Demographic Risk Factors and Gambling Preference May Not Explain the High Prevalence of Gambling Problems Among the Population with Migration Background: Results from a German Nationwide Survey

The Effect of Inequality and Prosperity on the European Market for Gambling Machines: A Socioeconomic Panel Analysis

This study examines the potential influence of prosperity and inequality on gambling participation in Europe. We combined data from the Eurostat database, the Global Wealth Report, and the European Casino Association and estimated fixed effects panel regression models. We show that income inequality has a negative effect on the number of gambling machines that flattens for high values, while wealth inequality has a linear negative effect. Moreover, an increase in the disposable income of the lower quintiles leads to significant increases in the number of gambling machines per country. These findings are important for future researchers who relate any kind of economic variable to gambling as well as for policy makers, as our results suggest that the lower-income groups should be given the most attention with regards to gambling regulation.

Development of Gambling Behaviour and Its Relationship with Perceived Social Support: A Longitudinal Study of Young Adult Male Gamblers

Young adult men who gamble frequently face an elevated risk of developing gambling-related problems. So far, little is known about how changing levels of perceived social support interact with the course of gambling behaviour and gambling-related problems in this population. Using data from a prospective single-arm cohort study (Munich Leisure Time Study), we applied hierarchical linear models to investigate the longitudinal association of changes in perceived emotional and social support (hereafter PESS; operationalized as ENRICHD Social Support Instrument score) with gambling intensity, gambling frequency, and fulfilled criteria for gambling disorder. Pooling data from three time points (baseline, 12-month and 24-month follow-ups) to assess two 1-year intervals, these models disentangle the associations of (a) "level of PESS" (cross-sectional, between participants) and (b) "changes in individual PESS" (longitudinally, within-participants). Among the 169 study participants, higher levels of PESS were associated with fewer gambling-related problems (- 0.12 criteria met; p = 0.014). Furthermore, increasing individual PESS was associated with lower gambling frequency (- 0.25 gambling days; p = 0.060) and intensity (- 0.11 gambling hours; p = 0.006), and fewer gambling-related problems (- 0.19 problems; p < 0.001). The results suggest a mitigating influence of PESS on gambling behaviour and gambling-related problems. Increasing individual PESS appears more decisive for this pathway than high initial levels of PESS. Treatment and prevention strategies that activate and reinforce beneficial social resources in people with gambling-related problems are recommended and promising.

Prevalence and Trends in Problem Gambling in Denmark with Special Focus on Country of Origin: Results from the Danish Health and Morbidity Surveys

Belonging to an ethnic minority has been described as a possible risk factor for problem gambling, but the literature is inconclusive whether this association is true or just a proxy for other underlying risk factors. Hence, the aims were to investigate: (1) past year prevalence of problem gambling in the adult Danish population and trends since 2005, (2) past year prevalence of problem gambling in 2017 and trends since 2010 by country of origin, and (3) whether a marginalisation by country of origin or problem gambling, respectively, is seen in various health-related indicators. Data were derived from the Danish Health and Morbidity Surveys in 2005, 2010, 2013, and 2017. The Lie/Bet Questionnaire was used to define problem gamblers. The overall prevalence of past year problem gambling has increased slightly from 2005 (1.0%) to 2017 (1.5%), but a more alarming increase was observed among men with non-western origin (3.1% in 2010 and 7.0% in 2017). A lower prevalence of good self-rated health and a higher prevalence of poor mental health was observed among individuals with a non-western origin compared to those with a Danish origin, although the differences became smaller between 2010 and 2017. The findings indicate a slightly increase in the prevalence of past year problem gambling and that particular attention should be paid to individuals with a non-western origin. The study also highlights the need for better differentiation of risk factors that may variously predispose different ethnic groups to develop gambling problems.

Changes in gambling behaviour and related problems in clients seeking help in outpatient addiction care: Results from a 36-month follow-up study in Bavaria

BACKGROUND AND AIM

Evidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe.

METHODS

We investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status.

RESULTS

Within the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB.

DISCUSSION AND CONCLUSION

Our study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.

