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IIR 04-212 – HSR&D Study

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IIR 04-212
Relationship of General, Behavioral and Emotional Health among Veterans Receiving VA Health Care
Joseph Westermeyer MD PhD MPH
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, MN
Funding Period: July 2006 - December 2008

BACKGROUND/RATIONALE:
Previous studies have suggested that prevalence rates of Pathological Gambling (PG) and problem gambling (pg) might be excessively high among veterans.

OBJECTIVE(S):
We investigated the nature and extent of PG and pg in veterans receiving VA health care. We determined the comorbidity of psychiatric diagnoses and symptoms, identified associated demographic and clinical risk factors, and recommended focused screening and intervention.

METHODS:
We selected a random sample of veterans receiving care in 2006 and 2007 at Albuquerque VAMC and Minneapolis VAMC and their associated Community Based Outpatient Clinics. Women and younger veterans were oversampled. The 2,199 veterans answered approximately two hours of computerized diagnostic, symptomatic, demographic, and behavior questionnaires.

FINDINGS/RESULTS:
Lifetime prevalence rate of PG was 2.6%, two to three times the general adult population rate. Current prevalence of PG was 1.5%, with 0.2% continuing pg, and 0.9% recovered. Lifetime pg rate was 7.1%. Altogether, 9.7% had lifetime PG or pg. Increasing anxiety, mood, cognitive, and substance symptoms accompanied pg. Mood, anxiety and substance use disorders were highly comorbid with PG.
Women had higher prevalence rates of PG, while pg rates were similar in men and women. The greater prevalence for ages 20-29 (1.3%) than for 30-39 (0.8%) is unusual and warrants further investigation. Ethnic self-identification showed no statistically significant differences in lifetime PG, while pg showed only modest differences. Demographic factors unrelated to PG and pg included age, education, residence, employment, and marital status.
Among these veterans, 2.9% reported that gambling was a problem for them, while only 1.4% had ever seen a professional for gambling problems. Of those who sought treatment for PG or pg in the past year, 53% could not obtain care. Veterans with PG utilized more mental health services than others. More veterans with PG thought that they should have sought mental health care in the past, but felt less likely to seek treatment if needed in the future.

IMPACT:
These findings suggest that, without intervention, pg often progresses to PG and ultimately to severe problems and disability. Targeted screening and intervention in VA-sponsored women's, mental health, and selected clinics are likely to reduce morbidity, disability, and cost of care.

PUBLICATIONS:

Conference Presentations

  1. Westermeyer J. Problem and Pathological Gambling Among Veterans in Clinical Care: Prevalence and Demographic Risk Factors. Paper presented at: American Psychiatric Association Annual Meeting; 2011 May 17; Honolulu, HI.
  2. Westermeyer J. PTSD Among American Indian Veterans: Is it More Comorbid With Externalizing or Internalizing Disorder? Paper presented at: American Psychiatric Association Annual Meeting; 2011 May 15; Honolulu, HI.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: none
Keywords: Behavior (patient)
MeSH Terms: none

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