Towards a comprehensive developmental model of pathological gambling.

AIMS: To develop a comprehensive etiological model of pathological gambling (PG) for men and women based on Kendler's development model for major depression, which groups 22 risk factors into five developmental tiers (childhood, early adolescence, late adolescence, adulthood, last year). We hypothesized that: (1) all risk factors would be associated significantly with PG; (2) the effect of risk factors in earlier developmental tiers would be accounted for by later tiers; and (3) there would be few gender differences.

DESIGN

Separate models were built for life-time gambling and for 12-month PG among those with life-time gambling.

SETTING

Data drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the United States.

PARTICIPANTS

Respondents to NESARC wave 1 (n = 43 093).

MEASUREMENTS: Odds ratios (OR) and adjusted OR (AOR) were used to determine the risk factors in multiple models.

FINDINGS: After mutually adjusting for other risk factors, family history of substance use disorders (SUD) or depression, impulsivity, childhood-onset anxiety, number of Axis I and II disorders, history of SUD, nicotine dependence, social deviance in adulthood, and past-year history of SUD, nicotine dependence and independent stressful life events predicted life-time gambling. Past history of PG, number of personality disorders and past year nicotine dependence were associated significantly with 12-month PG (all P < 0.05). There were no significant gender interactions for 12-month PG.

CONCLUSIONS

A modification of Kendler's model for major depression provides a foundation for the development of a comprehensive developmental model of pathological gambling. Life-time history of gambling and 12-month pathological gambling appear to be determined by risk factors in several developmental levels, with the effect of earlier development tiers accounted for by later ones.