Evaluating the problem gambling severity index

The associations between autistic characteristics and microtransaction spending

Microtransactions provide optional, virtual, video game goods that, for an additional cost to the player, provide additional game content and alter the gameplay experience. Loot boxes-a specific form of microtransaction-offer randomised rewards in exchange for payment, and are argued to be structurally and psychologically similar to gambling. Nascent research suggests that a link exists between autism and both problematic gaming and problematic gambling. Here, we investigated the relationships between autistic characteristics and experiences, and excessive video gaming and microtransaction expenditure. A sample of 1178 adults from Australia, Aotearoa, and The United States were recruited from Prolific Academic, and completed a survey measuring in-game expenditure, autistic characteristics and experiences, problematic gaming, problematic gambling, and risky loot box use. Analyses showed positive associations between autistic characteristics and experiences with problematic gaming and problem gambling symptomatology. However, results also showed a small, negative association between autistic characteristics and experiences and spending on loot boxes when problem gambling symptoms, problematic gaming, and risky loot box use were statistically controlled for. These results suggest that autistic gamers may be vulnerable to problematic gaming and gambling, but that this effect does not extend to the purchasing of microtransactions.

Correlates of Problematic Gambling in Emerging Adult University Students in Ireland

INTRODUCTION

Understanding the correlates of problematic gambling among emerging adult university students is crucial for developing effective approaches to minimise harm.

METHODS

This cross-sectional survey study reports on 397 18-25 year old emerging adults studying at Irish universities who completed an online survey about problematic gambling and a range of biopsychosocial variables. Chi-square and binary logistic regression analyses explored the relationships between problematic gambling and the biopsychosocial variables measured.

RESULTS

Chi-square analyses showed that being male, having an online gambling account, having a mobile gambling app, novelty seeking (impulsivity), harm avoidance (fear of uncertainty), and high alcohol volume consumption were significantly associated with problematic gambling. Regression analyses showed that individuals were more likely to report problematic gambling if they were male (OR = 9.57 times), had an online gambling account (OR = 17.05 times), had a mobile gambling app (OR = 20.37 times), scored high in impulsivity (OR = 7.79 times), and reported high alcohol volume consumption (OR = 4.66 times). Individuals were less likely to report problematic gambling if they scored high in fear of uncertainty (OR = 0.26 times).

CONCLUSIONS

A high rate of problematic gambling was observed among the current study sample. Participants were more likely to reported problematic gambling if they were male, had online gambling accounts, mobile gambling apps, scored high in impulsivity, scored low in fear of uncertainty, or consumed high volumes of alcohol in typical drinking sessions. These findings have implications for Irish legislation and policy-makers, Irish higher education institutions, and young adult Irish university students.

Gambling Motives and Offshore Gambling: A Finnish Population Study

The rise of online gambling has drawn attention towards offshore gambling. Currently there is lack of evidence on reasons and motivations to gamble on offshore gambling sites. This study investigated the general gambling motives of onshore and offshore gamblers, and the reasons to gamble on offshore gambling sites. The study used binary logistic regression model to analyze the data from Finnish Gambling 2019 population survey including adult past-year online gamblers (n = 1,422). The validated measure for problem gambling severity (PGSI, Problem Gambling Severity Index) was used. Furthermore, data-driven qualitative analysis was used to form categories for the reasons to gamble on offshore gambling sites. Offshore gambling was more common among men and younger age groups than among women or older age groups. Offshore gamblers gambled less often for money or worthy causes than onshore gamblers. Furthermore, offshore gamblers had more different types of motives to gamble, they gambled more frequently and had higher problem gambling severity scores (PGSI) than onshore gamblers. Finally, the most common reasons to gamble offshore were: (1) larger game supply and game features, (2) benefits, bonuses, and the usability of the website, and (3) inner motivation. Offshore gambling is characterized with intensity and diversity of gambling behavior and motives, and it poses a risk especially for young men.

Association between endocrine and neuropsychological endophenotypes and gambling disorder severity

BACKGROUND

Neurobiological characteristics have been identified regarding the severity of gambling disorder (GD). The aims of this study were: (1) to examine, through a path analysis, whether there was a relationship between neuroendocrine features, potentially mediational GD variables, and GD severity, and (2) to associate neuroendocrine variables, with GD severity-related variables according to gambling preferences.

METHODS

The sample included 297 outpatients with GD. We analyzed endocrine concentrations of different appetite-related hormones (ghrelin, liver antimicrobial peptide 2 [LEAP-2], leptin, adiponectin), and neuropsychological performance (working memory, cognitive flexibility, inhibition, decision making, premorbid intelligence). Path analysis assessed mechanisms between neuroendocrine features and GD severity, including mediational GD variables (impulsivity traits and gambling-related cognitive distortions). Partial correlations evaluated the associations between neuroendocrine variables, including impulsivity traits, and variables related to GD severity (DSM-5, South Oaks Gambling Screen, illness duration, and gambling-related cognitive distortions).

RESULTS

Lower adiponectin concentrations predicted greater GD severity, while higher LEAP-2 concentrations predicted more gambling-related cognitive distortions. Likewise, better neuropsychological performance directly predicted GD severity, but worse neuropsychological performance was associated with GD severity through the mediational variables of impulsivity traits and gambling-related cognitive distortions. Also, in non-strategic individuals with GD, poor working memory was associated with gambling expectancies and predictive control. In strategic individuals with GD, poor cognitive flexibility was associated with illusion of control, predictive control, and inability to stop gambling.

CONCLUSIONS

These results provide updated information about the comprehension of the interaction between neuroendocrine features, clinical variables, and severity of GD. Thus, neurobiological functions seem to be strongly related to GD severity.

The relationship between gambling behaviour and gambling-related harm: A data fusion approach using open banking data

BACKGROUND AND AIMS

UK-based gambling policymakers have proposed affordability checks starting at monthly losses of £125. The present study combines open banking data with self-reports of the Problem Gambling Severity Index (PGSI) and other relevant information to explore the harm profiles of people who gamble at different levels of electronic gambling behaviour.

DESIGN, SETTING AND PARTICIPANTS

This was a data fusion study in which participants consented to share their bank data via an open banking application programming interface (API) and who also completed relevant self-report items. Hierarchical hurdle models were used to predict being an at-risk gambler (PGSI > 0) and being a 'higher-risk' gambler (higher PGSI scores among those with non-zero scores) using four specifications of electronic gambling behaviour (net-spend, outgoing expenditure, incoming withdrawals, interaction model combining expenditure and withdrawals), and by adding self-reported data across two additional steps. The study took place in the United Kingdom. Participants were past-year people who gamble (n = 424), recruited via Prolific.

MEASUREMENTS

Self-report measures were used of gambling-related harm (PGSI), depression [Patient Health Questionnaire 9 (PHQ-9)], age and gender; bank-recorded measures of income and electronic gambling behaviour.

FINDINGS

Unharmed gamblers had an average monthly gambling net-spend of £16.41, compared with £208.91 among highest-risk gamblers (PGSI ≥ 5). Being an at-risk gambler (PGSI > 0) was predicted significantly by all four types of gambling behaviour throughout all three steps [1.08 ≤ odds ratios (ORs) ≤ 2.92; Ps < 0.001), with only outgoing expenditure being significant in the interaction model (2.26 ≤ ORs ≤ 2.81; Ps < 0.001). Higher PHQ-9 scores also predicted at-risk gambling in steps 2-3 (1.09 ≤ ORs ≤ 1.10; Ps < 0.001), as did lower age (0.95 ≤ ORs ≤ 0.96; Ps < 0.001) and male gender identity in step 3 (2.51 ≤ ORs ≤ 2.95; Ps < 0.001). Being a higher-risk gambler was predicted significantly by gambling behaviour only in the expenditure-only (1.16 ≤ ORs ≤ 1.17; Ps ≤ 0.048) and withdrawal-only (1.08 ≤ ORs ≤ 1.09; Ps ≤ 0.004) models, and was not predicted by income (0.98 ≤ ORs ≤ 1.14; Ps ≥ 0.601), age (0.98 ≤ ORs ≤ 0.99; Ps ≥ 0.143) or male gender identity (1.07 ≤ ORs ≤ 1.15; Ps ≥ 0.472).

