Impact of COVID-19 on Online Gambling - A General Population Survey During the Pandemic

The Mediating Role of Problematic Alcohol Consumption on the Association Between Pandemic-Related Strains and Domestic Violence Across Six Countries

Research has documented that domestic violence increased worldwide during the COVID-19 pandemic. Studies have also suggested that alcohol use, which also increased during COVID-19, is a risk factor for domestic violence victimization. However, research has yet to examine whether alcohol consumption mediated the relationship between pandemic-related stressful events and domestic violence. Using structural equation modeling, the current study examines the impact of three types of pandemic-related strains (financial problems, familial problems, and work problems) on individual assessments about whether their drinking became problematic during the pandemic and then whether problematic alcohol use increases the risk of psychological and physical domestic violence. This model was analyzed across six countries: Ukraine, The Netherlands, Pakistan, Denmark, Guatemala, and the United States. Results indicate that the associations between pandemic-related strains and self-assessed problematic drinking varied by country. However, across all countries, problematic alcohol consumption was associated with increased physical and psychological domestic violence victimization. Overall, the findings of the current study support the use of programs that aim to reduce problematic consumption of alcohol with the hopes that they may, in turn, reduce psychological and physical domestic violence victimization.

Illegal Online Gambling Site Detection using Multiple Resource-Oriented Machine Learning

The COVID-19 pandemic has led to faster digitalization and illegal online gambling has become popular. As illegal online gambling brings not only financial threats but also breaches in overall cyber security, this study defines the concept of absolute illegal online gambling (AIOG) using a machine-learning-driven approach with information gathered from public webpages. By analysing 11,172 sites to detect illegal online gambling, the proposed model classifies key features such as URLs (Uniform Resource Locator), WHOIS, INDEX, and landing page information. With a combination of text and image analyses with machine learning-driven approach, the proposed model offers the ensemble combination of attributes for high detection performance with the verification of common attributes from metadata in online gambling. This study suggests a strategy for dynamic resource utilization to increase the classification accuracy of the current environment. As a result, this research expands the scope of hybrid web mining through constant updating of data to achieve content-based filtering.

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.

Online Gambling Patterns and Predictors of Problem Gambling Among Korean Adolescents During the COVID-19 Pandemic: A Cross-sectional Study

PURPOSE

This study examined online gambling patterns among Korean adolescents during the COVID-19 pandemic and identified predictors of problem gambling based on a socio-ecological model.

METHODS

It used nationally representative data from the 2020 National Survey on Youth Gambling Problems conducted by the Korea Center on Gambling Problems. This study selected a sample of 780 adolescents aged 13-18 years who reported having gambled online at least once in the last three months from the raw data of respondents. They were classified as the non-problem group and problem group according to the Gambling Problems Severity Scale (GPSS) of the Canadian Adolescent Gambling Inventory (CAGI). The predictive factors of problem gambling were analyzed by logistic regression analysis.

RESULTS

The prevalence of problem gambling was 24.6 %. Its predictors included intrapersonal [male (odds ratios, OR = 1.67); gambling prior to COVID-19 (OR = 2.08)] and interpersonal factors [frequent gamblers in peers (OR = 4.34); peer pressure (OR = 2.34)]. Social factors, such as gambling in online community (OR = 5.60), sports betting (OR = 53.24), and lotteries (OR = 17.03) were associated with problem gambling.

CONCLUSIONS

The major predictors of problem gambling among adolescent online gamblers included peer gambling and specific types of gambling. To prevent problem gambling, strategies targeting peer groups are essential. In addition, nurses need to share with families, schools, communities, and policymakers that online gambling, such as lotteries and sports betting, are high-risk of adolescent problem gambling, and recommend them to collaborate for stricter regulatory measures.

Motivational telephone intervention to risk gamblers by a state-owned gambling operator in Sweden

Background and aims

Few studies have tested the effect of a motivational telephone intervention from a gambling operator to clients with high-risk gambling practices. This study aimed to study subsequent limit setting, self-exclusions and gambling post-intervention, compared to controls.

Methods

The study assessed a motivational, personalized telephone intervention by the state-owned Swedish gambling operator AB Svenska Spel within its subsection of sports, poker, online casino and bingo gambling. Clients successfully reached with the telephone intervention (n = 1,420) were compared to clients who could not be reached (n = 1,504). Gambling practices during 8 weeks pre-intervention were assessed, and outcome measures limit setting, self-exclusion, and gambling 4 weeks post-intervention.

Results

The telephone intervention was associated with increased limit settings (10 vs. 5 percent, p < 0.001), self-exclusions (11 vs. 8 percent, p < 0.01), lowered theoretical losses (p < 0.001), but not significantly associated with gambling abstinence (18 vs. 15 percent, p = 0.07). In unadjusted analyses of sub-groups, significant associations of the intervention with full gambling abstinence were seen in people who gamble on online casino/bingo (19 vs. 14 percent, p < 0.01), but not in sports bettors. In logistic regression, the intervention was not associated with full week 1-4 abstinence.

