Abstract

Aims

To synthesize evidence regarding gambling problems in primary care contexts as evidence suggests that problem gambling may be overrepresented. Objectives were to review all the available evidence regarding the frequency and implications of gambling problems in primary care. The latter were operationalized by covariates relating to physical and mental health that suggest clinical implications, as well as co-occurring addictive behaviors.

Methods

Peer-reviewed articles published in MEDLINE, Embase, PsycINFO, CINAHL, and sociological abstracts reporting data relating to gambling and associated problems were screened. Where possible, random-effects meta-analysis was used to combine study estimates.

Findings

The search identified 14 articles (based on 11 individual studies) from 1708 deduplicated records. Meta-analyses of data from 10 studies indicated around 3.0% of patients reported significant levels of problem gambling, although there was substantial heterogeneity and rates ranged from around 1 to 15% across studies. In contrast, there were few studies reporting findings relating to gambling problems across a broader continuum of severity, and there is little known about subclinical problems (i.e. at-risk gambling) in primary care. There was generally consistent evidence of links between problem gambling and poor mental health and co-occurring substance use problems. In contrast, there was less evidence regarding the physical health implications of problem gambling in primary care.

Conclusions

Primary care may provide an important environment for the detection of gambling problems and should identify patients reporting gambling problems across a continuum, consistent with principles of case finding; thereby targeting investigation on those suspected to be ‘at risk’.

中文翻译：

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初级保健中的赌博问题：系统评价和荟萃分析

摘要

目的

综合有关初级保健背景下赌博问题的证据，作为证据表明问题赌博可能被过度代表。目的是审查有关初级保健中赌博问题的发生频率及其影响的所有现有证据。后者通过与身体和精神健康有关的协变量进行操作，这些协变量暗示了临床意义以及共同发生的成瘾行为。

方法

筛选了在MEDLINE，Embase，PsycINFO，CINAHL上发表的经过同行评审的文章，以及与赌博和相关问题有关的社会学摘要报告数据。在可能的情况下，使用随机效应荟萃分析来合并研究估计数。

发现

搜索从1708个重复数据删除的记录中识别出14篇文章（基于11项个人研究）。来自10项研究的数据的荟萃分析表明，尽管在研究之间存在很大的异质性，且发生率范围在1％至15％左右，但仍有大约3.0％的患者报告了严重的问题赌博。相比之下，很少有研究报告涉及范围更广的严重性方面的赌博问题的研究，而对初级保健中的亚临床问题（即高风险赌博）知之甚少。通常有一致的证据表明问题赌博与精神健康不良和共同存在的物质使用问题之间存在联系。相反，关于在初级保健中赌博问题对身体健康的影响的证据较少。

结论

初级保健可能会为发现赌博问题提供重要的环境，并应根据病例发现的原则确定连续报告赌博问题的患者；从而针对疑似处于“危险中”的人进行调查。