CONCLUSION

The UK government's proposed affordability checks for gamblers should rarely affect people who are not experiencing gambling-related harm. At-risk gambling is predicted well by different types of gambling behaviour. Novel insights about gambling can be generated by fusing self-reported and objective data.

Intersection of gambling with smoking and alcohol use in Great Britain: a cross-sectional survey in October 2022

OBJECTIVES

Gambling is associated with cigarette smoking and alcohol consumption. We explored the intersection of gambling across all risk levels of harm with smoking and alcohol use among adults in Great Britain.

DESIGN

A nationally representative cross-sectional survey in October 2022.

SETTING

Great Britain.

PARTICIPANTS

A weighted total of 2398 adults (18+ years).

OUTCOME MEASURES

We examined the prevalence of past-year gambling and, among those reporting gambling, assessed the associations between the outcome of any risk of harm from gambling (scoring >0 on the Problem Gambling Severity Index) and the binary predictor variables of current cigarette smoking and higher risk alcohol consumption (AUDIT-C score≥4). We also explored data on weekly expenditure on gambling with smoking and alcohol use among those categorised at any-risk of harm from gambling.

RESULTS

Overall, 43.6% (95% CI 41.2% to 45.9%) of adults gambled in the past year. Among these, 7.3% (95% CI 5.3% to 9.3%) were classified at any-risk of harm from gambling, 16.0% (95% CI 13.2% to 18.8%) were currently smoking and 40.8% (95% CI 37.2% to 44.4%) were drinking at increasing and higher risk levels. There were no associations between any risk of harm from gambling and current smoking (OR adjusted=0.80, 95% CI 0.35 to 1.66) or drinking at increasing and higher risk levels (OR adjusted=0.94, 95% CI 0.52 to 1.69), respectively. Analyses using Bayes factors indicated that these data were insensitive to distinguish no effect from a range of associations (OR=95% CI 0.5 to 1.9). The mean weekly spend on gambling was £7.69 (95% CI £5.17 to £10.21) overall, £4.80 (95% CI £4.18 to £5.43) among those classified as at no risk and £45.68 (95% CI £12.07 to £79.29) among those at any risk of harm from gambling.

CONCLUSIONS

Pilot data in a population-level survey on smoking and alcohol use yielded similar estimates to other population-level surveys on gambling participation and at-risk gambling. Further data are needed to elucidate the intersections more reliably between gambling, smoking and alcohol use and inform population-level approaches to reduce harm.

Post-reinforcement pauses during slot machine gambling are moderated by immersion

The post-reinforcement pause (PRP) is an operant effect in which response latencies increase on trials following the receipt and consumption of reward. Human studies demonstrate analogous effects in electronic gambling machines that utilise random ratio reinforcement schedules. We sought to identify moderators of the human PRP effect, hypothesising that the magnitude of gamblers' PRPs is moderated by the type of reinforcing outcome (genuine wins vs. losses-disguised-as-wins [LDWs] vs. free-spin bonus features) and individuals' level of gambling immersion, a cognitive state linked to problem gambling. Experienced slot machine users (N = 53) played a real slot machine for 20 min. The dependent variable was defined as the time delay in the initiation of each bet ("Spin Initiation Latency"; SIL). Using 80% of trials, a linear model was fit regressing SIL on the independent variables (outcome type, immersion, and outcome-by-immersion interaction), and a larger group of covariates (participant ID, trial number, winnings, etc.) selected using double-robust LASSO-regularised regression. The previously unseen 20% of cases were used to validate the model. Positively reinforcing outcome types (wins, LDWs, bonus spins) showed significantly larger SILs than losses, indicating a PRP effect. Immersion did not predict response latencies, but win-by-immersion and LDW-by-immersion interactions indicated that pauses were greater among more immersed participants. The small number of free-spin bonus features showed similar trends that were not statistically significant. These results indicate that gamblers immersed in play remained sensitive to in-game reinforcement (contrary to a prevailing account), and provide guidance for researchers bridging laboratory research and real-world behaviour.

Components of identity expression in problem and non-problem gamblers

Few studies have examined whether specific aspects of group identification predict problematic and non-problematic addictive behaviours and none have focused on gambling. Applying Leach et al.'s (2008) hierarchical model of in-group identification, we tested the associations between components of self-investment (satisfaction, solidarity, and centrality) and components of self-definition (individual self-stereotyping, in-group homogeneity) on distinguishing between problem and non-problem gambling (n = 10,157) and on the severity of problematic gambling behaviour (n = 2,568). Results showed that (i) in-group-based identities are important in predicting problematic vs. non-problematic gambling behaviours; (ii) in-group-based identities are important in predicting the severity of problematic gambling; (iii) how self-invested an individual is with their in-group and aspects associated with self-definition processes are both important predictors; (iv) perceptions related to how chronically salient one's group membership is for the self (centrality) are essential features of the self-investment mechanism; and (v) self-stereotypical beliefs about one's essential similarities to the prototypical gambling group member norm are fundamental for the defining oneself as a gambler.

Harms from Other People's Gambling: Associations with an Individual's Own Gambling Behaviours, Health Risk Behaviours, Financial Problems, General Health, and Mental Wellbeing

This study aimed to explore relationships between being an 'affected other' (AO) and an individual's own gambling, health risk behaviours, financial problems, poor general health, and low mental wellbeing. A cross-sectional survey using representative and supplementary convenience samples was undertaken with 1234 residents of a British Island aged 16 + years. Being an AO was measured as having a partner or relative who has been gambling regularly in the past 12 months. PGSI was used to assess gambling severity. Health risk behaviours included: poor diet, low physical activity, daily smoking, and binge drinking. Other measures included experiencing financial problems, poor general health, and low mental wellbeing. Analyses were performed using χ2 and binary logistic regressions. 11.0% of participants were AOs. AOs were more likely to gamble at at-risk/problem-gambling levels and experience financial problems compared to those who were not affected others. The significant relationship between being an AO and low mental wellbeing was mediated by experiencing financial problems. The relationship between being an AO and engaging in two or more health risk behaviours was no longer significant after controlling for sociodemographics and an individual's own gambling. The relationship between being an AO and poor general health was no longer significant after controlling for sociodemographics, health risk behaviours and an individual's own gambling. AOs experienced risks to health and wellbeing, with findings not limited to AOs specifically with a relationship to an individual with problem-gambling. Therefore, support for AOs should be more widely available, aiming to address AOs' needs holistically.

Betting on the House: The Impact of Gambling on Homeownership in Australia

Gambling is commonly associated with social and economic disadvantage. In this paper we examine the impact of gambling on homeownership, using Australian panel data. We find that gambling is associated with a lower probability of homeownership. Specifically, our endogeneity corrected estimates show that an increase in problem gambling is associated with between 1.6 and 1.8 percentage point decrease in the probability of owning a home depending on the model. Our result show that financial stress and social capital are channels through which gambling influences the probability of homeownership.

Anticipated Motives for Gambling Treatment in Adults from the U.S

Prior works note that identifying problematic play is a leading barrier to treatment seeking, contributing to low treatment rates in those with gambling problems (e.g., Bijker et al., 2022; Suurvali et al., 2012a). While research has looked at treatment seekers' motives for treatment (Gainsbury et al., 2014; Suurvali et al., 2012b), the situations or signs (anticipated motives) individuals look for that suggest they would need treatment in the future remains unknown. Participants were gamblers (N = 1,791) from a census-matched U.S. sample of adults who reported no concerns about their gambling. Participants completed questions assessing how much money they would have to lose while gambling to think they might have a problem and what factors might motivate them to pursue treatment for gambling problems in the future. Participants reported a wide range of financial loss that would suggest they had a problem, and higher income men who gambled more frequently reported higher necessary losses. There was little variation in endorsement (40-60%) of 14 situations that may lead them to seek treatment in the future (e.g., felt guilty). However, income, gender identity, and problem gambling behavior were linked to the endorsement of some of these anticipated motives, with some differences in endorsement between those engaging in high- and low-level problem gambling. Collectively, results are consistent with the inference that many individuals may not be aware of what problematic gambling would look like for them, though income, gender identity, and problem gambling behavior may impact their consideration of anticipated motives.