Conclusion

A personalized motivational telephone intervention to people displaying high-risk gambling, delivered by a gambling operator, is promising, and effects were seen on the uptake of responsible gambling tools post-intervention. Effects may be more pronounced in users of chance-based, online games, than in sports bettors.

Gambling helpline contacts during COVID-19-related availability restrictions: an interrupted time series analysis

OBJECTIVES

Gambling causes significant public health harms that are addressed in the help service network. Helplines are the most widely used service among those experiencing harms. The COVID-19 pandemic changed the global gambling landscape. This study assesses the effect of COVID-19-related restrictions on help-seeking for gambling via helplines.

STUDY DESIGN

We analysed data of national helplines in Sweden, Finland, and Denmark before and during the pandemic. The countries differed in their restrictions on the availability and accessibility of gambling during the pandemic.

METHODS

We performed an interrupted time series analysis of contact and web traffic data to helplines in Sweden, Finland, and Denmark before and during the COVID-19 pandemic (2017-2021). We also compared forecasted time series to the actual data to assess change.

RESULTS

The results show diverging patterns across the three countries. In Sweden, the number of helpline contacts remained stable throughout COVID-19, but there was an increasing trend in website visits. In Finland, the number of contacts declined during the first wave but rebounded during the second wave. Website visitation increased moderately. In Denmark, the number of contacts to the helpline soared over the COVID-19 period.

CONCLUSIONS

The diverging results suggest that help-seeking behaviour is likely to be impacted by differing policy approaches to gambling availability and limit-setting, visibility of helplines, and the prevalence of different forms of gambling in the three Nordic countries before and during the pandemic. This has implications for a preventive public health approach for 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 Correlates of Sports Betting: A Systematic Review

Sports betting is becoming increasingly widespread, and a growing number of individuals, both adolescents and adults, participate in this type of gambling. The main aim of this systematic review was to assess correlates of sports betting (sociodemographic features, gambling-related variables, co-occurring psychopathologies, and personality tendencies) through a systematic review conducted following the PRISMA guidelines. Relevant studies were identified via searches of NCBI/PubMed and APA PsycInfo databases. Individuals from the general population and/or with a clinical diagnosis of gambling disorder (GD) were included, irrespective of gender and age. In addition, the studies needed to have administered at least one clinical interview/psychometric instrument to assess the presence of problematic gambling/GD, contain at least one group of participants with sports betting, and directly analyze the association between sports betting and any of the following features: sociodemographics, gambling-related variables, co-occurring psychopathologies, and/or personality tendencies. Fifty-four articles were included. Multiple sociodemographic variables have been studied in relation to sports betting. In general, males with high impulsivity have greater tendencies for sports betting. The co-occurrence of certain pathologies, especially substance use or other addictive disorders, was also suggested. Most studies were cross-sectional, assessed participants using self-administered instruments, recruited samples using non-probability online panels, included small samples, had unbalanced samples, and included samples from only one country. Impulsive males may be particularly prone to sports gambling and related problems. Future research should examine prevention strategies that may help prevent the development of sport-betting-related GD and other addictive behaviors in vulnerable individuals.

Social norms and goal-setting interventions to promote responsible gambling in low-to-moderate online gamblers: protocol for a four-arm randomised controlled feasibility study

INTRODUCTION

Gambling is increasingly recognised as an important public health issue. Problem gambling is associated with highly negative impacts on physical, psychological and social well-being, not only for those who gamble but also for those around them. There has been a rapid expansion of internet gambling and attributes such as continuous play and instant rewards, and enhanced privacy may lead to a greater likelihood of gambling-related harms. In this randomised controlled feasibility study, we are testing (1) the acceptability and feasibility of three online responsible gambling interventions targeting people with low-to-moderate risk of online problem gambling and (2) the feasibility of a future full-scale randomised controlled trial (RCT) to test their effectiveness and cost-effectiveness.

METHODS AND ANALYSIS

Four-arm randomised controlled feasibility study with qualitative substudy. One-hundred and forty UK residents with low-to-moderate risk of online gambling recruited via gambling operators and social media will be randomised (1:1:1:1) to either (1) goal setting, (2) descriptive norms messages (challenge perceptions of peer behaviours), (3) injunctive norms messages (challenge perceptions of peer attitudes) and (4) control (delayed intervention). Interventions will be delivered over 6 weeks and individually tailored. Outcomes, administered online, will be measured at baseline, 7 weeks, and 3 and 6 months post randomisation (including gambling risk behaviours and cognitions, anxiety and depression, quality of life, health use and productivity). Analyses will be descriptive, focusing on feasibility and acceptability of the interventions and study procedures. Telephone/online interviews, with a subsample of approximately 30 participants, will elicit experiences of participating in the study. Prespecified progression criteria will guide decisions around whether to progress to a definitive RCT.

ETHICS AND DISSEMINATION

Ethical approval obtained from Bournemouth University Research Ethics Committee (reference number 33247). Participants will be given a participant information sheet plus a 'Key Facts' summary and will provide informed online consent. Findings will be published in peer-reviewed journals and presented at conferences and public engagement events.

TRIAL REGISTRATION NUMBER

ISRCTN37874344.

