Effect of genes, environment, and lifetime co-occurring disorders on health-related quality of life in problem and pathological gamblers

Background: Problem and pathological gambling are associated with many impairments in quality of life, including financial, family, legal, and social problems. Gambling disorders commonly co-occur with other psychiatric disorders, such as alcoholism and depression. Although these consequences and correlates have been reported, little is known about the health-related functional impairment associated with gambling. Objective: To model differences in the health-related quality of life (HRQoL) among non-problem gamblers, problem gamblers, and pathological gamblers after controlling for lifetime co-occurring substance use disorders, psychiatric disorders, sociodemographics, and genetic and family environmental influences. Design: Cohort and co-twin studies. Setting: Nationally distributed community sample. Patients: Male twin members of the Vietnam Era Twin Registry: 53 pathological gamblers, 270 subclinical problem gamblers, and 1346 non-problem gamblers (controls). Interventions: We obtained HRQoL data, via the 8-Item Short-Form Health Survey, from all participants. Data from a subset of twin pairs discordant for gambling behavior was used to control for genetic and family environmental effects on HRQoL and problem gambling. Main Outcome Measure: Health-related quality of life. Results: Results from adjusted logistic regression analyses suggest little difference across groups in the physical domains of the health survey; however, for each mental health domain, pathological gamblers had lower HRQoL scores than problem gamblers (P<.05), who in turn had lower scores than non-problem gamblers (P<.05). After controlling for genes and family environment, no significant differences existed between the non-problem gambling twins and their problem or pathological gambling brothers, but adjusted co-twin analyses resulted in statistically significant differences in 4 of 8 subscales. Conclusions: Pathological and problem gambling are associated with significant decrements in HRQoL. This association is partly explained by genetic and family environmental effects and by lifetime co-occurring substance use disorders. Implications for clinicians, health care utilization, and public health issues are discussed.