Management of Mental Health Challenges in Athletes: Screening, Pharmacology, and Behavioral Approaches

Athletes are incredibly motivated and perpetually pursuing dominance in skill, strength, endurance, and execution-often while balancing many additional responsibilities. Despite the appearance of living fun, luxurious, care-free lifestyles, they are vulnerable to exceptional stressors and the same mental health challenges as the general population. The use of screening tools and assessment guided by a biopsychosocial framework can assist in understanding the factors that contribute to the athlete's mental health status. This can facilitate the development of a targeted management approach to mental health challenges.

Loot box purchasing and indebtedness: The role of psychosocial factors and problem gambling

Introduction

Loot boxes are increasingly common random-reward monetization mechanisms in digital games. They are popular among gamblers and pose various risks due to their gambling-like nature, but little is known about psychosocial vulnerabilities and financial consequences of purchasing them. This article examined psychosocial associations with self-reported increase in loot box purchasing and indebtedness among past-year gamblers during the COVID-19 pandemic.

Methods

Cross-sectional survey data were collected in April 2021 from Finnish, Swedish, and British past-year gamblers aged 18 to 75 (n = 2,022). Measures of loneliness, psychological resilience, and problem gambling were studied in relation to loot box purchasing and indebtedness. Structural equation modeling was used as an analytical technique.

Results

Loneliness was positively associated with self-reported increase in loot box purchasing. No evidence was found regarding the protective role of psychological resilience in loot box purchasing. Increased loot box purchasing was associated with problem gambling. Problem gambling mediated the relationship between loot box purchasing and indebtedness.

Conclusions

The findings bring valuable insight into the psychosocial vulnerabilities and financial consequences in loot box purchasing. Loot box purchasing can add to one's financial strain particularly among vulnerable individuals such as problem gamblers, making it crucial to regulate such monetization practices.

Behavioural expressions of loss-chasing in gambling: A systematic scoping review

BANERJEE Nilosmita., CHEN Zhang., CLARK Luke., NOËL Xavier. Behavioural expressions of loss-chasing in gambling: A systematic scoping review NEUROSCI BIOBEHAV REV 152(1) XXX-XXX, 2023. - Loss-chasing, the tendency to continue and/or intensify gambling following losses, is a key clinical symptom in gambling disorder and a central feature endorsed by at-risk problem gamblers. Despite its centrality, loss-chasing has been often operationalised across distinct behavioural expressions. The current systematic scoping review aimed to map the heterogeneous operationalisations of loss-chasing in the literature. The reviewed studies defined loss-chasing either between-sessions (n = 39) or within-sessions (n = 38), as a long-recognised distinction. For both categories, further behavioural expressions could be distinguished. Between-session loss-chasing was captured by endorsing an item 'returning another day/time to recoup losses', or behaviourally as the interval between successive sessions, or as increasing stakes in the next session. Within-session loss-chasing was defined as continuing and/or intensifying gambling either by increased risk-taking, stake size, or speed of play. Additionally, much heterogeneity was observed in the gambling contexts examined, the exact definition of loss, and the potential delineation of win-chasing. Open questions and future directions are discussed. Overall, this paper serves as a first step towards more conceptual clarity of loss-chasing.

Longitudinal joint trajectories of gambling disorder and hypomentalization: A latent class growth analysis among young adults

INTRODUCTION

Only a few studies have investigated the relationship between risk for gambling disorder (GD) and mentalization difficulties. However, these results on positive correlations were all from cross-sectional studies; therefore, it would be important to investigate the longitudinal relationship between the constructs.

AIMS

It was aimed to identify subgroups of gamblers with different joint growth trajectories of risk for GD and hypomentalization (i.e., uncertainty of understanding own and others' mental states) and to compare the identified latent classes along impulsivity, sensation seeking and depression.

METHODS

Data from waves 1-3 of the Budapest Longitudinal Study were used. The final sample included 219 young adult gamblers who completed the study questionnaire and reported past-year gambling in all three waves (Females: N = 93 [42.29%]; Mean age: 28.36 years [SD = 4.29]). Standardized questionnaires were administered to measure the main constructs.

RESULTS

A four-class model was retained based on latent class growth analysis. Class 1 had consistently moderately high risk for GD and hypomentalization, and Class 4 presented consistently low risk for GD and hypomentalization. Classes 2-3 were characterized by low risk for GD and increasing hypomentalization. Class 1 had significantly higher sensation seeking and depression compared with the other subgroups in multiple cases. Class 4 showed significantly lower impulsivity and sensation seeking than the other classes.

CONCLUSIONS

Elevated hypomentalization was presented among individuals with risk for GD. However, there is little empirical evidence to support that the two constructs have convergently changing trajectories. A cautious interpretation of the results is recommended due to low symptom presence.

Using artificial intelligence algorithms to predict self-reported problem gambling with account-based player data in an online casino setting

In recent years researchers have emphasized the importance of artificial intelligence (AI) algorithms as a tool to detect problem gambling online. AI algorithms require a training dataset to learn the patterns of a prespecified group. Problem gambling screens are one method for the collection of the necessary input data to train AI algorithms. The present study's main aim was to identify the most significant behavioral patterns which predict self-reported problem gambling. In order to fulfil the aim, the study analyzed data from a sample of real-world online casino players and matched their self-report (subjective) responses concerning problem gambling with the participants' actual (objective) gambling behavior. More specifically, the authors were given access to the raw data of 1,287 players from a European online gambling casino who answered questions on the Problem Gambling Severity Index (PGSI) between September 2021 and February 2022. Random forest and gradient boost machine algorithms were trained to predict self-reported problem gambling based on the independent variables (e.g., wagering, depositing, gambling frequency). The random forest model predicted self-reported problem gambling better than gradient boost. Moreover, problem gamblers showed a distinct pattern with respect to their gambling based on the player tracking data. More specifically, problem gamblers lost more money per gambling day, lost more money per gambling session, and deposited money more frequently per gambling session. Problem gamblers also tended to deplete their gambling accounts more frequently compared to non-problem gamblers. A subgroup of problem gamblers identified as being at greater harm (based on their response to PGSI items) showed even higher values with respect to the aforementioned gambling behaviors. The study showed that self-reported problem gambling can be predicted by AI algorithms with high accuracy based on player tracking data.

An Empirical Study of the Pathway Model Link Between Cognitive Distortions and Gambling Problems

This research empirically tests the relationship between gambling-related cognitive distortions and the development of gambling problems. In two separate studies using methodologies designed to support non-experimental causal inference, we demonstrate that holding false beliefs about gambling experiences is related to current and future risk of developing problems with gambling. In our first study, we use an instrumental variable estimation strategy on an internet sample (n = 184) and observe a statistically significant relationship between Gamblers' Belief Questionnaire scores and measures of loss chasing, overspending, and gambling problems. These findings were robust to linear and ordinal estimation strategies and multiple model specifications. In our second study, we examine five-year prospective longitudinal data (n = 1,431) to validate our initial findings and test whether irrational thoughts are also related to future problems with gambling. While controlling for current fallacies, we find that past Gambling Fallacies Measure scores are related to present gambling problems across two survey waves. The effect size of each of the past fallacy levels is roughly half of the effect size of present levels, suggesting meaningful impacts. Our findings support the Pathways Model of Problem and Pathological Gambling.