Experience of LGBTQIA2S+ populations with gambling during the COVID-19 pandemic: protocol for a mixed-methods study

INTRODUCTION

Research undertaken since the beginning of the COVID-19 pandemic has provided us information about the impact of the pandemic on the gambling habits of the general population. However, very little is known about certain subgroups at increased risk of developing gambling disorder, such as the LGBTQIA2S+ population. The purpose of this study is to describe the impact of the COVID-19 pandemic on gambling behaviours among LGBTQIA2S+ individuals. In addition, we want to understand the experiences of the LGBTQIA2S+ population with gambling disorder and identify interventions that LGBTQIA2S+ people have found to be effective in addressing problem gambling during the COVID-19 pandemic.

METHODS AND ANALYSIS

This study has a sequential explanatory mixed-method design in two phases over 2 years. The first phase is a correlational study. We will conduct a cross-sectional survey using a stratified random sampling among Canadian residents who are 18 years of age or older, self-identify as sexually and gender-diverse (ie, LGBTQIA2S+) and have gambled at least once in the previous 12 months. This survey will be administered online via a web panel (n=1500). The second phase is a qualitative study. Semistructured interviews will be conducted with LGBTQIA2S+ people with problematic gambling (n=30).

ETHICS AND DISSEMINATION

This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l'Estrie-CHUS scientific evaluation committee on 3 March 2022 (reference number: 2022-4633-LGBTQ-JHA). Electronic and/or written informed consent, depending on the data collection format (online survey and online or in-person interviews), will be obtained from each participant. A copy of the consent form and contact information will be delivered to each participant.

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.

COVID-19 and resultant restrictions on gambling behaviour

Since the onset of COVID-19, studies suggest a significant increase in online gambling, potentially facilitated by increased time at home, social isolation and boredom. This study aimed to address what is known about the impact of the pandemic on gambling behaviour by conducting a mapping review. A systematic literature search was conducted using four online databases. Additional studies were identified using reference lists. Relevant studies were quality scored and their findings synthesised in terms of overall changes at the population level and potentially vulnerable groups. The weight of evidence from 35 relevant reports across 12 countries indicated reductions of gambling during the pandemic at the level of the general population. However, marked increases in gambling amongst vulnerable sub-populations including amongst young adults and people with pre-existing at-risk gambling were also noted. The impact of COVID-19 on gambling is highly contingent on context. If policy makers examine only population level data, this could overlook profound negative effects identified in those with at-risk gambling, gambling disorder, and amongst young adults.

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.

Estimation of Behavioral Addiction Prevalence During COVID-19 Pandemic: A Systematic Review and Meta-analysis

Purpose of Review

The COVID-19 pandemic changed people’s lifestyles and such changed lifestyles included the potential of increasing addictive behaviors. The present systematic review and meta-analysis aimed to estimate the prevalence of different behavioral addictions (i.e., internet addiction, smartphone addiction, gaming addiction, social media addiction, food addiction, exercise addiction, gambling addiction, and shopping addiction) both overall and separately.

Recent Findings

Four databases (PubMed, Scopus, ISI Web of Knowledge, and ProQuest) were searched. Peer-reviewed papers published in English between December 2019 and July 2022 were reviewed and analyzed. Search terms were selected using PECO-S criteria: population (no limitation in participants’ characteristics), exposure (COVID-19 pandemic), comparison (healthy populations), outcome (frequency or prevalence of behavioral addiction), and study design (observational study). A total of 94 studies with 237,657 participants from 40 different countries (mean age 25.02 years; 57.41% females). The overall prevalence of behavioral addiction irrespective of addiction type (after correcting for publication bias) was 11.1% (95% CI: 5.4 to 16.8%). The prevalence rates for each separate behavioral addiction (after correcting for publication bias) were 10.6% for internet addiction, 30.7% for smartphone addiction, 5.3% for gaming addiction, 15.1% for social media addiction, 21% for food addiction, 9.4% for sex addiction, 7% for exercise addiction, 7.2% for gambling addiction, and 7.2% for shopping addiction. In the lockdown periods, prevalence of food addiction, gaming addiction, and social media addiction was higher compared to non-lockdown periods. Smartphone and social media addiction was associated with methodological quality of studies (i.e., the higher the risk of boas, the higher the prevalence rate). Other associated factors of social media addiction were the percentage of female participants, mean age of participants, percentage of individuals using the internet in country, and developing status of country. The percentage of individuals in the population using the internet was associated with all the prevalence of behavioral addiction overall and the prevalence of sex addiction and gambling addiction. Gaming addiction prevalence was associated with data collection method (online vs. other methods) that is gaming addiction prevalence was much lower using online methods to collect the data.

Summary

Behavioral addictions appeared to be potential health issues during the COVID-19 pandemic. Healthcare providers and government authorities should foster some campaigns that assist people in coping with stress during COVID-19 pandemics to prevent them from developing behavioral addictions during COVID-19 and subsequent pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40429-022-00435-6.

