Optimizing DSM-IV_TR Classification Accuracy: A Brief Biosocial Screen for Detecting Current Gambling Disorders Among Gamblers in the General Household Population

W La Revue canadienne de psychiatrie vol 55, no 2, février 2010 82 Objective: To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers. Method: We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related problems; the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) measured and collected this data. The NESARC conducted computer-assisted personal interviews with 43 093 households and identified the largest sample of pathological gamblers drawn from the general household population. Results: We created a 3-item, brief biosocial gambling screen (BBGS) with high sensitivity (Sensitivity = 0.96; 76 of 79 pathological gamblers correctly identified) and high specificiy (Specificity = 0.99; 10 892 of 11 027 nonpathological gamblers correctly identified). Conclusions: Major US studies reveal extensive comorbidity of PG with other mental illnesses. The BBGS features psychometric advantages for health care providers that should encourage clinicians and epidemiologists to consider current PG along with other problems. The BBGS is practical for clinical application because it uses only 3 items and they are easy to ask, answer, and include in all modes of interviewing, including self-administered surveys. The BBGS has a strong theoretical foundation because it includes 1 item from each of the addiction syndrome 3 domains: neuroadaptation (for example, withdrawal); psychosocial characteristics (for example, lying); and adverse social consequences of gambling (for example, obtaining money from others). Can J Psychiatry. 2010;55(2):82-90. Clinical Implications · Expansion of land-based and Internet gambling opportunities may alert clinicians to the need for increased screening for PG. · The presence of comorbidity among disordered gamblers has major implications for treatment planning, relapse, and recovery. · Expanding the clinical care of patients with a co-occurring gambling disorder could result in improved treatment for various associated behavioural health problems. Limitations · The BBGS is based on self-reported endorsement of DSM-IV-TR-based criteria; screens using an expanded set of criteria or actual behaviours might yield different clinical tools. · The BBGS is specific to screening for a current gambling disorder; other criteria might be more sensitive to PG measured over a longer time frame than the past-year. · The DSM-IV-TR-based criteria have been used successfully in non-US populations; however, the BBGS remains to be tested using these other populations