Psychosocial Perspective on Problem Gambling: The role of Social Relationships, Resilience, and COVID-19 Worry

The COVID-19 pandemic has amplified several psychosocial risks and problem behaviors among vulnerable individuals. Given that gambling has high addictive potential, it is important to consider the underlying mechanisms of problem gambling. This study examined psychosocial factors associated with pandemic-time problem gambling.Cross-sectional data were gathered via an online survey of 18-75-year-old Finnish, Swedish, and British respondents (n = 2,022) who reported having gambled at least occasionally during the pandemic. Measures included problem gambling, loneliness, COVID-19 worry, social support, and psychological resilience. Control variables included gender, age, and education. Structural equation modeling was used as an analytical technique.Loneliness was found to be associated with problem gambling. While COVID-19 worry was not directly associated with problem gambling, it predicted higher loneliness, which in turn was associated with problem gambling. Evidence was not found regarding the protective role of resilience or social support in problem gambling. However, social support was found to be associated with higher problem gambling severity. Male gender and younger age were associated with problem gambling.The results bring insight into underlying vulnerabilities regarding problem gambling during the pandemic. More focus should be placed on the quality and sources of social support, as well as on how psychosocial risk and protective factors might work differently among different populations of gamblers.

Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

OBJECTIVES

The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings.

METHODS

Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.

RESULTS

Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework.

CONCLUSIONS

Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.

A Cross-Sectional Analysis of Young Men's Gambling and Intimate Partner Violence Perpetration in Mwanza, Tanzania

Objectives: The prevalence of intimate partner violence (IPV) in Tanzania is one of the highest in sub-Saharan Africa. There are very few studies on the co-occurrence of gambling and IPV and none from LMICs, despite gambling being a behaviour associated with gender norms exalting masculinity underlying IPV perpetration. Methods: Cross-sectional survey data of 755 currently partnered men aged 18-24 from Mwanza, Tanzania were analysed to investigate whether gambling was associated with past-year physical, sexual, emotional and economic IPV. We conducted bivariate and multivariate logistic regressions to control for potential confounders, based on their significant association bivariately with the main outcome variables. Results: Of the men who gambled, 18 percent perpetrated physical IPV, 39 percent sexual IPV, 60 percent emotional IPV and 39 percent economic IPV. Gambling was significantly associated with sexual (aOR: 2.59; 95% CI: 1.70-3.97), emotional (aOR: 1.55; 95% CI: 1.12-2.14) and economic IPV (aOR: 1.38; 95% CI: 1.02-1.88) after controlling for confounders. Conclusion: The analysis shows that gambling is associated with IPV perpetration. More research is needed to understand how current IPV prevention efforts can be expanded to include problem gambling treatment.

Five-Factor Model and DSM-5 Alternative Model of Personality Disorder Profile Construction: Associations with Cognitive Ability and Clinical Symptoms

Although numerous studies have explored latent profiles using the Five-Factor Model (FFM) of normative personality, no studies have investigated how broad personality traits (i.e., FFM) and pathological personality traits using the alternative model of personality disorder (AMPD) may combine for latent personality profiles. The present study recruited outpatients (N = 201) who completed the Big Five Aspects Scales (BFAS), Personality Inventory for DSM-5 (PID-5), Structured Clinical Interview for DSM-IV (SCID-I/P), gambling and alcohol use measures, and the Weschler Intelligence subtests. When FFM and AMPD measures were combined, latent profile analyses revealed four profiles, Internalizing-Thought disorder, Externalizing, Average-Detached, and Adaptive. Detachment and openness to experience were the most and least essential traits for profile distinction, respectively. No associations between group membership and cognitive ability measures were found. Internalizing-Thought disorder membership was linked with a current mood and anxiety disorder diagnosis. Externalizing profile membership was associated with younger age, problematic gambling, alcohol use, and a current substance use disorder diagnosis. The four FFM-AMPD profiles overlapped with the four FFM-only and three AMPD-only profiles. Overall, the FFM-AMPD profiles appeared to have better convergent and discriminant validity with DSM-relevant psychopathology.

Validity, reliability, and correlates of the Smartphone Addiction Scale-Short Version among Japanese adults

BACKGROUND

The short version of the smartphone addiction scale (SAS-SV) is widely used to measure problematic smartphone use (PSU). This study examined the validity and reliability of the SAS-SV among Japanese adults, as well as cross-sectional and longitudinal associations with relevant mental health traits and problems.

METHODS

Datasets from a larger project on smartphone use and mental health were used to conduct two studies. Participants were adults aged over 20 years who carried a smartphone.

RESULTS

Study 1 (n = 99,156) showed the acceptable internal consistency and structural validity of the SAS-SV with a bifactor model with three factors. For the test-retest reliability of the SAS-SV, the intraclass correlation coefficient (ICC) was .70, 95% CI [.69, 70], when the SAS-SV was measured seven and twelve months apart (n = 20,389). Study 2 (n = 3419) revealed that when measured concurrently, the SAS-SV was strongly positively correlated with another measure of PSU and moderately correlated with smartphone use time, problematic internet use (PIU), depression, the attentional factor of impulsiveness, and symptoms related to attention-deficit hyperactivity disorder and obsessive-compulsive disorder. When measured 12 months apart, the SAS-SV was positively strongly associated with another measure of PSU and PIU and moderately associated with depression.

DISCUSSION

The structural validity of the SAS-SV appeared acceptable among Japanese adults with the bifactor model. The reliability of the SAS-SV was demonstrated in the subsequent seven- and twelve-month associations.

CONCLUSION

The cross-sectional and longitudinal associations of the SAS-SV provided further evidence regarding PSU characteristics.

Using machine learning to retrospectively predict self-reported gambling problems in Quebec

BACKGROUND AND AIMS

Participating in online gambling is associated with an increased risk for experiencing gambling-related harms, driving calls for more effective, personalized harm prevention initiatives. Such initiatives depend on the development of models capable of detecting at-risk online gamblers. We aimed to determine whether machine learning algorithms can use site data to detect retrospectively at-risk online gamblers indicated by the Problem Gambling Severity Index (PGSI).

DESIGN

Exploratory comparison of six prominent supervised machine learning methods (decision trees, random forests, K-nearest neighbours, logistic regressions, artificial neural networks and support vector machines) to predict problem gambling risk levels reported on the PGSI.

SETTING

Lotoquebec.com (formerly espacejeux.com), an online gambling platform operated by Loto-Québec (a provincial Crown Corporation) in Quebec, Canada.

PARTICIPANTS

N = 9145 adults (18+) who completed the survey measure and placed at least one bet using real money on the site.

MEASUREMENTS

Participants completed the PGSI, a self-report questionnaire with validated cut-offs denoting a moderate-to-high-risk (PGSI 5+) or high-risk (PGSI 8+) for experiencing past-year gambling-related problems. Participants agreed to release additional data about the preceding 12 months from their user accounts. Predictor variables (144) were derived from users' transactions, apparent betting behaviours, listed demographics and use of responsible gambling tools on the platform.

FINDINGS

Our best classification models (random forests) for the PGSI 5+ and 8+ outcome variables accounted for 84.33% (95% CI = 82.24-86.41) and 82.52% (95% CI = 79.96-85.08) of the total area under their receiver operating characteristic curves, respectively. The most important factors in these models included the frequency and variability of participants' betting behaviour and repeat engagement on the site.

CONCLUSIONS

Machine learning algorithms appear to be able to classify at-risk online gamblers using data generated from their use of online gambling platforms. They may enable personalized harm prevention initiatives, but are constrained by trade-offs between their sensitivity and precision.

Self-Generated Motives of Social Casino Gamers

Social casino games have achieved widespread popularity, and are accessed by more than 85 million people each day. Yet, why people play social casino games is largely unknown. To address this gap, an inductive approach was taken to better understand the motives for playing social casino games, as well as the motives for transitioning from social casino gaming to gambling and vice versa. To this end, 269 social casino gamers were asked to provide a ranked list of their motives for playing social casino games. Additionally, we asked participants their motivations for transitioning from gambling to social casino gaming (n = 202) or vice versa (n = 67). A total of 795, 605, and 201 unique responses describing motives for playing social casino games, transitioning from social casino gaming to gambling, and transitioning from gambling to social casino gaming, respectively, were analyzed using a thematic content analysis. The most frequently endorsed motive for playing social casino games was for enhancement (e.g., fun, challenge). Participants also noted playing to earn rewards, including money, and for social reasons. Several motives linked social casino game play to gambling. These included: to hone gambling-related 'skills', a desire to transition to gambling to win real money, and as a gambling harm-reduction strategy. Motives for playing social casino games did not differ significantly between those who first gambled and then transitioned to social casino gaming and vice versa, suggesting that once people begin playing social casino games, they have similar motives for continued engagement. The present study contributes to understanding the immense popularity of social casino games and their links to gambling.

