Abstract
Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively).Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.
Highlights
The COVID-19 pandemic, declared as a public health emergency by the World Health Organization [World Health Organization (WHO), 2020], has affected more than 200 countries around the world since the first case appeared in Wuhan (China) in December 2019 (Yuki et al, 2020)
The present study was designed to explore the impact of the COVID-19 pandemic and confinement on treatment adherence among patients with gambling disorder (GD)
Lower levels of anxiety and depressive symptoms due to pandemic and higher socio-economic positions at baseline were stated among the individuals who dropped out during the lockdown. These findings possibly suggest that those patients with better socio-economic background prior to confinement and lower referred psychological impact due to pandemic may have been more likely to discontinue treatment, already from the initial stages of confinement
Summary
The COVID-19 pandemic, declared as a public health emergency by the World Health Organization [World Health Organization (WHO), 2020], has affected more than 200 countries around the world since the first case appeared in Wuhan (China) in December 2019 (Yuki et al, 2020). Confinement and other restrictive measures have been stated everywhere (Hale et al, 2020), being social distancing, disruption of daily routines, and economic and employment uncertainty reported as some of the most frequent COVID-19-related concerns (Chew et al, 2020). This context alongside with health worries due to the pandemic has led to an increase in anxiety and depressive symptoms among general population (Islam et al, 2020; Wang et al, 2020). The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout
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