Screening for problem gambling within mental health services: a comparison of the classification accuracy of brief instruments

Lived Experience Performance to Reduce Stigma, Enhance Understanding of Gambling Harm and Change Attitudes and Behaviours of Professionals and Community Members

Gamblers and their family members or friends (affected others) can experience stigma and shame due to gambling which can result in a reluctance to seek timely support. However, gamblers and affected others access intersecting health services and talk to friends or family, thereby providing opportunities for early intervention. Three sides of the coin is a group of storytellers with lived experience of gambling harm who use dramatic performance to share personal stories to enhance the understanding of gambling-related harm in allied professions and the broader community. They do this to encourage attitude and behaviour change so that gamblers and affected others receive empathy and support during encounters with these groups. A mixed-methods study was used to explore whether these performances were successful in increasing understanding and changing attitudes and behaviour of allied professionals and the community in the short and longer-term. Data collected immediately post-performance revealed that performances increased understanding of gambling, and improved attitudes and behavioural intent of audience members in relation to gamblers and affected others. Professionals also reported an increased willingness and confidence to discuss gambling harm with clients. Follow-up data demonstrated potential longer-term impact, with respondents continuing to report more positive attitudes towards those affected by gambling harm and professionals being confident to explore gambling issues in their clients and provide appropriate referrals. These finding demonstrate that performance based on lived experience can be a powerful education tool, encouraging deep connection to the issue, resulting in a nuanced understanding and sustained attitudinal and behavioural change.

The Price of Gambling: Examining Gambling Disorders

Gambling disorders are a serious public health problem. This manuscript will provide a comprehensive overview on this topic. Gambling disorder involves repeated patterns of gambling behaviors, that result in significant distress or impairment in a person's interpersonal relationships, employment, educational/career opportunities, and finances over a period of 12 months. Gambling is defined as an activity that involves risking something of value with the hopes of acquiring something of greater value. Comparable to substance use disorders, individuals with a gambling disorder may be unsuccessful in exercising control over their problematic behavior, engage in the behavior despite negative consequences, and have preoccupations/cravings to gamble. Gambling disorder has higher comorbidity rates of mental disorders including depression, anxiety, substance use, and personality disorders. Gamblers rarely seek treatment. Treatments must be tailored to the individual which may include psychological interventions, cognitive behavioral therapy, gamblers anonymous, and psychopharmacological agents such as selective serotonin reuptake inhibitors, mood stabilizers, and opioid antagonists to treat clinical symptoms.

Problem gambling within sexual and gender minorities: A systematic review

A body of literature now suggests that sexual and gender minorities (SGMs) experience a distinct set of stressors in the form of minority stress, which may function as a risk factor for the development of negative psychological and behavioral health outcomes. A systematic review of the literature was conducted through June 1st, 2022. Inclusion was limited to peer-reviewed publications in academic journals, with prospective and retrospective studies of a quantitative nature included for synthesis. Articles were required to contain an empirical measure of gambling cognitions, behaviors, motives, or outcomes. Studies that did not include sexual minorities within the sample or did not provide quantitative results which shed light on gambling in sexual minorities were excluded from the present review.In total, 12 eligible studies were identified for the current review. In general, this review highlighted methodological weaknesses within the literature and suggested that little is known about gambling in this population. Given conflicting findings across studies, further research is necessary to understand gambling in sexual and gender minorities. From a methodological standpoint, there is a need for clearer conceptualization and standardized measurement of gambling-related variables in vulnerable populations. Further, longitudinal research would be beneficial to understand the nuances of gambling disorder across sexual orientations and gender identities, as well as aid in the development of holistic intervention options that meet the needs of these more vulnerable groups.

Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

BACKGROUND

The limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches.

METHODS

This is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients' medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population.

DISCUSSION

A better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians' and researchers' awareness and serve as the basis to adapted treatments that will better support recovery.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

Towards a health promoting university: descriptive findings on health, wellbeing and academic performance amongst university students in Australia

BACKGROUND

Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university's new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students.

METHODS

The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent.

RESULTS

Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online.

CONCLUSIONS

This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic.