The Relationship Between Childhood Trauma, Pathological Dissociation, and Behavioral Addictions in Young Adults: Findings from a Cross-Sectional Study

Interactions between childhood trauma (CT) and dissociation can contribute to psychiatric disturbances. We explored this phenomenon in relation to behavioral addictions (BAs) in a sample (n = 633) of young adults (age: 18-34 years). Self-report measures investigating CT, dissociation, and symptoms related to gambling disorder, internet gaming disorder, problematic social media use, exercise dependence and compulsive buying were used. Scales related to BAs were summarized into a single measure ("Total Behavioral Addiction Index" - TBAI) for inferential analyses. A model analyzing the direct and indirect effects of CT on TBAI through the mediation of pathological dissociation was performed, controlling for confounding factors. Measures on CT, dissociation, and TBAI were significantly associated with each other (all p < .001). The total effect of CT on TBAI was significant (B = 0.063; CI: 0.045; 0.081); pathological dissociation significantly mediated such association (B = 0.023; CI: 0.013; 0.036). Our findings support the possibility that the interaction between CT and dissociation contributes to increase disturbances related to BAs.

The evaluation of a brief ICBT program with therapist support for individuals with gambling problems in the context of a gambling helpline: a randomized pilot trial

BACKGROUND AND AIMS

Gambling helplines are a natural way of first contact for individuals with gambling problems. However, few studies have evaluated the feasibility and effectiveness of brief interventions in a gambling helpline. To reduce this knowledge gap, this study evaluated the feasibility of an online cognitive behavioral therapy (ICBT) program in the context of a gambling helpline as a first step towards a full-scale RCT.

DESIGN

This is a two-group parallel randomized controlled pilot trial where the participants were randomized to either a brief four-module ICBT program (n = 22) or a control group (n = 21). Participants were followed up weekly during the intervention, post intervention, and 6 weeks upon completion of intervention.

PARTICIPANTS

A total of 43 self-identified individuals with gambling problems (scoring 3 or more on the Problem Gambling Severity Index) were recruited via the Swedish national gambling helpline, 59% females, mean age 43.7 years.

MEASUREMENTS

Feasibility of the procedure and intervention (i.e., recruitment pace, attrition, program engagement, and satisfaction) were the primary outcomes; treatment effect (net gambling losses) was the secondary outcome.

RESULTS

Approximately 2 participants per week were randomized, and retention was low, with 47% lost to follow-up at the 6-week follow-up time-point. Most participants engaged in the online modules (86%) and rated their overall satisfaction with the program as high (7.5 out of 10). Both groups decreased their weekly gambling losses at both follow-up time-points, but the between-group comparisons were inconclusive.

CONCLUSION

It is not advisable to conduct a full-scale RCT based on the results from this pilot study. Future studies in a gambling helpline should consider interventions that are more suited to be incorporated in a gambling helpline and identify ways to increase participant engagement.

TRIAL REGISTRATION

The study was retrospectively registered on ClinicalTrials.gov (ID: NCT04609007 , 29/10/2020).

Problem gambling severity, gambling behavior, substance use, and mental health in gamblers who do and do not use cannabis: Evidence from a Canadian national sample

INTRODUCTION

Cannabis use frequently co-occurs with gambling, and evidence indicates that both acute and chronic cannabis use may influence gambling behavior. The primary aim of the present study was to further contribute to the literature on this relationship by examining data collected from a Canadian national study of gambling.

METHODS

Respondents consisted of 10,054 Canadian gamblers recruited from Leger Opinion's (LEO) online panel. In this study, gamblers who used cannabis were compared with non-users across a number of gambling as well as demographic and mental health variables.

RESULTS

Of the total sample, 25.4 % reported past 12-month cannabis use. Among the 2,553 cannabis-users, 21.3 % reported daily use, and 69.9 % reported using once a month or more. A total of 56.2 % indicated they had used cannabis while gambling in the past 12 months. Bivariate analysis found significant differences between cannabis use and non-use on numerous demographic, mental health, and gambling-related variables. Individuals with greater problem gambling severity scores, more hours gambling, and a larger range of gambling activities were more likely to endorse using cannabis. Hierarchical logistic regression revealed that tobacco use, and having experienced significant child abuse were predictors of cannabis use. Non-use of cannabis was associated with older age, less engagement in online gambling, and being less likely to consume alcohol.

CONCLUSION

The present findings both corroborate previous studies and expand upon the relationship between cannabis and gambling.

Gamblers' Perceptions of the Impact of the COVID-19 Pandemic on Their Gambling Behaviours: Analysis of Free-Text Responses Collected through a Cross-Sectional Online Survey

The COVID-19 pandemic has brought drastic changes to the lives of a substantial portion of the world's population. Many stakeholders have expressed concern about the impact of the pandemic on gambling practices, which have historically increased during times of crisis. The purpose of this study was to provide a snapshot of the impact of the pandemic on gambling practices, focusing on the lived experiences of people who gamble. An online cross-sectional survey was conducted between 16 February and 15 March 2021. An open-ended question allowed the participants to describe in their own words the impact of the COVID-19 pandemic on their gambling practices. A qualitative analysis was conducted based on 724 responses to this question. Among the participants, 57% were problem gamblers, according to their Problem Gambling Severity Index score. Three themes were identified: (1) changes in gambling practices perceived by the respondents during the pandemic, (2) the impacts of these changes, and (3) the factors that influenced the changes in their gambling practices. A meaningful proportion of the sample of gamblers felt that their gambling practices had increased during the pandemic. Many of them did not report the deleterious effects of this increase, whereas others were devastated. Thus, variations in gambling practices during the pandemic must be interpreted with caution, as they may reflect a variety of realities.

Longitudinal perspective on cryptocurrency trading and increased gambling problems: a 3 wave national survey study

OBJECTIVES

Cryptocurrency trading has gained popularity over the last few years. Trading is facilitated by online platforms that enable 24/7 trading. Cryptocurrency trading is potentially attractive to gamblers, and it may increase their gambling problems. Furthermore, cryptocurrency trading might be a particularly harmful activity for those gambling offshore. We investigated whether cryptocurrency trading predicts excessive gambling over time. We also analyzed how cryptocurrency trading combined with offshore gambling is associated with excessive gambling.

STUDY DESIGN

This was a population-based longitudinal survey study.

METHODS

We surveyed a sample of Finnish people aged 18-75 years (N = 1022, 51.27% male) at three time points in 6-month intervals: April 2021 (T1), October to November 2021 (T2), and April to May 2022 (T3). Of the original T1 respondents, 66.80% took part in T2 and T3. Outcome measure was excessive gambling using the Problem Gambling Severity Index, and the predictor was cryptocurrency trading. We adjusted models for onshore and offshore gambling online, excessive gaming (Internet Gaming Disorder Test), excessive internet use (Compulsive Internet Use Scale), excessive alcohol use (Alcohol Use Disorders Identification Test), and sociodemographic background factors. We used multilevel regression models to investigate within-person and between-person effects.

RESULTS

Cryptocurrency trading has increased in popularity over time. Within-person changes in cryptocurrency trading predicted increased excessive gambling. Excessive gambling was also generally more common among cryptocurrency traders. The full model that was adjusted for the number of confounding factors showed that cryptocurrency trading had a within-person effect on excessive gambling. Of the confounding factors, offshore online gambling, excessive gaming, and excessive internet use had within-person effects on excessive gambling. Offshore and onshore online gamblers and excessive gamers showed more excessive gambling than others. Those participants who were both cryptocurrency traders and offshore gamblers showed significantly higher rate of excessive gambling than others.

