Long‑Term Gambling Disorder Care Trajectories and Associated Patient Characteristics and Quality of Care

Given the limited evidence on the long‑term course of gambling disorder (GD), this study identified GD care trajectories, estimated GD duration, and examined their associations with patient and gambling characteristics and quality of care. A cohort of 2,154 patients with GD was examined using Quebec's administrative health records. We generated 13‑year GD care trajectories (2009-2022) using group‑based trajectory modeling. Multinomial logistic regression assessed the influence of sociodemographic, clinical, and gambling characteristics and quality‑of‑care indicators on trajectory membership. Four care trajectories were identified: Trajectory 1 (Transient GD, 34%), Trajectory 2 (Low‑intensity GD, 32%), Trajectory 3 (High initial, decreasing GD, 18%), and Trajectory 4 (Chronic GD, 16%). Two thirds of patients had GD records for an average of 1-2 years (Trajectories 1-2); GD persisted for 4 years in Trajectory 3 and 8 years in Trajectory 4. Compared with Trajectory 1, Trajectories 4 and 3 included patients more likely to be in their 50s and at higher risk of presenting severe clinical conditions, whereas Trajectory 2 patients were likelier to be younger, more socioeconomically deprived, and at greater risk of having a criminal history and co‑occurring alcohol‑ and drug‑related disorders. Patients in Trajectories 4 and 3 were more likely to receive GD‑specific treatments than those in Trajectories 1 and especially 2; however, Trajectories 2, 3, and 4 were at higher risk of showing lower treatment motivation. Trajectories 4 and 2 were also more likely to use non‑GD health services. Patients with long‑standing GD would benefit from enhanced follow‑up and crisis‑intervention strategies. Overall, improved detection across non‑GD care settings is needed to increase help‑seeking and support this vulnerable population.