Dept. of Psychiatry & Behavioral Health, Penn State University College of Medicine, 500 University Dr., Hershey, PA 17033, USA.
St. David's Medical Center, 1015 E 32 nd Street, Suite 408, Austin, TX 78705, USA.
Addict Behav. 2021 Jul;118:106872. doi: 10.1016/j.addbeh.2021.106872. Epub 2021 Feb 16.
There is a frequent occurrence of gambling disorder (GD) in patients with major depressive disorder (MDD). Psychiatric comorbidities can present more severely in patients diagnosed with pathological gambling. There is limited information on symptom trends in MDD patients with GD, particularly in association with suicidality.
Our primary aim was to compare baseline characteristics in MDD patients with and without a GD diagnosis. The secondary aim was to assess the rate of suicidality (suicidal ideation/attempt) between groups and evaluate any predictors that may be associated with an increased risk of suicidal behavior. In addition, we also assessed the variation in gambling trends in MDD patients over several years.
Data for the study were obtained retrospectively from the Nationwide Inpatient Sample (NIS) dataset for the years 2006-2017. Our primary patient cohort was composed of patients age ≥ 18 years; admitted to the hospital with a primary diagnosis of MDD and a secondary diagnosis of GD. For baseline characteristics and suicidality, we compared these patients to MDD patients without a GD diagnosis. In addition, we also assessed the trends of baseline characteristics in MDD patients with GD over the years.
A total of 6646 patients were included in the MDD with GD group, and compared with 4,021,063 MDD patients without a GD diagnosis. More patients in MDD with GD group were older, white, and male. Alcohol abuse and obesity were seen more commonly in the GD group. In the outcome analysis, suicidal ideation (45.4% vs. 39.5%, p < 0.001), suicide attempt (7.2% v. 4.5%, p < 0.001) and composite of suicidal ideation/attempt (50.7% vs. 43.1%, p < 0.001) were more common in MDD with GD group compared to MDD without GD. In the multivariate analysis, GD was associated with higher odds of suicidality (Odds Ratio: 1.42 (1.35-1.49), p < 0.001). For the in-hospital trend analysis, we observed that, out of all MDD related admissions, comorbid GD related admissions decreased from 0.20% in 2006-2008 to 0.12% in 2015-2017. Among MDD patients with GD, there was an upward trend of inpatient admissions for non-white race, and Southern part of the United States (US) and a downward trend white race, and Western part of the US.
There is a higher risk of suicide, with an upward trend over the years in MDD patients with GD when compared to MDD patients without GD. Also, the prevalence of alcohol abuse was high in the GD group. Increased resource allocation and efforts to raise awareness campaigns for suicide prevention are needed to address the morbidity in this vulnerable patient population.
在患有重度抑郁症（MDD）的患者中，赌博障碍（GD）经常发生。在被诊断为病态赌博的患者中，精神共病可能表现得更为严重。关于 MDD 合并 GD 患者的症状趋势的信息有限，特别是与自杀意念相关的信息。
我们的主要目的是比较 MDD 患者中有无 GD 诊断的基线特征。次要目的是评估自杀意念/自杀企图的发生率（自杀意念/自杀企图）在各组之间，并评估任何可能与自杀行为风险增加相关的预测因素。此外，我们还评估了 MDD 患者在几年内的赌博趋势变化。
本研究的数据从 2006 年至 2017 年的全国住院患者样本（NIS）数据集回顾性获得。我们的主要患者队列由年龄≥18 岁的患者组成；因主要诊断为 MDD 和次要诊断为 GD 而住院。对于基线特征和自杀意念，我们将这些患者与无 GD 诊断的 MDD 患者进行了比较。此外，我们还评估了 MDD 合并 GD 患者的基线特征在过去几年中的趋势。
共有 6646 名患者纳入 MDD 合并 GD 组，与 4021033 名无 GD 诊断的 MDD 患者进行了比较。MDD 合并 GD 组中更多的患者年龄较大、为白人、为男性。酒精滥用和肥胖在 GD 组中更为常见。在结果分析中，与无 GD 的 MDD 患者相比，MDD 合并 GD 组中自杀意念（45.4%比 39.5%，p<0.001）、自杀企图（7.2%比 4.5%，p<0.001）和自杀意念/企图复合症状（50.7%比 43.1%，p<0.001）更为常见。多变量分析显示，GD 与自杀意念的发生风险更高相关（优势比：1.42（1.35-1.49），p<0.001）。对于住院期间的趋势分析，我们观察到，在所有与 MDD 相关的住院患者中，合并 GD 相关的住院患者比例从 2006-2008 年的 0.20%下降到 2015-2017 年的 0.12%。在 MDD 合并 GD 的患者中，非白种人的住院比例呈上升趋势，而美国南部和白种人的住院比例呈下降趋势，美国西部。
与无 GD 的 MDD 患者相比，MDD 合并 GD 患者的自杀风险更高，且呈逐年上升趋势。此外，GD 组中酒精滥用的发生率较高。需要增加资源分配并加强自杀预防宣传活动，以解决这一弱势群体患者的发病率问题。