CONCLUSIONS

Cryptocurrency trading is a risky activity and associated with a higher rate of excessive gambling over time. Such activity is especially risky among offshore online gamblers, who could view cryptocurrency trading as another form of gambling or as a way to make money for gambling. Policymakers and counselors should be aware of the risks of cryptocurrency trading.

One size does not fit all. Should gambling loss limits be based on income?

Background

Previous research has suggested empirically based gambling loss limits, with the goal of preventing gambling related harm in the population. However, there is a lack of studies relating gambling loss limits to individual factors such as income. The current study examines whether gambling loss limits should be income-specific.

Materials and methods

The dataset was derived from three representative cross-sectional surveys of the Norwegian population and consisted of 14,630 gamblers. Four income groups, based on a quartile approximation, were formed. Gambling related harm was measured with the Problem Gambling Severity Index (PGSI), and precision-recall (PR) analyses were used to identify loss limits for the different income groups at two levels of gambling severity: moderate-risk gambling and problem gambling.

Results

For both levels of gambling severity, we found the lowest income group to have the lowest gambling loss limits, and the highest income group to have the highest loss limits, which compared to the loss limits for the total sample, were lower and higher, respectively. Calculating the cut-offs for moderate-risk gamblers, we found a consistently ascending pattern from the lowest to the highest income group. Calculating the cut-offs for problem gamblers, we found a similar pattern except for the two middle income groups.

Conclusion

The results suggest that income moderates empirically derived gambling loss limits. Although replication is required, income-based gambling loss limits may have higher applied value for preventing gambling related harm, compared to general loss limits aimed at the entire population.

Associations between playing free-to-play sports gambling predictor games and online sports betting frequency for men in the United Kingdom

Aim

This study aimed to describe associations between playing predictor games and online sports betting behaviours, and problem gambling.

Methods

An online survey using a convenience sample was completed by males aged 18 + years, living in the United Kingdom, and having participated in any gambling activity in the past year (n = 384). The survey asked questions about sociodemographics, gambling behaviours and predictor game playing behaviours. The Problem Gambling Severity Index (PGSI) tool was used to determine existence of at-risk and problem gambling. Bivariate analyses using X2, and multivariate analyses using binary logistic regressions were carried out.

Results

Predictor games were played by 45.8% of all participants. In bivariate analyses, there was an association between predictor game playing and age (p = 0.019), with predictor game playing most prevalent in the age group 18–24 years 51.8%. In bivariate analysis, there was a significant graded relationship between playing predictor games and PGSI group (p < 0.001), with predictor game playing most prevalent among those with problem gambling 76.9%. In multivariate analysis, after controlling for sociodemographics and PGSI group, those who played predictor games were 2.80 (1.65–4.74 p < 0.001) times more likely to engage in high frequency online sports gambling than those who did not play predictor games.

Conclusions

This study suggests there may be links between playing predictor games and gambling harms through increased frequency of online sports gambling, particularly amongst already vulnerable groups. Policy options placing restrictions on the most harmful inducements – one of which being predictor games – must be considered to protect against gambling harms.

Neural cue-reactivity in pathological gambling as evidence for behavioral addiction: a systematic review

Increasing incidence of problem gambling has led to prioritizing the problem from the point of view of public health. Additionally, gambling disorder has been recently classified as a behavioral addiction, with implications for both its diagnosis and treatment. However, the shared neural substrate of addictions, to substances and behavioral, is still discussed. Thus, this systematic review aims to provide up-to-date knowledge from the past five years (2017-2022) concerning the neural correlates of gambling related stimuli (cue-reactivity) on the basis of a previous review (Brevers et al., Cognitive, Affective and Behavioral Neuroscience 18:718-729, 2019). A total of five studies were included in the review. Activation of brain areas related to memory, reward and executive functions could be the underlying mechanism of this behavioral addiction. Specifically, nucleus accumbens and striatum (ventral and dorsal), parahippocampal regions, the right amygdala and several prefrontal cortex regions have systematically been found more active in those subjects exposed to gambling-related cues. Also, the insula could play a pivotal role connecting these three systems in a highly integrated neural network with several implications for reward processing modulation, associative learning and top-down attentional regulation to improve saliency of addiction-related cues. These results are consistent with previous findings on other substance addictions, such as alcohol, tobacco, marijuana or cocaine. The study of neural reactivity to stimuli related to addiction could be useful as a biomarker of the severity of the disorder, the efficacy of the treatment, the risk of relapse, in addition to being an objective criterion to measure the effectiveness of prevention campaigns.

Escapism and Excessive Online Behaviors: A Three-Wave Longitudinal Study in Finland during the COVID-19 Pandemic

Excessive online behaviors refer to harmful or disproportionate use of digital network applications. Such behaviors are likely to be associated with escapist motives. Our aim was to analyze whether escapism predicts excessive gambling, excessive gaming, and excessive internet use over time. A longitudinal sample of Finnish residents aged 18-75 years (n = 1022, 51.27% male) was surveyed at three time points during the COVID-19 pandemic in 6-month intervals: April 2021 (Time 1), October-November 2021 (Time 2), and April-May 2022 (Time 3). Of the original Time 1 respondents, 66.80% took part in the surveys at both Time 2 and Time 3. All surveys included measures for excessive gambling (Problem Gambling Severity Index), excessive gaming (Internet Gaming Disorder Test), and excessive internet use (Compulsive Internet Use Scale). Three escapism-specific questions were used to construct a dedicated escapism variable. Socio-demographic variables, alcohol consumption, and psychological distress were used as controls. The study was conducted with multilevel regression analyses using hybrid models. Our research showed that escapism had strong within-person effects on excessive gambling, B = 0.18, p = 0.003; excessive gaming, B = 0.50, p < 0.001; and excessive internet use, B = 0.77, p < 0.001 over time. The between-person effect of escapism was demonstrated on excessive gaming B = 0.91, p < 0.001, and excessive internet use B = 0.61, p = 0.036. Adverse societal events and uncertain times can manifest in excessive online behaviors motivated by escapism, highlighting a need to focus prevention efforts on healthy coping methods.

Surprisingly high prevalence rates of severe psychological distress among consumers who purchase loot boxes in video games

Loot boxes are randomised rewards available in some video games, often purchasable for real-world money. Loot boxes have been likened to conventional forms of gambling and may satisfy legal requirements to be considered bona fide gambling in some jurisdictions. Research has consistently shown that people with problem gambling symptoms report spending more on these mechanisms than people without such symptoms. However, a significant gap in our current understanding is whether engaging with these mechanisms is associated with harm. Here we examine the prevalence rates of severe psychological distress among purchasers of loot boxes relative to non-purchasers. A reanalysis of two cross-sectional surveys collected online via online collection platforms. Participants were 2432 Aotearoa New Zealand, Australian, and United States residents recruited through online survey. Our results show that purchasers of loot boxes are at approximately 1.87 times higher risk of severe psychological distress on a standardised clinical screening tool than people who do not purchase loot boxes. These relative risk rates are not due to gender, age, spending on other video game related purchases, or problem gambling symptoms. Individuals who purchased loot boxes appeared to also have higher risk of severe psychological distress irrespective of demographic characteristics or problem gambling status. Loot boxes appear to be associated with significantly higher risk of experiencing psychological harm even for players without problem gambling symptoms.

Psychometric properties of the Jonsson-Abbott Scale: Rasch and confirmatory factor analyses

Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.

Gambling and gaming during COVID-19: The role of mental health and social motives in gambling and gaming problems

BACKGROUND

The uncertain and stressful global situation caused by the COVID-19 pandemic has the potential to cause anxiety and impact people's mental health. Simultaneously, social distancing policies have isolated people from their normal social interactions. These societal changes have inevitably influenced gambling and gaming practices, and many people may have turned to betting or gaming as a means of social exchange. This study examined the influence of COVID-19 anxiety on increased mental health problems and their relationship to gambling and gaming problems. The mediating role of social motives for gambling and gaming was also investigated.

