Incidence and predictors of problem gambling in first-episode psychosis: A prospective multicentre cohort study.

BACKGROUND

Psychiatric comorbidities are common in first-episode psychosis (FEP) and hinder recovery. Problem gambling (PBG), despite potentially serious clinical consequences, remains under-investigated in this population. This study aimed to estimate the incidence of PBG in FEP and identify predictive factors.

METHODS

This prospective cohort study was conducted at two FEP programmes in Quebec, Canada. Individuals aged 18-35 years diagnosed with FEP between November-1-2019 and January-31-2023 were screened for PBG using the Problem Gambling Severity Index through May-1-2023. The primary outcome was incident PBG. Time-varying Cox regression models were used to estimate hazard ratios (HRs) for candidate predictors.

RESULTS

Among 520 individuals without prior PBG (mean age = 24.6±4.0 years; 28.8% women), 18 developed PBG during a mean follow-up of 478 days, yielding an incidence rate of 2.6 cases/ 100 person-years. In site-adjusted analyses, white ethnicity (HR = 9.7; 95%CI = 1.3-74.8), incomplete high school education (HR = 2.8; 95%CI = 1.1-7.2), stimulant use disorder (HR=2.8; 95%CI = 1.0-7.3), use of D2/D3-5-HT1A partial agonists (HR = 4.6; 95%CI = 1.5-14.1), and prior non-problematic gambling (HR = 3.1; 95%CI = 1.1-8.4) predicted increased risk. Thirteen cases occurred during aripiprazole treatment, which remained associated with increased PBG risk after multivariable adjustment (adjusted HR = 4.7; 95%CI = 1.6-13.9).

CONCLUSIONS

Despite the limited number of incident cases, these results suggest that PBG is relatively common PBG and is associated with potential risk factors, including white ethnicity, incomplete high school education, stimulant use disorder, prior non-problematic gambling, and treatment with D2/D3-5-HT1A partial agonists, particularly aripiprazole. These findings underscore the importance of routine screening for PBG and risk-informed antipsychotic prescribing in FEP.