Relationship between attention-deficit hyperactivity disorder symptoms and problem gambling: A mediation analysis of influential factors among 7,403 individuals from the UK

Abstract

Background and aims: Our goal was to examine the association between attention-deficit hyperactivity disorder (ADHD) symptoms and gambling problems, and to identify potential mediating factors of this association.

Methods: This study used cross-sectional, community-based data from 7,403 people aged ≥16 years who participated in the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS) Screener. Problem gambling was assessed using a questionnaire based on the 10 DSM-IV diagnostic criteria for pathological gambling. Respondents were classified as having no problem, at-risk, or problem gambling. Logistic regression and mediation analyses were conducted to analyze the association between ADHD symptoms (i.e., ASRS score ≥14) and problem gambling and the role of several variables in this association.

Results: The prevalence of at-risk (5.3% vs. 2.4%) and problem gambling (2.4% vs. 0.6%) was higher in individuals with ADHD symptoms than in those without ADHD symptoms. ADHD symptoms were significantly associated with both at-risk (OR = 2.15; 95% CI = 1.22-3.79) and problem gambling (OR = 3.57; 95% CI = 1.53-8.31) when adjusted for age, sex, and ethnicity. Common mental disorders (CMDs; i.e., depression and anxiety disorders) (mediated percentage = 22.4%), borderline personality disorder (BPD) traits (22.1%), stressful life events (13.2%), stress at work or home (12.6%), alcohol dependence (11.8%), and impulsivity (11.2%) were significant mediators in the ADHD-gambling association.

Discussion and conclusions: Overall, ADHD symptoms were positively associated with problem gambling. CMDs, BPD traits, and stressful life events were important mediators in this relationship.

Keywords: United Kingdom; attention-deficit hyperactivity disorder symptoms; mediation analysis; problem gambling; risk factor.

Figure 1.

Prevalence of gambling problems by attention-deficit hyperactivity disorder (ADHD) status. ADHD symptoms were assessed using the 6 items from the Adult ADHD Self-Report Scale. Scores from the individual items were added to give a total score that ranged from 0 to 24. In this study, a score of 14 and above was used to signify the possible presence of ADHD. Gambling status was assessed using 10 items from the DSM-IV criteria and the British Gambling Prevalence Survey studies. Participants were classified as having “no problems” (0 criteria), “at-risk” (1–2 criteria), or “problem gambling” (≥3 criteria)