Assessing potential brief screening questions for use within different social care-related contexts to identify individuals experiencing gambling-related harms: A scoping review

Gambling-related harms are increasingly recognised as public health concerns internationally. One response is to improve identification of and support for those affected by gambling-related harms, including individuals who gamble and those close to them, 'affected others'. Adult social care services have been identified as a setting in which screening for gambling-related harms is suitable and desirable. To achieve this, a tool is required which can identify gambling-related harms experienced by individuals and affected others. This scoping review aimed to identify whether any brief (i.e. three questions or less) screening tools are being used and, if so, how brief screening for gambling-related harm is being implemented in health and social care-related contexts. An international English language scoping review of research and grey literature was undertaken between April and July 2021. The search included single-item and brief screening tools which have been developed to identify gambling-related harms for individuals and affected others across a range of health and social care-related contexts. Findings show that screening tools for gambling-related harms have been developed for use in health settings rather than in social care contexts. For example within gambling, mental health or substance misuse support services. We found no evidence of a brief or single-item screening tool for identifying harms to individuals and affected others which is of adequate quality to strongly recommend for use in an adult social care setting. Development of a validated brief or single-item screening tool is recommended to assist adult social care practitioners to effectively screen, identify, support and signpost people affected by gambling-related harms.

Update on Gambling Disorder

Gambling disorder (GD) is estimated to be experienced by about 0.5% of the adult population in the United States. The etiology of GD is complex and includes genetic and environmental factors. Specific populations appear particularly vulnerable to GD. GD often goes unrecognized and untreated. GD often co-occurs with other conditions, particularly psychiatric disorders. Behavioral interventions are supported in the treatment of GD. No medications have a formal indication for the GD, although clinical trials suggest some may be helpful. Noninvasive neuromodulation is being explored as a possible treatment. Improved identification, prevention, and treatment of GD are warranted.

Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya

Background

There is limited research on the use of digital interventions among individuals with opioid use disorders (OUD) in low-and-middle income countries. This study aimed to assess mobile phone ownership, digital technology use and acceptability of digital interventions for treatment among individuals on treatment for OUD in Nairobi, Kenya.

Methods

A cross-sectional study was conducted among individuals with OUD. Structured questionnaires were used to collect data on socio-demographic and clinical characteristics, use of mobile phones and other digital technology and acceptability of digital interventions for treatment.

Results

One hundred and eighty participants were enrolled comprising 83.3% males with mean age of 31.5 years (SD 8.6). Mobile phone ownership was reported by 77.2% of participants of which 59.7% used smartphones. One hundred and sixty-six (92.2%) used phones to call, 82.8 and 77.2% used phones to send and receive text messages respectively; 30% used the internet; 57.2% had replaced the phone in past year and 51.1% of participants reported use of at least one social media platform, of these 44.4% had searched social media for information on drug use. Acceptability to receive treatment by phone was 95% and computer 49.4% with majority (88.1%) preferring a text message-based intervention. The preferred approach of delivery of a text message-based intervention were: one text message per day once a week, message to be personalized and individuals allowed to choose time and day to receive the message. Factors associated with acceptability of digital interventions were education level, being single, smartphone ownership and employment.

Conclusion

Majority of individuals on treatment for OUD had access to mobile phones but with high device turnover and limited access to computers and internet. There was high acceptability of digital interventions to provide treatment for OUDs, mostly through phones. These findings highlight factors to consider in the design of a digital intervention for this population.

Gambling along the schizotypal spectrum: The associations between schizotypal personality, gambling-related cognitions, luck, and problem gambling

Objective

Schizotypal personality (schizotypy) is a cluster of traits in the general population, including alterations in belief formation that may underpin delusional thinking. The psychological processes described by schizotypy could also fuel cognitive distortions in the context of gambling. This study sought to characterize the relationships between schizotypy, gambling-related cognitive distortions, and levels of problem gambling.

Methods

Analyses were conducted on three groups, a student sample (n = 104) with minimal self-reported gambling involvement, a crowdsourced sample of regular gamblers (via MTurk; n = 277), and an additional crowdsourced sample with a range of gambling involvement (via MTurk; n = 144). Primary measures included the Schizotypal Personality Questionnaire - Brief (SPQ-B), the Peters et al. Delusions Inventory (PDI-21), the Gambling Related Cognitions Scale (GRCS), and the Problem Gambling Severity Index (PGSI). Luck was measured with either the Belief in Good Luck Scale (BIGLS) or the Beliefs Around Luck Scale (BALS).