MATERIAL AND METHODS

Finnish adults (N = 1530; Mage = 46.67; 50.33% male) were recruited from a volunteer participant panel to participate in a survey study. COVID-19 anxiety was assessed using a scale adapted from the Spielberger State-Trait Anxiety Inventory. Mental health problems were evaluated with the five-item Mental Health Inventory. Gambling problems were measured using the Problem Gambling Severity Index, and gaming problems were measured with the Internet Gaming Disorder Test. Social motives for gaming were evaluated using a single-item measure. Analyses used generalised structural equation modelling.

RESULTS

COVID-19 anxiety predicted increased mental health problems, which were associated with heightened gambling and gaming problems. Social motives for gambling and gaming were a significant mediator, suggesting that gambling and gaming problems are emphasized markedly among those who are socially motivated by and involved in such games.

CONCLUSIONS

Mental health problems experienced during the pandemic and the social properties of games might accentuate gambling and gaming problems.

Loot box spending is associated with problem gambling but not mental wellbeing

There are emerging concerns that loot boxes-digital video game items that can be purchased for a chance at randomized rewards-are associated with problematic gambling behaviours and, in turn, are potentially harmful. Current research suggests consistent correlations between loot box spending (LS) and problematic gambling symptomology; however, little research has looked at relationships with mental wellbeing. Here, we used a Bayesian hypothesis testing framework to assess the relative strength of evidence for relationships between LS, excessive gaming, problem gambling, mental wellbeing and psychological distress. Two thousand seven hundred twenty-eight participants who reported playing games containing loot box mechanics in the past month answered a survey assessing the above measures, as well as other forms of digital spending. The results showed extremely strong evidence for a positive correlation between LS and problem gambling; however, there was no evidence to suggest relationships between such spending and mental wellbeing or psychological distress. Exploratory results suggested that individuals who spend money on loot boxes also spend more across a range of digital purchases generally. The findings highlight an urgent need to understand what constitutes harm when considering LS effects and provide further context for discussions regarding how best to regulate such mechanisms.

Loot box spending is associated with problem gambling but not mental wellbeing

There are emerging concerns that loot boxes-digital video game items that can be purchased for a chance at randomized rewards-are associated with problematic gambling behaviours and, in turn, are potentially harmful. Current research suggests consistent correlations between loot box spending (LS) and problematic gambling symptomology; however, little research has looked at relationships with mental wellbeing. Here, we used a Bayesian hypothesis testing framework to assess the relative strength of evidence for relationships between LS, excessive gaming, problem gambling, mental wellbeing and psychological distress. Two thousand seven hundred twenty-eight participants who reported playing games containing loot box mechanics in the past month answered a survey assessing the above measures, as well as other forms of digital spending. The results showed extremely strong evidence for a positive correlation between LS and problem gambling; however, there was no evidence to suggest relationships between such spending and mental wellbeing or psychological distress. Exploratory results suggested that individuals who spend money on loot boxes also spend more across a range of digital purchases generally. The findings highlight an urgent need to understand what constitutes harm when considering LS effects and provide further context for discussions regarding how best to regulate such mechanisms.

Psychometric evaluation of the NORC diagnostic screen for gambling problems (NODS) for the assessment of DSM-5 gambling disorder

The National Opinion Research Center (NORC) Diagnostic Screen for Gambling Problems (NODS) is one of the most used outcome measures in gambling intervention trials. However, a screen based on DSM-5 gambling disorder criteria has yet to be developed or validated since the DSM-5 release in 2013. This omission is possibly because the criteria for gambling disorder only underwent minor changes from DSM-IV to DSM-5: the diagnostic threshold was reduced from 5 to 4 criteria, and the illegal activity criterion was removed. Validation of a measure that captures these changes is still warranted. The current study examined the psychometric properties of an online self-report past-year adaptation of the NODS based on DSM-5 diagnostic criteria for gambling disorder (i.e., NODS-GD). A diverse sample of participants (N = 959) was crowdsourced via Amazon's TurkPrime. Internal consistency and one-week test-retest reliability were good. High correlations (r = 0.74-0.77) with other measures of gambling problem severity were observed in addition to moderate correlations (r = 0.21-0.36) with related but distinct constructs (e.g., gambling expenditures, time spent gambling, other addictive behaviors). All nine of the DSM-5 criteria loaded positively on one principal component, which accounted for 40% of the variance. Classification accuracy (i.e., sensitivity, specificity, predictive power) was generally very good with respect to the PGSI and ICD-10 diagnostic criteria. Future studies are encouraged to establish a gold standard self-report measure of gambling problems and develop agreed-upon recommendations for the use and interpretation of crowdsourced addiction data.

Examination of the Problem Gambling Severity Index for Use with Older Adults: A Rasch Model Approach

Research and prevalence studies commonly use the nine-item Problem Gambling Severity Index (PGSI; Ferris and Wynne in The Canadian Problem Gambling Index, 2001) to measure problem gambling severity in older adults. However, the appropriateness of the PGSI for use with older adults must be evaluated to ensure accurate interpretation of scores. This study evaluated the PGSI with older adults that gamble using a Rasch model approach, which has not yet been examined in the literature. Data from the Quinte Longitudinal Study (Wiiliams et al. in The Quinte Longitudinal Study of Gambling and Problem Gambling 2006-2011, Bay of Quinte region, Ontario [Canada] (V28), 2014) were utilized, accessed through the Gambling Research Exchange of Ontario (GREO). Using WINSTEPS.V5, a Rasch rating scale model was applied to an older adult sample from Ontario, Canada (n = 571, M_age = 66, range = 60-80 +) to assess: (1) the dimensionality and fit between individual PGSI items and the underlying latent construct of problem gambling; (2) utility of items and response options; and (3) potential differential item functioning (DIF) between genders. Using a larger sample (N = 3206, M_age = 45, range = 18-80 +), DIF was examined across three age subgroups. Results supported unidimensionality of the PGSI and item polarity (r_pm range = 0.42-0.85). Infit and outfit statistics showed mixed model misfit for three items. The use of three response options were deemed productive for measurement, but almost always was not frequently endorsed. Model-person separation (1.00) and reliability (0.50) were poor, and model-item separation (6.12) and reliability (0.97) were excellent. There was no significant DIF between older adults by gender. Three items showed significant DIF between older and younger adults. Possible modifications to improve the PGSI for use with older adults are discussed.

Differences in problem and pathological gambling: A narrative review considering sex and gender

Background and aim

A wide range of studies indicates that men and women with Problem (PrG) and Pathological Gambling (PG) differ in several clinical and sociodemographic characteristics. However, evidence for sex differences, such as the telescoping effect, is contradictory, and it is still unclear whether sex differences observed in offline gambling can also be found for online gambling. Furthermore, reviews have so far focused on binary sex differences but neglect gender aspects. In this study, an updated literature survey of sex- and gender-related differences in PrG and PG was conducted.

Methods

We searched PsyInfo, Medline/Pubmed, and the Web of Science databases from 2005 to 2020 for studies investigating sex and gender differences in gambling. A total of 126 papers were included in the literature survey.

Results

We are presenting our findings according to the categories 'prevalence' (offline, online, LGBTQI*), 'sociodemographic factors', 'preferred gambling type', 'gambling motives', 'severity', 'progression of gambling problems', 'use of professional help/motivation for treatment', 'comorbidity', 'trauma', 'violence and criminality/delinquency'. The studies indicate that, despite some robust sex differences (e.g., concerning prevalence rates), results for most areas were mixed or suggest no sex differences (e.g., violence, gambling motives).

Discussion and conclusion

To date, there is a lack of studies assessing gender, and not only sex, warranting further research in this area.

No Significant Changes in Addictive and Problematic Behaviors During the COVID-19 Pandemic and Related Lockdowns: A Three-Wave Longitudinal Study

Introduction

The COVID-19 outbreak and related lockdowns brought substantial changes in people's lives and led to concerns about possible increases of addictive behaviors at the initial stages of the pandemic. To examine these concerns, the aim of the present study was to assess longitudinal changes in addictive and problematic behaviors (i.e., problematic social media use, Internet gaming disorder, gambling disorder, problematic pornography use, and compulsive sexual behavior disorder) over time during the COVID-19 pandemic.

