Traumatic brain injury as an independent risk factor for problem gambling: a matched case-control study



To assess whether traumatic brain injury (TBI) increases the risks of subsequent problem gambling.


We conducted a matched case–control analysis of adults in Ontario, Canada. The study included those who self-reported their gambling activities in the Canadian Community Health Survey 2007–2008. Using Problem Gambling Severity Index, we defined cases as those who were problem gamblers and controls who were recreational gamblers. Cases were matched to controls 1:2 using propensity scores based on demographics, prior mental health, and self-reported behaviours. The main predictor was prior TBI defined as requiring emergency care and identified using ICD-10 codes from administrative health databases. We estimated the likelihood of prior TBI in problem gamblers compared to controls using conditional logistic regression.


Of 30,652 survey participants, 16,002 (53%) reported gambling activity of whom 14,910 (49%) were recreational gamblers and 4% (n = 1092) were problem gamblers. A total of 1469 respondents (5%) had a prior TBI. Propensity score matching yielded 2038 matched pairs with 1019 cases matched to 2037 controls. Case–control analysis showed a significant association between prior TBI and subsequent problem gambling (odds ratio 1.27, 95% confidence interval 1.07–1.51, P = 0.007). The increased risk was mostly apparent in men aged 35 to 64 years who reported alcohol use or smoking. The relative risk of problem gambling in those with two or more TBIs equated to an odds ratio of 2.04 (95% confidence interval 1.05–3.99).


We found that a prior TBI was associated with an increased subsequent risk of problem gambling. Our findings support more awareness, screening, and treating problem gambling risks among TBI patients.

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This work did not receive any direct funding. DAR is Canada Research Chair in Decision Sciences.

Author information




JAB, DT, and DAR had full access to the data and take responsibility for accuracy of data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of manuscript: JAB, DAR Statistical analysis: JAB, DT, DAR, Administrative support, obtained funding and supervision: Redelmeier.

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Correspondence to Junaid A. Bhatti.

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The opinions, results, and conclusions of this manuscript are those of authors, and are independent of funding sources. No endorsement by the authors’ affiliate institutions or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.

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No additional data available.

Research ethics statement

The study methods were approved by the Research Ethics Board of the Sunnybrook Health Sciences Centre, both located in Toronto ON, Canada.

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Bhatti, J.A., Thiruchelvam, D. & Redelmeier, D.A. Traumatic brain injury as an independent risk factor for problem gambling: a matched case-control study. Soc Psychiatry Psychiatr Epidemiol 54, 517–523 (2019).

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  • Concussion
  • Head injury
  • Pathological gambling