Internet use and internet-based addictive behaviours during coronavirus pandemic

PURPOSE OF REVIEW

The COVID-19 outbreak profoundly influenced human lives on different levels. This narrative review aims to present recent data relating to the COVID-19 pandemic and internet use and internet-based addictive behaviours [problematic Internet use (PIU), Internet addiction, Internet gaming disorder, problem gambling or gambling disorder, social media addiction including smartphone use disorder, problematic pornography use, and compulsive buying].

RECENT FINDINGS

During the COVID-19 pandemic, the prevalence of Internet use and Internet-based addictive behaviours increased in all age groups. The COVID-19 pandemic and related containment measures were been associated with increased levels of stress, anxiety, and depression in the general population, especially among children and adolescents, which are the vulnerable groups for the development of mental disorders during the crisis. Furthermore, the fear resulting from the disease, the 'lockdown' measures, high levels of uncertainty regarding the future, and financial insecurity increased levels of loneliness, PIU, and Internet addiction.

SUMMARY

Longitudinal researches focused on the negative impacts of Internet use in prolonged stress situations on mental health, vulnerable groups, and quality of life (QoL) are needed to help clinicians and policymakers to reduce adverse consequences. Prevention programs for Internet use and Internet-based addictive behaviours must be customized to meet the needs of children, adolescents, and adults. Also, treatment programs must be tailored to the needs of patients with different Internet-based addictions.

An interrupted time series analysis of gambling behavior based on gambling operator revenue-based taxation during the COVID-19 pandemic in Sweden

OBJECTIVES

The impact of COVID-19 on gambling behavior and the gambling industry itself has been widely speculated. Prior studies have shown how boredom, social isolation, poor mental health, and financial hardships, all of which have been associated with COVID-19, can aggravate problem gambling behaviors in patients with gambling disorders while also luring newcomers. Few studies have used methods other than self-report to assess longitudinal behavioral changes in gambling behavior before versus during the pandemic.

STUDY DESIGN

The present study addresses this gap by using an interrupted time series approach on data obtained from the Swedish Gambling Authority measuring taxation on gambling vendors' revenue between January 2019 and November 2021.

METHODS

March, June, and October 2020 were chosen as interruption points as they correspond to the pandemic's commencement, the return of elite sports, and the second wave of cases in Sweden, respectively. We hypothesized that the pandemic would be associated with both temporary changes for select gambling types and long-term increases in online gambling.

RESULTS

Results revealed the pandemic's onset was associated with transient effects at each point of interruption, as well as long-term upward trends in total gambling and commercial online gambling, excluding horse betting and the state-owned operator for online casinos and betting.

CONCLUSIONS

The present study's findings, although consistent with the theory that gambling activity could increase during the pandemic, contradict previous studies that found no changes or a decrease from pre-COVID-19 levels. Findings indicate that the pandemic and Sweden's reaction to it were associated with increased use of some gambling products.

Gambling by Young Adults in the UK During COVID-19 Lockdown

Gambling is a common activity amongst young adults in the UK, and was a behavior of interest during the early mitigation against COVID-19 (first lockdown). The Avon Longitudinal Study of Parents and Children (ALSPAC) was used to investigate attitudes, moods and behavior during lockdown in England. ALSPAC participants were invited to complete online questionnaires in May 2020, including a set of questions about frequency of gambling and gambling activities which had been asked three years previously. Mental health and wellbeing data and alcohol use were also collected as part of lockdown questionnaires. Gambling questions were completed by 2632 young adults, 71% female, with a mean age of 27.8 years. Overall, gambling frequency reduced during lockdown for both males and females, but more males engaged in regular (weekly) gambling. Gambling activities became more restricted compared to previous reports, but online gambling (e.g. online poker, bingo, casino games) was more frequent. Previous gambling behaviour predicted gambling frequency during lockdown. No associations were apparent between gambling frequency and measures of mental health and well-being. Heavy alcohol use was strongly linked with regular gambling during lockdown. Gamblers were more than twice as likely as non-gamblers to have experienced financial difficulties pre-COVID, but gambling frequency was not related to employment status during lockdown. Online gambling increased during lockdown, whilst offline gambling activities decreased in frequency. A small minority of regular weekly gamblers, who tended to be male and heavy users of alcohol, participated in a wide range of online and offline gambling activities.

Predictors and patterns of gambling behaviour across the COVID-19 lockdown: Findings from a UK cohort study

The negative impact of the COVID-19 pandemic on the economy has raised concerns about negative coping behaviours to offset financial losses. We used a subset of a longitudinal study of UK adults (N = 19,963) to examine a range of predictors of (i) gambling during the first strict lockdown, (ii) gambling more frequently during this strict lockdown compared to before lockdown, and (iii) continued increased frequency of gambling during the relaxation of restrictions. Results from logistic regressions indicated that amongst other factors, those with progressively lower levels of education, were stressed due to boredom, frequently drank alcohol, and had high risk-taking tendencies were more likely to gamble during strict lockdown. Individuals who were more likely to have increased their frequency of gambling during strict lockdown compared to before the lockdown were stressed by boredom, employed, frequently drank alcohol, and had depression and anxiety, whilst men and current smokers were less likely. As lockdown restrictions eased, individuals of ethnic minority backgrounds, who were current smokers, and with lower educational attainment were more likely to continue gambling more than usual. Findings contribute to knowledge of who is most at risk for increasing their gambling during the COVID-19 pandemic.