Results

Small-to-moderate associations were detected between the components of schizotypy, including delusion proneness, and the gambling-related variables. Schizotypy was associated with the general belief in luck and bad luck, but not beliefs in good luck. A series of partial correlations demonstrated that when the GRCS was controlled for, the relationship between schizotypy and problem gambling was attenuated.

Conclusions

This study demonstrates that schizotypy is a small-to-moderate correlate of erroneous gambling beliefs and PG. These data help characterize clinical comorbidities between the schizotypal spectrum and problem gambling, and point to shared biases relating to belief formation and decision-making under chance.

Gambling problems and help-seeking in serving United Kingdom military personnel: A qualitative study

INTRODUCTION

In military personnel are vulnerable to gambling problems, yet many are reluctant to seek help. The aim of the current study was to explore the lived experience of problem gambling and help-seeking among serving members of the United Kingdom Armed Forces.

METHODS

Seventeen individuals from a larger, cross-sectional survey of gambling and wellbeing in the Royal Air Force (RAF) completed semi-structured interviews. Interview questions focused on personal experiences, the context of the RAF and its influence, knowledge and experiences of treatment and support services, and the impact of COVID-19.

RESULTS

Reflexive thematic analysis revealed four themes: (1) harmful and protective occupational factors; (2) socio-cultural and personal influences; (3) organizational attitudes toward mental health and help-seeking, and (4) current support pathways and provision.

DISCUSSION

Findings also indicated that gambling and alcohol use are common within the RAF, and that personnel are actively coping with mental health challenges.

At-risk gambling in patients with severe psychiatric illness and in community subjects matched for age and sex

In the recent literature the rates of gambling in psychiatric patients have been compared only indirectly with those found in community samples and no study has so far matched a clinical sample with community controls. We selected 875 outpatients attending two community mental health centers and 3.500 community subjects, matched for age and sex. At-risk gambling was defined according to the four categories of the Canadian Problem Gambling Index (CPGI) scores: 0 no-risk, 1-2 low-risk, 3-7 moderate-risk, 8+ high-risk. Data were also collected on substance, alcohol, and tobacco use. Patients were diagnosed with schizophrenia, bipolar disorder, unipolar depression, cluster B personality. At-risk gambling was significantly higher in psychiatric patients compared to community subjects. In the univariate multinomial logistic regression analysis, high-risk gambling was associated with lifetime substance use and being unmarried, moderate-risk with age at onset of alcohol use and lifetime tobacco use, and low-risk with higher education. In the multinomial logistic regression analysis high risk-gambling in psychiatric patients was four times that of community controls, while in substance users high-risk gambling was two times that of non-users. The results suggest that screening for gambling could improve the care of psychiatric patients who suffer from a comorbid behavioral addiction.

Treatment and help services for gambling during COVID-19: Experiences of gamblers and their concerned significant others

Aims:

During the COVID-19 pandemic, many treatment or help services for gambling were closed or moved online. At the same time, closures of gambling opportunities impacted gambling availability and practices. This study investigates gamblers’ and their concerned significant others’ (CSOs) experiences and views on treatment and help services during this exceptional time and perceptions on how to develop services further after the pandemic.

Design:

Three online questionnaires to elicit gambler and CSO experiences were conducted during the spring 2020 in Finland. In total, 847 respondents answered and shared experiences on how the situation had impacted their gambling behaviour and service needs, how service closures or the moving of services online had impacted them, and how they thought the prevention and treatment of gambling harms should be organised during and after COVID-19.

Results:

Changed gambling practices reduced overall service needs. Service closures had negative impacts, but online services were considered positively, as these provided a low-threshold option. Respondents also shared insights into how the service provision for gamblers should further be developed during and after COVID-19.

Gambling and COVID-19: Initial Findings from a UK Sample

In response to the COVID-19 pandemic, the UK Government placed society on ‘lockdown’, altering the gambling landscape. This study sought to capture the immediate lockdown-enforced changes in gambling behaviour. UK adults (n = 1028) were recruited online. Gambling behaviour (frequency and weekly expenditure, perceived increase/decrease) was measured using a survey-specific questionnaire. Analyses compared gambling behaviour as a function of pre-lockdown gambling status, measured by the Brief Problem Gambling Scale. In the whole sample, gambling participation decreased between pre- and during-lockdown. Both gambling frequency and weekly expenditure decreased during the first month of lockdown overall, but, the most engaged gamblers did not show a change in gambling behaviour, despite the decrease in opportunity and availability. Individuals whose financial circumstances were negatively affected by lockdown were more likely to perceive an increase in gambling than those whose financial circumstances were not negatively affected. Findings reflect short-term behaviour change; it will be crucial to examine, at future release of lockdown, if behaviour returns to pre-lockdown patterns, or whether new behavioural patterns persist.

