Jacob, L., Haro, J. M., & Koyanagi, A. (2018). Relationship between attention-deficit hyperactivity

The results of the mediation analysis are displayed

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6). The results of the mediation analysis are displayed in Table 3 . CMDs (mediated percentage = 22.4%), BPD traits (22.1%), stressful life events (13.2%), stress at work or home (12.6%), alcohol dependence (11.8%), and impulsivi- ty (11.2%) were signi fi cant mediators in the association between ADHD symptoms and problem gambling. DISCUSSION Main fi ndings This nationally representative community-based study found that the prevalence of at-risk and problem gambling was higher in people with ADHD than in those without ADHD. It also showed that the strongest signi fi cant med- iators in the ADHD gambling association were CMDs, BPD traits, and stressful life events. Interpretation of the fi ndings Despite previous literature pointing to the potentially im- portant role of impulsivity in the relation between ADHD and problem gambling, in this study, CMDs and BPD traits explained a larger proportion of the association with each of these factors explaining about a quarter of the association. This may not be surprising given that 65% 89% of indivi- duals with ADHD have been reported to suffer from at least one additional psychiatric condition, the most frequent ones being mood and anxiety disorders, substance-use disorders, and personality disorders ( Sobanski, 2006 ). Moreover, peo- ple affected by childhood ADHD are at an increased risk of personality disorders, such as borderline, antisocial, avoi- dant, and narcissistic personality disorders ( Miller et al., 2008 ). On the other hand, almost two third of people with problem gambling display a lifetime comorbid psychiatric disorder (i.e., mood disorders, adjustment disorder, or sub- stance-use disorders) ( Shek, Chan, & Wong, 2012 ). Other authors have further estimated that approximately 32% of 784 | Journal of Behavioral Addictions 7(3), pp. 781 791 (2018) Jacob et al.
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pathological gamblers show at least one personality disorder ( Fernández-Montalvo & Echeburúa, 2004 ). Furthermore, stressful life events, stress at work and home, alcohol dependence, and impulsivity explained 11% 13% of the relation between ADHD symptoms and problem gambling. Individuals with ADHD are more likely to be stressed, to experience stressful life events, and to display memory biases ( Vrijsen et al., 2017 ). Regarding problem gambling, several sources of stress (i.e., family problems, relationship dif fi culties, or fi nancial worries) have been found to favor the risk of developing this addiction and to even play a role in the decision-making process ( Biback & Zack, 2015 ). In the case of alcohol dependence and other addictive substances, ADHD is a common risk factor, which involves more rapid transition to dependence and longer dependence ( Wilens, 2004 ). Finally, the evolution and the severity of problem gambling can be worsened by the consumption of alcohol ( del Pino-Gutiérrez et al., 2017 ). Although impulsivity only explained 11% of the ADHD gambling association in this study, research has suggested that impulsivity plays an important role in this association ( Theule et al., 2016 ). Engaging in risk-taking and sensation-seeking activities in impulsive people such as
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  • Fall '17
  • The Land, Attention-deficit hyperactivity disorder, Diagnostic and Statistical Manual of Mental Disorders, Problem gambling

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