OUP accepted manuscript

The Coronavirus disease of 2019 (COVID-19) and measures to curb it created population-level changes in male-dominant impulsive and risky behaviors such as violent crimes and gambling. One possible explanation for this is that the pandemic has been stressful, and males, more so than females, tend to respond to stress by altering their focus on immediate versus delayed rewards, as reflected in their delay discounting rates. Delay discounting rates from healthy undergraduate students were collected twice during the pandemic. Discounting rates of males (n=190) but not of females (n=493) increased during the pandemic. Using machine learning, we show that prepandemic functional connectome predict increased discounting rates in males (n=88). Moreover, considering that delay discounting is associated with multiple psychiatric disorders, we found the same neural pattern that predicted increased discounting rates in this study, in secondary datasets of patients with major depression and schizophrenia. The findings point to sex-based differences in maladaptive delay discounting under real-world stress events, and to connectome-based neuromarkers of such effects. They can explain why there was a population-level increase in several impulsive and risky behaviors during the pandemic and point to intriguing questions about the shared underlying mechanisms of stress responses, psychiatric disorders and delay discounting.

Problematic use of the internet during the COVID-19 pandemic: Good practices and mental health recommendations

With the onset of the COVID-19 pandemic and the accelerated spread of the SARS-CoV-2 virus came jurisdictional limitations on mobility of citizens and distinct alterations in their daily routines. Confined to their homes, many people increased their overall internet use, with problematic use of the internet (PUI) becoming a potential reason for increased mental health concerns. Our narrative review summarizes information on the extent of PUI during the pandemic, by focusing on three types: online gaming, gambling and pornography viewing. We conclude by providing guidance for mental health professionals and those affected by PUI (with an outline of immediate research priorities and best therapeutic approaches), as well as for the general public (with an overview of safe and preventative practices).

Impact of Gambling Supply Reduction During COVID-19 Shutdowns on Gambling Problems and Gambling Behaviour in Australia: A National Longitudinal Study

Restricting access to gambling products is one possible harm reduction strategy. We examined whether land-based gambling product supply restrictions during the COVID-19 pandemic impacted gambling problems and gambling engagement. In a three-wave, online, longitudinal study, 462 Australian adults (M_age = 44.94; 87% male) who gambled completed survey measures of demographics, gambling engagement (land-based and online), gambling problems, and psychological distress. Analyses were pre-registered and examined the impacts of restrictions on gambling problems and engagement. During the period of restrictions, there were no significant differences in gambling problems (OR = 0.88 [95%CI 0.55-1.42], p = .610) nor online gambling (B = 4.48 [95%CI-0.40-9.35], p = .071) between states experiencing and not experiencing restrictions. There was a small overall reduction in gambling engagement at 2-(t = 2.03, p = .043) and 5-months (t = 2.37, p = .019) post-restrictions, but no change in gambling problems (t = 1.25, p = .211; t = 1.50, p = .134). Amongst those at moderate-to-high risk of problems at baseline, there were no significant reductions in gambling engagement (t = 0.58, p = .564; t = 1.20, p = .232) or problems (t = 0.92, p = .359; t = 1.53, p = .126) at 2- and 5-months post-restrictions. Findings show only a modest impact of COVID-related supply restrictions on gambling engagement and no impact on gambling problems up to 5 months follow-up. The wide-ranging psychosocial and financial impacts of the pandemic may have overshadowed any potential beneficial effects of the supply restrictions on problem gambling levels. Policies to promote and improve access to problem gambling treatment services are needed even following periods of reduced availability of gambling products.

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.

Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).

Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively).

Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.

Gambling and the COVID-19 pandemic: A scoping review

BACKGROUND

The impact of COVID-19 on mental health is tremendous. Since the beginning of the pandemic, several actors have raised concerns about the impact of the pandemic on gambling. Many actors fear a switch to online gambling in the context of the closure of many land-based gambling activities due to the restrictions imposed by public health authorities, such as physical distancing and lockdowns. This switch is worrisome because online gambling is considered a high-risk game. In that context, we need to know more about the impacts of the pandemic on gambling. This scoping review aims to summarize the literature that addresses the impacts of the COVID-19 pandemic on gambling. To our knowledge, this is the first review to focus on this subject.

METHODS

An electronic literature search involving a strategy using keywords related to COVID-19 and gambling was conducted using MEDLINE, Academic Search Complete, CINAHL, PsychINFO, Social Works Abstract, and Socio Index databases on February 25th 2021. This search was combined with a manual search in Google Scholar. To be included, studies had to discuss gambling and COVID-19 as a primary theme, be written in English, and be published in a peer-reviewed journal. After collecting the information, we collated, summarized, and reported the results using narrative synthesis.

RESULTS

The search identified 181 articles. After the removal of duplicates and screening, 24 full-text articles were reviewed and included in this study: 14 original articles, 8 commentaries or editorials, and 2 protocols. Contrary to expectations, preliminary evidence suggested that gambling behavior often either decreased or stayed the same for most gamblers during the pandemic. However, for the minority who showed increased gambling behavior, there was frequently an association with problem gambling.