Development of the Gambling Disorder Identification Test: Results from an international Delphi and consensus process

OBJECTIVES

Diverse instruments are used to measure problem gambling and Gambling Disorder intervention outcomes. The 2004 Banff consensus agreement proposed necessary features for reporting gambling treatment efficacy. To address the challenge of including these features in a single instrument, a process was initiated to develop the Gambling Disorder Identification Test (GDIT), as an instrument analogous to the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test.

METHODS

Gambling experts from 10 countries participated in an international two-round Delphi (n = 61; n = 30), rating 30 items proposed for inclusion in the GDIT. Gambling researchers and clinicians from several countries participated in three consensus meetings (n = 10; n = 4; n = 3). User feedback was obtained from individuals with experience of problem gambling (n = 12) and from treatment-seekers with Gambling Disorder (n = 8).

RESULTS

Ten items fulfilled Delphi consensus criteria for inclusion in the GDIT (M ≥ 7 on a scale of 1-9 in the second round). Item-related issues were addressed, and four more items were added to conform to the Banff agreement recommendations, yielding a final draft version of the GDIT with 14 items in three domains: gambling behavior, gambling symptoms and negative consequences.

CONCLUSIONS

This study established preliminary construct and face validity for the GDIT.

Should screening for risk of gambling-related harm be undertaken in health, care and support settings? A systematic review of the international evidence

Background

Gambling-related harm is an increasing recognised problem internationally. Recent years have seen an explosion in opportunities to gamble, both in person and online. Health and other care settings have the potential to act as screening sites to identify and support gamblers who may be at high risk of experiencing gambling-related harm. This study aimed to identify interventions to screen for risk of gambling-related harm in the general population which may be delivered in health, care and support settings.

Methods

Systematic review. Searches of key databases and grey sources since 2012 were undertaken in October 2019. Electronic database searches generated a total of 5826 unique hits. Nine studies published 2013–2019, along with thirteen grey literature documents met our eligibility criteria. The criteria were setting (health, care and support settings), participants (any attendee in help, care and support settings), interventions (screening to identify risk of harm from gambling behaviours) and outcome measures (gambling behaviours, service use).

Results

Three papers evaluating screening interventions delivered in general practice (repeat visits and written advice), mental health service (the use of screening tools to identify risk of harm), and substance abuse treatment (intensive outpatient treatment for substance use disorders or methadone maintenance) indicated evidence of potential effectiveness. Six papers supported the feasibility and acceptability of delivering interventions in various settings. Grey literature reports described the implementation of interventions such as training materials, and transfer of interventions developed for substance abuse populations by practitioners.

Conclusions

Health, care and support services offer potentially important contexts in which to identify and offer support to people who are at risk of gambling related harm. Screening interventions appear feasible and acceptable in a range of community and healthcare settings for those at risk of gambling harm. Evaluation of effectiveness and cost-effectiveness of screening in these populations should therefore be prioritised.

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.

"You don't really see the dangers of it at the time." Risk perceptions and behaviours of older female gamblers

Older women are vulnerable to the risks associated with some forms of gambling. While research has examined how individuals functionally interact with gambling products, very limited research has investigated how individuals conceptualise and interpret the risks associated with these products. Theorists suggest that risk-taking is not based on a lack of knowledge but on the different ways people make sense of their lives. As such, this study aimed to understand the factors that may influence how older women who gamble on electronic gambling machines (EGMs) perceive the risks associated with gambling on these products. It examined how risk perceptions interacted with a range of complex social factors in women's everyday lives to influence their risk behaviours. Semi-structured interviews were conducted with 20 Australian women aged 55 and over who had been negatively impacted by EGM gambling. This study found that older women's risk perceptions of gambling were shaped by their early recreational experiences with gambling, rather than their current regular and harmful gambling behaviours. Risk perceptions of EGMs were often downplayed or ignored as women sought to maintain valued social identities within the venues. Women went through a process of risk negotiation whereby the benefits of this social interaction outweighed the potential harms associated with the machines. This also led them to deflect or ignore risk minimisation messaging which was completely focused on individual behaviours. This study signals the importance of moving away from individualised responsible gambling messages towards risk information about gambling products. This research also provides evidence of the need for regulation addressing the design features of EGMs that ultimately may make products safer and protect the most vulnerable from gambling harm.