Risk factors, physical and mental health burden of male and female pathological gamblers in the German general population aged 40-80

BACKGROUND

Gambling Disorder (GD) has been associated with considerable mental and physical health risks in clinical samples. The paper determines risk factors, mental and physical health burden of probable GD for both men and women in the general population.

METHODS

In the Gutenberg Health Study, a population-based sample of N = 11,875 aged 40-80 years was analyzed regarding lifetime probable GD prevalence (measured with the Lie/ Bet Questionnaire) and a wide array of health variables including standardized measures of depression, anxiety, and somatic symptoms.

RESULTS

Probable GD lifetime prevalence was 2.1%, with higher rates among 1st generation migrants (5.5%; vs. non-migrants 1.6%), men (3.0%; vs. women 1.2%), and the sample's youngest age decade (40-49 y., 3.1%). Lifetime probable GD was associated with current work-related, family and financial stressors as well as unhealthy behavior (smoking, extended screen time), and lifetime legal offenses. In men, but not in women, increased rates of imprisonment, mental and somatic symptoms were found.

CONCLUSIONS

GD is a major public health problem with serious social, mental and physical health burden. Epidemiological findings underscore the preponderance of GD among 1st generation migrants and men. Findings are consistent with a vicious cycle of family, work related and financial stress factors, and mental and physical burden, particularly in men. Demographic risk factors may help to target specific prevention and treatment efforts.

The association of cognitive distortions and the type of gambling in problematic and disordered gambling

BACKGROUND

Previous studies have shown that particular types of gambling are related to the development of gambling-related problems. Further, gambling-related cognitive distortions contribute to the development of disordered gambling. The aim of the present study is to compare different gambling types with respect to cognitive distortions and the development of disordered gambling.

METHODS

Based on a proactively screened sample of vocational school students (N = 6718), 309 students were selected to undergo an in-depth interview. We assessed the Gamblers-Belief-Questionnaire (GBQ) to measure gambling-related cognitive distortions and the Stinchfield questionnaire for assessing gambling-related problems. Associations between cognitive distortions, gambling-related symptoms, and types of gambling were analysed using logistic regression analyses.

RESULTS

Higher scores on the GBQ subscale "belief in luck/perseverance" led to a significantly higher chance to be classified as a person with Gambling Disorder (Conditional Odds Ratio (COR) = 1.05, Confidence Interval (CI) = 1.02-1.08) as well as problematic gambling (COR = 1.04, CI = 1.01-1.06). Higher scores on the subscale "illusion of control" were also associated with problematic gambling (COR = 1.04, CI = 1.00-1.08). The multivariate analyses of the gambling types identified only sports betting as a predictor for problematic gambling (COR = 1.91, CI = 1.05-3.49). When controlling for cognitive distortions, sports betting was not significant anymore. With respect to disordered gambling, gambling on electronic gambling machines (EGMs) turned out to be a risk factor besides cognitive distortions (COR = 2.59, CI = 1.04-6.49).

DISCUSSION

The present study confirmed the high relevance of cognitive distortions for problematic and disordered gambling especially for sports betting and gambling on EGMs. Preventive measures and psychotherapy should take these relationships into account.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder

BACKGROUND AND AIMS

Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.

METHODS

Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.

RESULTS

Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).

CONCLUSION

Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

Genome-wide association study of pathological gambling

Background

Pathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence.

Methods

Four hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence.

Results

No genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease (P-value = 6.63 × 10−3); 5′-adenosine monophosphate-activated protein kinase signalling (P-value = 9.57 × 10−3); and apoptosis (P-value = 1.75 × 10−2) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P-value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status.

Conclusions

The present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies.

Gambling habits, gambling norms, and problem gambling in foreign born and native populations in Denmark - A general population survey

Background

Being foreign born, i.e. not born in the reception country or belonging to an ethnic minority, has been described as a risk factor of problem gambling, although research so far has been inconclusive. Also, there is limited knowledge about whether this association is caused by differing gambling norms. The present study aimed to study whether foreign origin is associated with problem gambling, when controlling for several potential risk factors, gambling frequency and beliefs about peer gambling, i.e. gambling norms.

