Author: Ka Fai Ip

香港求助人士中病態賭博與精神病合併症 (psychiatric comorbidity) 之間的關係

問題賭博非常複雜，其中不少問題賭博人士同時會有其他心理健康問題。鑑於華人社區之中賭博與精神病合併症的研究非常有限，Shek, Chan & Wong進行了一項研究 (於2012年發表)，其目的為（a）確定尋求治療的病態賭博人士中患有精神病合併症的流行率; （b）比較患有和沒有患有精神病合併症的病態賭博人士的人口統計特徵和臨床特徵; （c）探討病態賭博與精神疾病之間的關聯及兩者的時間關係。在該項硏究中，201名參與者為尋求戒賭輔導的人士，硏究小組根據美國精神病協會 (American Psychiatric Association) 的診斷標準 (DSM-IV) Axis-I為該批參與者作出診斷，診斷範圍包括各種情緒病、精神分裂症、物質使用障礙，焦慮症和調節障礙。結果顯示，128名 (63.7％) 參與者曾患有精神病合併症, 其中90名 (44.8％) 參與者在該硏究評估時被診斷患有至少一種精神病合併症。其中最常見的精神病合併症是情緒病、調節障礙和物質使用障礙。與沒有精神病合併症的病態賭博人士一組相比，患有精神病合併症的病態賭博人士的精神病病情、社會心理功能障礙和賭博問題更為顯著嚴重。

Associations between pathological gambling and psychiatric comorbidity among help-seeking populations in Hong Kong

Problem gambling is complex and often comorbid with other mental health problems. Unfortunately, gambling studies on comorbid psychiatric disorders among Chinese communities are extremely limited. Hence, Shek, Chan & Wong conducted a study in Hong Kong (findings published in 2012) with the following objectives: (a) determine the prevalence of comorbid psychiatric disorders among treatment-seeking pathological gamblers; (b) compare the demographic profiles and clinical features of pathological gamblers with and without comorbid psychiatric disorders; (c) explore the associations between pathological gambling and psychiatric disorders and their temporal relationship. Participants (𝑁 = 2 0 1) who sought gambling counseling were examined by making Axis-I diagnoses including mood disorders, schizophrenia spectrum disorders, substance use disorders, anxiety disorders, and adjustment disorder. Results showed that 63.7% of participants (𝑁 = 128) had comorbid psychiatric disorders in their lifetime, whereas 44.8% of participants (𝑁 = 90) had at least one comorbid psychiatric disorder at the time of evaluation. The most common comorbid psychiatric mental disorders were mood disorders, adjustment disorder, and substance use disorders. Pathological gamblers with psychiatric comorbidities were significantly more severe in psychopathology, psychosocial functioning impairment, and gambling problems than those without the disorders. (Extract from the abstract of Shek, Chan & Wong (2012))

Reference
Shek, D. T. L., Chan, E. M. L., & Wong, R. H. Y. (2012). Associations between pathological gambling and psychiatric comorbidity among help-seeking populations in Hong Kong. The Scientific World Journal, Article ID 571434, 15 pages. doi:10.1100/2012/571434
https://www.hindawi.com/journals/tswj/2012/571434/

Wong 於2010年發表了一份就香港12至17歲學生參與賭博及發展出病態賭博的普遍程度以及問題賭博的相關因素的研究報告。該項研究徵得1,001名學生（551名男生，450名女生） 填寫 《青少年賭博行為量表》（DSM-IV-MR-J）（Fisher, 2000），回應率為89.3％。受訪者中，60％（601名學生: 406名男生，195名女生）在去年有參與賭博。參與賭博的學生中，69％是每月下注少過四次，4.8％至少每天賭一次。他們大部分（89.8％）每週下注不足100港元，只有3.1％每週下注超過500港元，而24％則曾經借錢用來賭博。大部分參與賭博的學生（78.6％）在15歲之前開始賭博。馬會投注方面，五分之一參與賭博的學生（21.5％）自行到馬會投注站下注，44.7％得到父母的協助，19.7％得到同伴的幫助。 根據DSM-IV標準，分別有3.4％和1.8％的受訪者可被分類為病態賭徒和問題賭徒。 結果顯示， 性別差異（χ2（1）= 8.3，p <0.01）和年齡差異（χ2（7）= 21，p <0.01）呈現出顯著不同的賭博成癮普遍程度。 病態賭博和問題賭博與年齡 （r = 0.44，p <0.01）、賭博頻率（r = 0.41，p <0.001）、性別（r = 0.33，p <0.01）、初次賭博年齡 （r = -0.31，p <0.05）、有精神障礙（r = 0.25，p <0.001）、父母有賭博問題（r = 0.21，p <0.01）以及同伴有賭博問題（r = 0.18，p <0.05）顯著相關。該調查結果對制定防賭措施有所啟示。