Utilizing Deep Learning and Oversampling Methods to Identify Children’s Emotional and Behavioral Risk

Deep neural network (DNN) has been widely used in various artificial intelligence applications and is, unsurprisingly, penetrating the field of school psychology. In the school environment, universal screening is used by teachers to identify children’s emotional and behavioral risk (EBR) within a screener. EBR can be used to predict possible emotional and behavioral disorders, which impact children’s educational and social outcomes. Using the BASC-2 Behavioral and Emotional Screening System Teacher Rating Scale (BASC-2 BESS TRS; Reynolds & Kamphaus (2004). Behavior Assessment System for Children (2nd ed.). Circle Pines, MN: American Guidance Service) norm data, we classified children’s EBR status from normal to at-risk using DNN. Data oversampling was used to overcome the imbalanced sample feature (i.e., few cases with emotional and behavioral disorder). Traditional machine learning methods, such as Naïve Bayes and logistic regression, were included for comparison. The results indicated that the DNN with oversampling achieved the highest performance levels with accuracy (ACC) of .957, precision (PPV) of .545, true positive rate (TPR or sensitivity) of 1.000, and true negative rate (TNR or specificity) of .942 compared with the other methods. This novel method is helpful to provide accurate screening results for early identification of children’s EBR. The current study provides a useful guide for researchers to apply the DNN and oversampling to classification in assessment-related research.

An Examination of Clinician Responses to Problem Gambling in Community Mental Health Services

Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.

Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.

Problem Gambling in the Fitness World-A General Population Web Survey

The world of sports has a complex association to problem gambling, and the sparse research examining problem gambling in athletes has suggested an increased prevalence and particularly high male predominance. The present study aimed to study frequency and correlates of problem gambling in populations with moderate to high involvement in fitness or physical exercise. This is a self-selective online survey focusing on addictive behaviors in physical exercise distributed by ‘fitness influencers’ on social media and other online fitness forums to their followers. Respondents were included if they reported exercise at least thrice weekly, were above 15 years of age, and provided informed consent (N = 3088). Problem gambling, measured with the Lie/Bet, was studied in association with demographic data, substance use, and mental health variables. The occurrence of lifetime problem gambling was 8 percent (12 percent in men, one percent in women). In logistic regression, problem gambling was associated with male gender, younger age, risky alcohol drinking, obsessive-compulsive disorder, and less frequent exercise habits. In conclusion, in this self-recruited population with moderate to high fitness involvement, problem gambling was moderately elevated. As shown previously in elite athletes, the male predominance was larger than in the general population. The findings strengthen the link between problem gambling and the world of sports.

"It was terrible. I didn't set a limit": Proximal and Distal Prevention Strategies for Reducing the Risk of a Bust in Gambling Venues

Although most gamblers set limits on their gambling and stick to them most of the time, there are times when limits are breached (a 'bust'). Little is known about the prevalence, reasons for and strategies to address busts despite associated harms with a single bust. This mixed methods study used an online survey with a sample of electronic gaming machine gamblers. A total of 104 gamblers were recruited from 11 Australian gambling venues and almost half (45%) reported a bust in the past 12 months. The amount of money spent on the bust ranged from $20 to $1500 AUD (M = $446, SD = $402). The presence of a bust was positively associated with the amount of money spent in the past 30 days, and self-reported greater gambling related harms and greater gambling severity. Reasons for busts included both distal (pre-venue) factors (i.e., negative affect, lapse in intentions to set a limit, needing to win money) and proximal (inside venue) factors (i.e., chasing losses, wins or spins, social facilitation and losing money too quickly). Bust-prevention strategies identified by participants were both distal (e.g., avoid gambling altogether, leave cards or cash at home, set a time or money limit) and proximal (e.g., walk away when losing and change the manner of gambling). As busts are relative to a priori limits, gamblers at any level of gambling severity can experience a bust. Repeated busts may be an indicator of loss of control and a progression towards problem gambling. Interventions need to focus on factors that mitigate the risk of a bust (e.g., pre-commitment) and that assist gamblers to stick to their limits all of the time.