CONCLUSION

The available literature on COVID-19 and gambling is limited and the impact of the COVID-19 pandemic on gambling behavior and gambling problems is still unclear. Therefore, there is a need for more research on this topic, both qualitative and mixed methods studies, to better understand the impact of the pandemic on gambling. Considering the results, we need to be careful, particularly with problem gamblers and other subgroups of the population who seem to be more vulnerable to increased gambling habits during this pandemic period.

Risk Factors for Increased Online Gambling during COVID-19 Lockdowns in New Zealand: A Longitudinal Study

Recent research investigating changes in gambling behaviors during periods of COVID-19 social restrictions, such as enforced lockdowns, are somewhat limited by methodology, being generally cross-sectional in nature and with participant samples recruited via online panels. The present study overcame these limitations via a secondary analysis of data collected in 2012 and 2015 from a New Zealand (NZ) longitudinal gambling study, with questions related to gambling behaviors due to COVID-19 lockdown periods included in an additional data collection, of participants who had previously scored as a risky gambler, during 2020/21. Almost one-quarter of online gamblers increased their gambling during lockdown with this most likely to be on overseas gambling sites, instant scratch card gambling and Lotto. The only sociodemographic risk factor for increased online gambling was higher education. Behavioral risk factors included being a current low risk/moderate risk/problem gambler, a previously hazardous alcohol drinker or past participation in free-to-play gambling-type games. These past behaviors could act as trigger points for health services or family and friends to monitor a person’s gambling behaviors during lockdown, or future stressful periods when usual terrestrial gambling opportunities are curtailed or unavailable, and to support safer gambling practices.

Alcohol and other substance use during the COVID-19 pandemic: A systematic review

BACKGROUND

Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this.

METHODS

A systematic review of all available evidence was carried out to document and interpret the frequency and severity of alcohol and other substance use during the Covid-19 pandemic and their relationship to demographic and mental health variables that may suggest further clinical implications. Peer reviewed articles in MEDLINE, Embase, PsycINFO, CINAHL complete and Sociological Abstracts were searched from December 2019 until November 2020.

RESULTS

The search and screening identified 45 articles from 513 deduplicated records. The evidence suggests a mixed picture for alcohol use. Overall, there was a trend towards increased alcohol consumption. The proportion of people consuming alcohol during the pandemic ranged from 21.7% to 72.9% in general population samples. Unlike alcohol use, there was a clear trend towards increased use of other substances use during the COVID-19 pandemic. The proportion of people consuming other substances during the pandemic ranged from 3.6% to 17.5% in the general population. Mental health factors were the most common correlates or triggers for increased use of both alcohol and other substances.

CONCLUSION

There is an increased need for treatment for alcohol and other substance use related problems during the pandemic. Increased targeting and evidence-based interventions will also be important in the period which follows this pandemic, to improve the quality of life for individuals and families, but also to prevent additional costs to society and health systems.

Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study

Background

Young people’s daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people’s online behaviors.

Objective

This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation.

Methods

This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors.

Results

Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16–24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25–39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25–39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25–39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25–39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16–24-year-old age group.

Conclusions

Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic.

Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study

Background

The COVID‑19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling.

Objective

This study explores self-reported web-based gambling behavior during the COVID‑19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes.

Methods

Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID‑19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress.

Results

The majority of the respondents who gambled reported no changes in their gambling habits during the COVID‑19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling.

Conclusions

The majority of respondents who gambled reported no changes in their gambling activity during the COVID‑19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress.

Effects of a national preventive intervention against potential COVID-19-related gambling problems. A self-report survey in online gamblers

BACKGROUND

The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments early introduced COVID-19-specific interventions aiming to prevent gambling problems, but their effects have not been evaluated.

OBJECTIVE

The present study aimed to evaluate a Swedish COVID-19-related temporary legislation imposing an automated weekly deposit limit for online casino gambling.

METHODS

The study was an anonymous survey sent by the state-owned gambling operator to online gamblers (N=619, among whom 54 percent moderate-risk/problem gamblers) who reached the weekly limit on online gambling during the summer of 2020.

RESULTS

Sixty percent were aware of having been limited by a COVID-19-related deposit limit, and a minority (23 percent) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 39 percent believed this intervention decreased their overall gambling, whereas eight percent believed it rather increased it. However, 83 percent reported having gambled on more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42 percent in moderate-risk/problem gamblers and 19 percent in others, p<0.001). Having increased gambling following the intervention was associated with being a moderate-risk/problem gambler, and by negative attitudes towards the intervention.

CONCLUSIONS

A weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting to gamble on other operators, and the lower effect in clients with gambling problems.

CLINICALTRIAL

Gambling and the COVID-19 pandemic in the province of Quebec (Canada): protocol for a mixed-methods study

INTRODUCTION

The COVID-19 pandemic has major collateral impacts on mental health. Gambling is among the major public health issues that seems to have been transformed by the pandemic. In the province of Quebec in Canada, gambling is an important leisure activity. About two out of three adults are in Quebec gamble. The objective of this study is to draw a portrait of the impacts of the COVID-19 pandemic on gamblers and to learn more about their experiences during the pandemic in the province of Quebec.