Methods

Three waves of data collection took place in different stages of the COVID-19 outbreak in Hungary in a general population, from the first wave of lockdowns to the second and third waves of restrictions (May, 2020; N T1 = 1747; June-August, 2020; N T2 = 656; January, 2021; N T3 = 411). Latent growth curve models were calculated to assess the potential changes in addictive and problematic behaviors over time.

Results

Latent growth curve models showed that the sample varied in their initial scores, but there were no significant changes over time in any of the examined behaviors, except for compulsive sexual behavior disorder, which demonstrated a small but significant increase (i.e., positive and significant slope factor). However, the rate of this change was negligible. Overall, there were no noteworthy changes over time regarding any of the examined addictive and problematic behaviors.

Conclusion

Contrary to initial concerns, no substantial changes over time were observed regarding the examined addictive behaviors during the COVID-19 pandemic and related lockdowns. These findings indicate that those who had no previous problem with these addictive behaviors, might have not developed a problem, and those who had problem with either of the behaviors previously, might have not experienced a significant increase in their symptoms.

Problem gambling and anxiety disorders in the general swedish population - a case control study

Co-occurring psychiatric comorbidity is high among problem gamblers, and anxiety disorders has repeatedly been linked to problem gambling. Less conclusive, however, is the association between problem gambling and specific anxiety disorders. The aim of this study is to examine the association between problem gambling and specific anxiety disorders in subgroups of gender, age and socio-economic status (SES) in the general Swedish population. A case-control design was employed - nested in the Swedish longitudinal gambling study cohort. All anxiety disorders studied - Panic Disorder, Social Phobia, Generalized Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD), were significantly associated with problem gambling, however the pattern differed across subgroups. Social Phobia was the anxiety disorder most commonly associated with problem gambling across subgroups. The strongest associations between problem gambling and various anxiety disorders were found in participants under the age of 25, among females, and in the group with middle SES. In those groups three of the four anxiety disorders studied were significantly associated with problem gambling, with different patterns. Quite remarkably, participants under the age of 25 had three times higher risk of having had GAD compared to their controls. Efforts to prevent an escalation of either gambling or anxiety could target the presented vulnerable groups specifically.

Gambling and online trading: emerging risks of real-time stock and cryptocurrency trading platforms

OBJECTIVES

Online platforms enable real-time trading activities that are similar to those of gambling. This study aimed to investigate the associations of traditional investing, real-time stock trading, and cryptocurrency trading with excessive behavior and mental health problems.

STUDY DESIGN

This was a cross-sectional population-based survey.

METHODS

The participants were Finnish people aged 18-75 years (N = 1530, 50.33% male). Survey asked about monthly regular investing, real-time stock-trading platform use, and cryptocurrency trading. The study had measures for excessive behavior: gambling (Problem Gambling Severity Index), gaming (Internet Gaming Disorder Test), internet use (Compulsive Internet Use Scale), and alcohol use (Alcohol Use Disorders Identification Test). Psychological distress (Mental Health Inventory), perceived stress (Perceived Stress Scale), COVID-19 anxiety, and perceived loneliness were also measured. Background factors included sociodemographic variables, instant loan taking, and involvement in social media identity bubbles (Identity Bubble Reinforcement Scale). Multivariate analyses were conducted with regression analysis.

RESULTS

Within the sample, 22.29% were categorized into monthly regular investors only, 3.01% were investors using real-time stock-trading platforms, and 3.59% were cryptomarket traders. Real-time stock-trading platform use and cryptocurrency trading were associated with younger age and male gender. Cryptomarket traders were more likely to have an immigrant background and have taken instant loans. Both real-time stock-trading platform use and cryptomarket trading were associated with higher excessive behavior. Cryptomarket traders especially reported higher excessive gambling, gaming, and internet use than others. Cryptomarket traders reported also higher psychological distress, perceived stress, and loneliness.

CONCLUSIONS

Regular investing is not a risk factor for excessive behavior. However, rapid online trading platforms and applications were significantly more commonly used by participants reporting excessive behavior and mental health problems. The strong association between cryptomarket trading and excessive behavior in particular underlines the need to acknowledge the potential risks related to real-time trading platforms.

Conceptualising emotional and cognitive dysregulation amongst sports bettors; an exploratory study of ‘tilting’ in a new context

Tilting is a poker-related phenomenon that involves cognitive and emotional dysregulation in response to unfavourable gambling outcomes. Tilting is characterised by an increase in irrational, impulsive and strategically weak betting decisions. This study aimed to adapt and investigate the concept of tilting amongst sport bettors in order to provide preliminary insight regarding previously unexplored instances of maladaptive sports betting. The sample consisted of 225 sports bettors who completed an online questionnaire that investigated their reported tilting episodes, awareness of tilting, impulsivity, perceived skill, gambling severity, gambling frequency, and product preferences. Cluster analyses revealed three distinct groups of sports bettors based on their reported tilting episodes and their awareness of this phenomenon. The first group were labelled ‘Conscious tilters’ due to being cognizant of their own tilting occurrence which was significantly higher than the other two groups. These ‘Conscious tilters’ had the highest mean problem gambling severity that was indicative of the ‘problem gambler’ categorisation. The second group were labelled ‘Unconscious tilters’ due to their underestimation of their own tilting occurrence and were categorised as ‘moderate risk gamblers’. The third group were labelled ‘Non-tilters’ due to a relatively accurate perception of their low to non-existent tilting occurrence and were categorised as ‘low-risk gamblers’. Additionally, there were significant differences between these groups in relation to reported gambling frequency, impulsivity, and product preferences. There is evidence of various classifications of ‘tilters’ within sports betting. Specific sports betting product features may also facilitate tilting and therefore require further research in this context. It is important for this research area to develop in order to mitigate harms associated with the rapidly changing sport betting environment.

Offline and Online Gambling in a Swiss Emerging-Adult Male Population

Faced with the rapid expansion of the online gambling offer, a growing number of jurisdictions around the world are developing legislation to regulate online gambling. The new Swiss Act on gambling extends legalization of online gambling from already authorized lottery-type to casino-type gambling. In this context, the present study examines offline and online gambling behaviors in emerging-adult males as a particularly at-risk population for gambling addiction. A sample of 1,869 young males completed a questionnaire assessing offline and online gambling behaviors as well as severity of problem gambling. Results show that 62.1% of the respondents were lifetime gamblers while 46.7% were past-year gamblers. Among the latter, 76.4% had gambled only within offline venues, 21.4% had gambled at both offline and online sites, and 2.2% had gambled online only. Furthermore, 17.6% of past-year gamblers were at moderate-risk of developing problem gambling whilst 3.6% were problem gamblers. Association analysis showed that, compared to non-problem gamblers, at-risk and problem gamblers played online at higher rates. These findings contribute to the growing literature on youth gambling behaviors and on offline-online transitions. In the context of the growing online gambling supply, the evolution of youth gambling behaviors should be monitored through periodical assessments.

The Association Between Problem Gambling and Suicidal Ideations and Attempts: A Case Control Study in the General Swedish Population

The association between problem gambling and suicidal behaviours is well established in treatment seeking populations, but less explored among sub-clinical problem gamblers in the general population. The aim of this study was to examine the association between problem gambling (including moderate risk gambling) and suicidal ideations/suicide attempts, in the general Swedish population. Another aim was to compare problem gamblers with and without suicide ideation/attempts. A case-control study nested in the Swelogs cohort was used. Both ideations and attempts were about twice as frequent among the cases compared to the controls. After controlling for socio-economic status and life-time mental health problems, suicidal ideation, but not attempts, remained significantly higher among the cases compared to the controls. The largest difference between attempters and non-attempters were on payment defaults and illicit drug abuse, whereas depression yielded the largest difference between ideators and non-ideators. Problem gambling severity (PGSI 8+) resulted in the smallest difference, compared to the other variables, between attempters and non-attempters. Even though no conclusion regarding the casual relationship can be drawn in this type of study, it seems like sub-clinical levels of problem gambling might have an impact on suicidal ideations whereas for suicide attempts to occur, other factors need to be present. In addition to mental health issues, financial difficulties may be such factors.