Suicide Attempt in Patients With Gambling Disorder-Associations With Comorbidity Including Substance Use Disorders

Background: Gambling disorder is known to be associated with increased risk of suicidal behavior. However, relatively little is known about how the risk of suicide attempts in gambling disorder is influenced by comorbid alcohol or drug use disorders, as well as other psychiatric conditions. Methods: The present study is a nationwide, diagnostic register study assessing the risk of suicide attempts (including fatal ones) in gambling disorder in Sweden in 2005-2016. Results: In a total of 2,099 individuals (23 percent women) with gambling disorder, 417 individuals had a suicide attempt (including 10 fatal cases of suicide) during the study period. Suicidal behavior was more common in patients with substance use disorders at any time during the study period (50 percent if both alcohol and drug use disorders were present, and 10 percent if none of these were present). In logistic regression, suicidal behavior was significantly associated with female gender (OR 2.13 [1.63-2.78]), mood disorders (OR 2.65 [2.00-3.50]), anxiety disorders (OR 1.78 [1.34-2.35]), and with alcohol (OR 1.95 [1.51-2.51]) or drug use disorders (OR 3.60 [2.76-4.69]), respectively. Conclusions: Suicidal behavior in clinical gambling disorder patients is common, but markedly more common in the presence of substance use and other comorbid disorders.

The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis

Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.

Associations between loot box use, problematic gaming and gambling, and gambling-related cognitions

Loot boxes are virtual goods in video games that produce randomly-generated in-game rewards, and have attracted scrutiny because of a resemblance to gambling. This study tests relationships between gaming involvement, engagement with loot boxes, and their associations with disordered gambling and gambling-related cognitions. Online questionnaires were completed by 144 adults via MTurk (Study 1) and 113 undergraduates (Study 2). Gaming and loot box-related variables included estimated time spent gaming and monthly expenditure, the Internet Gaming Disorder Scale (IGDS), and questions that assessed perceptions and behaviours related to loot boxes. Most participants thought loot boxes were a form of gambling (68.1% & 86.2%). A subset of items were condensed into a unidimensional "Risky Loot-box Index" (RLI) via exploratory factor analysis. In Study 1, the RLI showed significant associations with the Problem Gambling Severity Index (r = .491, p < .001) and the Gambling Related Cognitions Scale (r = .518, p < .001). Overall, gambling-related variables predicted 37.1% (p < .001) of the variance in RLI scores. Findings were replicated, though attenuated, in Study 2. These results demonstrate that besides the surface similarity of loot boxes to gambling, loot box engagement is correlated with gambling beliefs and problematic gambling behaviour in adult gamers.

An Exploratory RCT to Support Gamblers' Intentions to Stick to Monetary Limits: A Brief Intervention Using Action and Coping Planning

The aim of this study was to investigate the feasibility and impact of an action and coping planning intervention deployed in gambling venues to improve adherence to expenditure limits. We conducted a 2-group parallel-block randomised controlled trial comparing one 20-min session of action and coping planning to an assessment alone. Gamblers who were intending to set a monetary limit on EGMs (n = 184) were recruited in venues and administered the intervention prior to gambling. Measures were adherence to self-identified gambling limits and adherence to expenditure intentions at 30-days post-intervention using the Time Line Follow-Back. The intervention was feasible in terms of recruitment and willingness of gamblers to engage in a pre-gambling intervention. Most gamblers enacted strategies to limit their gambling prior to entering the venue, albeit these limits were on average higher than the Australian low risk gambling guidelines. In terms of impact, the intervention did not improve adherence to limits at post or 30-day follow-up assessment. However, Moderate Risk/Problem Gamblers in the Intervention group spent less (a median of $60 less) than intended (median $100) within the venue. All intervention participants intended to spend significantly less in the 30 days after the intervention compared to the amount spent in the 30 days prior to the intervention. This reduction was not found for participants in the control group. A simple brief intervention appears feasible in gambling venues and have an impact on gambling intentions over the short term.