METHOD AND ANALYSIS

This study has a sequential explanatory mixed-method design in two phases. The first phase is a cross-sectional online survey with Quebec residents who are 18 years of age or older and have gambled at least once in the previous 12 months. The second phase will be a qualitative study. Semistructured interviews will be conducted with gamblers, family members, addiction counsellors and state representatives selected through purposing sampling.

ETHICS AND DISSEMINATION

This study is one of the first mixed-methods studies on the impacts of the COVID-19 pandemic on gambling. This study will generate new scientific knowledge on a worrisome public health issue, that is, gambling, and provide a better understanding of the experiences and gambling behaviours of gamblers during the pandemic. This study is funded by the Ministry of Health and Social Services of the Government of Quebec and was approved on 27 October 2020 by the Scientific and Research Ethics Committee of the CIUSSS de l'Estrie-CHUS. This is a 2-year study that will be completed in June 2022.

Exploring the experience of Gamblers Anonymous meetings during COVID-19: a qualitative study

Whilst much research has explored the possible causes and consequences of gambling, Gamblers Anonymous (GA) − one of the most accessed forms of support for gamblers - has been largely overlooked and, to date, only a few studies have explored how members experience this programme. Core to GA is the social interaction between members. From March 2020, however, the COVID-19 pandemic forced GA to move their meetings online. The present qualitative study therefore explored how GA members experienced these online meetings in the absence of actual face to face interactions with others. Individual telephone or video call interviews (n = 21) were carried out with members of GA in the UK and analysed using Thematic Analysis. The results described three main themes: (1) ‘practicalities of GA in lockdown’, which highlighted the practical benefits of online meetings such as more opportunity to attend different meetings, which in turn expanded participants’ perspectives and social networks; (2) ‘the importance of relationships in GA’, reflecting strong and enduring social networks that were created, maintained, and strengthened by feelings of solidarity; and (3) ‘therapeutic elements of the meetings’, such as psychological contract making which helped participants to stay abstinent. Transcending these themes was a tension between individual versus group identity with interviewees reporting a shift to focusing more on their own needs rather than those of the group. Overall, whilst still providing a lifeline during COVID-19 and offering some practical benefits, the online GA meetings were not able to completely replicate the value individuals gained from face to face meetings. This transition also resulted in disruptions both to group dynamics and to individual interactions within each group, ultimately resulting in participants behaving more individualistically and less collectively than in face-to-face meetings.

Applications of Artificial Intelligence, Machine Learning, Big Data and the Internet of Things to the COVID-19 Pandemic: A Scientometric Review Using Text Mining

The COVID-19 pandemic has wreaked havoc in every country in the world, with serious health-related, economic, and social consequences. Since its outbreak in March 2020, many researchers from different fields have joined forces to provide a wide range of solutions, and the support for this work from artificial intelligence (AI) and other emerging concepts linked to intelligent data analysis has been decisive. The enormous amount of research and the high number of publications during this period makes it difficult to obtain an overall view of the different applications of AI to the management of COVID-19 and an understanding of how research in this field has been evolving. Therefore, in this paper, we carry out a scientometric analysis of this area supported by text mining, including a review of 18,955 publications related to AI and COVID-19 from the Scopus database from March 2020 to June 2021 inclusive. For this purpose, we used VOSviewer software, which was developed by researchers at Leiden University in the Netherlands. This allowed us to examine the exponential growth in research on this issue and its distribution by country, and to highlight the clear hegemony of the United States (USA) and China in this respect. We used an automatic process to extract topics of research interest and observed that the most important current lines of research focused on patient-based solutions. We also identified the most relevant journals in terms of the COVID-19 pandemic, demonstrated the growing value of open-access publication, and highlighted the most influential authors by means of an analysis of citations and co-citations. This study provides an overview of the current status of research on the application of AI to the pandemic.

Gaming, substance use and distress within a cohort of online gamblers

BACKGROUND

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included Internet Gaming Disorder (IGD) as a tentative diagnosis and inquires for additional research. The research on gaming is inconsistent regarding measurement approach and diagnostic cut-offs. Some scholars suggest the core approach, accentuating some of the diagnostic criteria to avoid pathologizing harmless behavior. Also, the co-occurrence of gaming and other addictions, gambling in specifically, is frequently reported but poorly understood. The present study aimed to explore gaming within a population of online gamblers in order to evaluate the core approach but also to investigate the possible co-occurrence of different addictions.

DESIGN AND METHODS

The present study is derived from material collected for a study on online gambling. The study addressed 1007 adult individuals from the general population who had gambled for money on an online casino site or an online betting site, on at least 10 occasions during the past 12 months.

RESULTS

Both the level of distress and problem gambling increased as the severity of gaming increased. The co-occurrence of problems with alcohol, illicit drug use/prescription sedatives/strong painkillers and gambling was roughly 50% among the addictive gamers.

