication has to be improved between parents and referring physicians of all specialties and neurosurgeons.