TOPLINE:
Problem gamblers have an 89% risk for long-term work disability, a new study suggests. Women, older persons, and those with psychiatric comorbidities or a history of psychotropic medication use were at highest risk.
METHODOLOGY:
The study included 2830 adults diagnosed with a gambling disorder (GD) in specialized healthcare (mean age, 35 years; 77% male) and 28,300 adults from the general population matched for age, sex, education, country of birth, and area of residence.Using linked health, demographic, and social insurance registers in Sweden, researchers assessed long-term (> 90 days a year) work disability, defined as sickness, absence and disability pension, during the 3 years before and the 3 years after GD diagnosis.Researchers applied statistical models and adjusted for important socioeconomic and health-related confounders.
TAKEAWAY:
In the fully adjusted model, there was an elevated risk for work disability starting from the year prior to GD diagnosis (adjusted odds ratio, 1.89; 95% CI, 1.67-2.13).The proportion with long-term disability among those with GD increased steadily during the years leading up to diagnosis, peaked the year before the diagnosis (33.6%), and remained elevated 2 years (28.9%) and 3 years (28.3%) after diagnosis. Among the matched cohort, work disability remained stable throughout the study period, at about 8% per year.Prior psychiatric diagnoses (anxiety, depression, and attention-deficit/hyperactivity disorder), female sex, older age, and use of psychotropic medications, particularly antidepressants, were factors associated with risk for long-term work disability among those with GD.Trajectory models identified four patterns of work disability: The “constant low” group (60.3% of the GD group) had low levels of work disability before and after the GD diagnosis, the “low and increasing” group (11.4%) had increased work disability throughout the study, and increases in work disability in the “constant high” (17.1%) and “medium-high and decreasing” (11.1%) groups were interrupted after GD diagnosis.
IN PRACTICE:
Because preventing and treating problem gambling in the workplace and elsewhere may involve obstacles such as stigma, embarrassment, and not wanting to disclose the reason for being absent from work, “systematic screening via health check-ups regularly conducted at the workplace could increase early detection,” the authors write.
SOURCE:
The study was conducted by Viktor Månsson, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden, and colleagues. It was published online on November 20, 2023, in Psychological Medicine.
LIMITATIONS:
There were no data on the first 14 days of sickness absence, when sickness benefits are paid by the employer, leading to underestimation of work disability. The study didn’t include primary care or individuals seeking help via social services, self-help groups, anonymous gambling helplines, or similar resources. The actual onset of gambling problems was unknown, and assuming a directionality in the association between such problems and work disability was not possible.
DISCLOSURES:
The study was funded by the Region of Stockholm and the Swedish Research Council for Health, Working Life and Welfare. The authors declared no competing interests concerning the work.
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