Wong conducted an investigation on the prevalence of gambling involvement and pathological gambling among students aged 12 to 17 years in Hong Kong, and investigated the correlates of problem gambling. The findings were published in 2010. In this study, the DSM-IV-MR-J was completed by 1,001 students. The response rate was 89.3%. Sixty percent of the participants gambled in the previous year, 69% were infrequent players who bet less than 4 times a month, and 4.8% gambled at least once a day. Most (89.8%) wagered less than HK$100 a week, only 3.1% staked over HK$500, and 24% borrowed money to finance their gambling activities. The majority (78.6%) had started gambling before the age of 15 years. One-fifth (21.5%) transferred gambling payments at the betting venues, 44.7% were assisted by their parents and 19.7% were helped by peers. Using the DSM-IV criteria, 3.4% and 1.8% of the participants could be classified as pathological and problem gamblers, respectively. Significant gender (χ 2(1)=8.3, p < 0.01) and age differences (χ 2(7)=21, p < 0.01) were noted for such gambling addiction. Pathological and problem gambling were significantly correlated with age (r= 0.44, p < 0.01), gambling frequency (r= 0.41, p < 0.001), gender (r= 0.33, p < 0.01), early initiation (r= −0.31, p < 0.05), psychiatric disturbances (r= 0.25, p < 0.001), as well as parents (r= 0.21, p < 0.01) and peers (r= 0.18, p < 0.05) having gambling problems. The findings have implications for preventive initiatives. (Abstract extracted from Wong (2010))

Reference

Wong, I. L. K. (2010). Gambling Behavior Among Underage Adolescents in Hong Kong. Asian Journal of Gambling Issues and Public Health, 1(1), 47-60. https://link.springer.com/content/pdf/10.1186/BF03342118.pdf

Wong & So於2014年發表了一份就香港12至19歲青少年的互聯網賭博活動和病態賭博的研究報告。該項研究透過隨機抽班方法，徵得1,004名學生（597名男生，407名女生） 填寫 《青少年賭博行為量表》（DSM-IV-MR-J）（Fisher, 2000），回應率為86.6％。結果顯示，參與傳統 (非互聯網) 賭博的受訪者比參與互聯網賭博的受訪者更多（63.5％對3.5％），但網絡賭客成為危機賭徒及病態賭徒的風險比非網絡賭客更高(為1.5倍和3.2倍)。根據DSM-IV-MR-J標準，5.7％和22.9％的網絡賭客可分別被識別為危機賭徒和病態賭徒。受訪的網絡賭客大多數（94.3％）在家中網上下注 ，91.4％在18歲前首次網上下注，60％在12歲前首次網上下注，他們大多視互聯網賭博為潮流（71.4％）和安全（54.3％）的娛樂。結果顯示，有問題的互聯網賭博與性別(男性)、(較高)年級、網上賭博頻率、投注額以及家中賭博環境顯著相關。該調查結果對賭博研究和防賭計劃有所啟示。

Wong & So conducted an investigation on internet gambling involvement and pathological gambling among Hong Kong adolescents aged 12–19 years, which findings were published in 2014. In this study, the diagnostic and statistical manual (4th edition) multiple response format for juveniles (DSM-IV-MR-J) (Fisher in J Gambl Stud 16:253–273, 2000) was filled by 1,004 students (597 boys, 407 girls) recruited by random selection of classes. The response rate was 86.6 %. Results indicate that more respondents participated in land-based gambling than Internet gambling (63.5 vs. 3.5 %) but online gamblers are 1.5 and 3.2 times more likely to develop pathological and at-risk gambling than non-Internet gamblers. Using the DSM-IV-MR-J criteria, 5.7 and 22.9 % of the Internet gamblers could be classified as at-risk gamblers and pathological gamblers, respectively. Majority (94.3 %) wagered online at home, and 91.4 % made their first bet before 18 years. Many perceived Internet gambling as a trendy (71.4 %) and safe entertainment (54.3 %). Problematic Internet gambling was significantly associated with the male gender, school grades, online gambling frequency, amount wagered and a gambling family environment. Survey results have implications for gambling research and preventive programs. (Abstract extracted from Wong & So (2014))

Reference

Wong, I. L. K., & So, E. M. T. (2014). Internet Gambling Among High School Students in Hong Kong. Journal of Gambling Studies, 30(3), 565-576. https://doi.org/10.1007/s10899-013-9413-6