Behaviour Change Strategies Endorsed by Gamblers Subtyped by Psychological Distress, Risky Alcohol Use, and Impulsivity

Problem gambling is often accompanied by co-morbid psychiatric disorders and maladaptive personality traits. Subtyping gamblers based on these pervasive comorbidities has been attempted so as to aid understanding of the aetiology of problem gambling and inform treatment options. However, there has been less focus on subtyping gamblers with (past or current) or without a history of problem gambling, or on providing more specific treatment or self-help recommendations. The current study sought to subtype current-, past-, and non-problem gamblers using three common comorbidities; psychological distress, risky alcohol use, and impulsivity. Participants' endorsement of helpful behaviour change strategies was also examined by subtype membership. A total of 385 participants were recruited who had a current gambling problem (n = 128; 33%), a past gambling problem (n = 131, 34%) or never had a gambling problem (n = 126, 33%). Hierarchical cluster analysis identified distinct subtypes of current (i.e., low comorbidity, high psychological distress, risky alcohol use and high comorbidity), past (i.e., low comorbidity, high psychological distress and high comorbidity) and non-problem gamblers (i.e., low comorbidity, high psychological distress, risky alcohol use and moderate impulsivity). The most helpful change strategies for current and past gamblers were similar across subtypes (i.e., accept that gambling needs to change, remind yourself of the negative consequences). Non-problem gamblers reported the most helpful strategy as setting financial limits. This study indicated that treatment of psychological distress, risky alcohol use or impulsivity may be important for all gamblers regardless of their level of risk.

Locating gambling problems across a continuum of severity: Rasch analysis of the Quinte Longitudinal Study (QLS)

Addressing gambling problems across a continuum requires understanding of low severity problems, as well as severe levels of problem gambling or disorder. The aims of this study were thus to derive a map of how problematic gambling behaviours and harms are situated across a continuum, and identify the best available indicators of low severity problems to inform assessment and secondary prevention. This involved the Rasch analyses of baseline data from the Quinte Longitudinal Study (QLS); a community-based survey involving random-digit dialling of numbers around Belleville, Canada. Participants were n = 1305 adults with non-zero scores across 26-items from: the Problem Gambling Severity Index (PGSI); the NORC DSM Screen for Gambling Problems (NODS); and the Problem and Pathological Gambling Measure (PPGM). Results indicated that item-level measures except chasing losses provided fit to the Rasch model, and most were clustered within a narrow region of the continuum which resembled addictive disorders. At the most severe end were mainly items about harms, while there were few items representing low severity levels (feeling guilty, betting more than one can afford, attempts to reduce gambling, gambling more than intended). There was Differential Item Functioning (DIF) for several indicators of low severity problems. The findings suggest that measures remain closely aligned with psychiatric models and are suited for discriminating across severe levels of problem gambling or addictive disorder. Although cognitive-affective and behavioural indicators comprise the best available indicators of low severity symptoms, there is an urgent need for improvements in conceptualisation and measurement.

Development of the Gambling Disorder Identification Test (G-DIT): Protocol for a Delphi Method Study

Background

Research on the identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. However, a single instrument measuring gambling behavior, severity, and specific deleterious effects is lacking.

Objective

This protocol describes the development of the Gambling Disorder Identification Test (G-DIT), which is a 9- to 12-item multiple-choice scale with three domains: gambling consumption, symptom severity, and negative consequences. The scale is analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT).

Methods

The G-DIT is developed in four steps: (1) identification of items eligible for the G-DIT from a pool of existing gambling measures; (2) presentation of items proposed for evaluation by invited expert researchers through an online Delphi process and subsequent consensus meetings; (3) pilot testing of a draft of the 9- to 12-item version in a small group of participants with problem gambling behavior (n=12); and (4) evaluation of the psychometric properties of the final G-DIT measure in relation to the existing instruments and self-reported criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), among individuals with problem gambling and nonproblematic recreational gambling behaviors (n=600). This protocol article summarizes step 1 and describes steps 2 and 3 in detail.

Results

As of October 2018, steps 1-3 are complete, and step 4 is underway.

Conclusions

Implementation of this online Delphi study early in the psychometric development process will contribute to the face and construct validity of the G-DIT. We believe the G-DIT will be useful as a standard outcome measure in the field of problem gambling research and serve as a problem-identification tool in clinical settings.

International Registered Report Identifier (IRRID)

RR1-10.2196/12006