Methods

Cross-sectional web survey including 1970 adult individuals from the general population in Denmark (50% female), in April 2018. Binary analyses and hierarchical logistic regression with respect to associations between foreign origin, relevant co-factors and problem gambling.

Results

Problem gambling was more common in individuals with foreign origin (15 vs 10%, p = 0.01). In logistic regression, problem gambling was associated with male sex, gambling frequency, foreign origin, psychological distress, smoking, and number of gambling types used. Beliefs about peer gambling did not differ with respect to foreign origin, but were associated with problem gambling until one's own gambling frequency was entered into the model.

Conclusions

When controlling for a number of relevant risk factors, foreign origin still appears to predict problem gambling. Gambling patterns or gambling norms are unlikely to be the sole explanation of the increased prevalence. The findings have implications for preventive work in the foreign born population, and gambling norms may be targeted in screening for at-risk gamblers.

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In the population, problem gambling was more common in first or second generation immigrants.

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The association with problem gambling was not explained by increased gambling norms in the immigrant population instead demonstrated lower beliefs about peer gambling.

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Instead, immigrants demonstrated lower beliefs about peer gambling

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Beliefs about peer gambling were associated with own's problem gambling risk

Deficits in emotion regulation strategies among problematic and pathological gamblers in a sample of vocational school students

BACKGROUND AND AIMS

Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample.

METHODS

A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses.

RESULTS

The analyses showed a significant negative correlation between the subscales "Adjusting" and "Tolerating" and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies "Adjusting" [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91-0.99] and "Tolerating" [COR = 0.95, CI = 0.92-99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only "Tolerating" turned out to be significant [COR = 0.96, CI = 0.93-0.99].

DISCUSSION AND CONCLUSIONS

For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptance-focused strategies, should be considered in prevention and psychotherapy.

The effect of online gambling on gambling problems and resulting economic health costs in Germany

Problematic and pathological gambling have emerged as substantial problems in many countries. One potential accelerating factor for this phenomenon during recent years is the Internet, which offers different kinds of games and online applications for gambling that are faster, more attractive due to a variety of design and marketing options, less costly and potentially more addictive than terrestrial gambling opportunities. However, the contributing role of the Internet for problematic gambling has not been analyzed sufficiently so far and remains inconclusive. The current study is based on a representative sample with 15,023 individuals from Germany. With a new concept of assessing online gambling with its relative fraction of total gambling activities and a control-function approach to account for possible endogeneity of online gambling, we estimate the impact of online gambling on gambling behavior while additionally controlling for a rich set of important covariates, like education, employment situation and family status. The results show that, on average, replacing 10% of offline gambling with online gambling increases the likelihood of being a problematic gambler by 8.8-12.6%. This increase is equivalent to 139,322 problematic gamblers and 27.24 million € per year of additional expenditures in the German health sector. Our findings underpin the necessity to keep online gambling restricted to prevent further developments of problematic and pathological gambling in Germany.

The Relationship Between Exclusions from Gambling Arcades and Accessibility: Evidence from a Newly Introduced Exclusion Program in Hesse, Germany

An exclusion system for gambling arcades has been introduced recently in the state of Hesse. The aim of this paper is to identify significant predictors that are useful in explaining the variation of exclusions between different Hessian communities. Next to socio-demographic factors, we control for three different accessibility variables in two models: the number of electronic gambling machines (EGMs) in model I, and the number of locations and density of gambling machines at a location in model II. We disentangle the association between EGMs and exclusions of model I into a location and a clustering effect. Considering the socio-demographic variables, the explanatory power of our cross-sectional models is rather low. Only the age group of the 30-39 years old and those who are not in a partnership (in model I) yield significant results. As self-exclusion systems reduce availability for the group of vulnerable players, this analysis provides evidence for the assumption that the two groups-pathological gamblers and vulnerable players-seem to have little overlap concerning sociodemographic characteristics. The accessibility variables, on the other hand, turn out to be significantly associated with the number of exclusions. All three of them are statistically significant and their association is positive. The results of model II show that the location effect is more pronounced then the clustering effect of EGMs, i.e. the effect of an additional single-licensed arcade on the number of exclusions is stronger than the increase in the number of license at one location.