CONCLUSION

The present study suggests that the core approach manages to distinguish in severity of gaming in regards to interference and comorbidity. We also brought light to the occurrence of gaming within a population of gamblers and our results indicate that this specific group of addicted gamers are particularly burdened by co-occurrent addictive behaviors and severe distress.

Gaming, substance use and distress within a cohort of online gamblers

Background: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included Internet Gaming Disorder (IGD) as a tentative diagnosis and inquires for additional research. The research on gaming is inconsistent regarding measurement approach and diagnostic cut-offs. Some scholars suggest the core approach, accentuating some of the diagnostic criteria to avoid pathologizing harmless behaviour. Also, the co-occurrence of gaming and other addictions, gambling in specifically, is frequently reported but poorly understood. The present study aimed to explore gaming within a population of online gamblers in order to evaluate the core approach but also to investigate the possible co-occurrence of different addictions. Design and methods: The present study is derived from material collected for a study on online gambling. The study addressed 1007 adult individuals from the general population who had gambled for money on an online casino site or an online betting site, on at least 10 occasions during the past 12 months. Results: Both the level of distress and problem gambling increased as the severity of gaming increased. The co-occurrence of problems with alcohol, illicit drug use/prescription sedatives/strong painkillers and gambling was roughly 50% among the addictive gamers. Conclusion: The present study suggests that the core approach manages to distinguish in severity of gaming in regards to interference and comorbidity. We also brought light to the occurrence of gaming within a population of gamblers and our results indicate that this specific group of addicted gamers are particularly burdened by co-occurrent addictive behaviours and severe distress.

Self-Exclusion from Gambling-A Measure of COVID-19 Impact on Gambling in a Highly Online-Based Gambling Market?

The COVID-19 pandemic, and related changes of the gambling market, have been suspected to affect the risk of problem gambling. Despite media attention and political concern with this risk, study findings hitherto have been mixed. Voluntary self-exclusion from gambling was introduced on a national level in Sweden as a harm reduction tool in 2019, and this self-exclusion service in Sweden is a rare example of such an official, nationwide, multi-operator system. The present study aimed to evaluate whether short-term self-exclusion patterns were affected by different phases of COVID-19-related impacts on gambling markets in 2020. During the lock-down of sports in the spring months of 2020, three-month self-exclusion was unaffected, and one-month self-exclusion appeared to increase, though not more than in a recent period prior to COVID-19. Despite large differences in sports betting practices between women and men, self-exclusion patterns during COVID-19 were not apparently gender-specific. Altogether, self-exclusion from gambling, to date, does not appear to be affected by COVID-19-related changes in society, in contrast with beliefs about such changes producing greater help-seeking behavior in gamblers. Limitations are discussed, including the fact that in a recently introduced system, seasonality aspects and the autocorrelated nature of the data made substantial statistical measures unfeasible.

Gambling and self-reported changes in gambling during COVID-19 in web survey respondents in Denmark

Problem gambling is among the public health hazards which may increase due to the COVID-19 pandemic and its consequences on society. Results from a few countries have hitherto been diverse with respect to gambling during the pandemic. The present study aimed to study gambling behaviors during COVID-19 in Denmark, with the same methodology as previously used in Sweden, and also to provide a comparison to previously published Swedish data. A web survey was answered by 2,012 individuals, from December 2, to December 10, 2020. Four percent reported increased gambling habits, and three percent reported decreased gambling, during COVID-19. Self-reported increase in gambling was associated with spending more time at home, mental distress, and higher gambling severity. Prevalence of self-reported, increased gaming during COVID-19 was significantly lower in Denmark than in Sweden. Although the overall changes in gambling patterns during COVID-19 may be limited, people who increase their gambling during the pandemic may be at particular risk. Stakeholders should pay attention to individuals who report altered gambling habits during the pandemic.

The impact of COVID-19 on gambling and gambling disorder: emerging data

PURPOSE OF REVIEW

The lockdown response to the COVID-19 pandemic has significantly impacted commercial gambling in many jurisdictions around the world. The goal of this review is to systematically identify and describe the survey data and findings to date examining the effect on individual gambling and gambling disorder.

RECENT FINDINGS

Of the 17 publications meeting inclusion criteria, the majority reported cross-sectional assessments (n = 11, 65%) and remainder were longitudinal in that they had earlier gambling data for participants (n = 6, 35%). Not surprisingly given the closure of land-based gambling, an overall reduction in gambling frequency and expenditure was reported in all studies. The estimate of the proportion of participants in both the general population and the population that gambles who increased overall gambling or online gambling was variable. The most consistent correlates of increased gambling during the lockdown were increased problem gambling severity, younger age groups, and being male.

SUMMARY

These results suggest that the impacts of the COVID-19 pandemic on gambling and problematic gambling are diverse - possibly causing a reduction in current or future problems in some, but also promoting increased problematic gambling in others. The longer-term implications of both the reduction in overall gambling, and the increase in some vulnerable groups are unclear, and requires assessment in subsequent follow-up studies. However, in the short term, individuals with existing gambling problems should be recognized as a vulnerable group.

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.

Online Gambling in Iranian Social Media Users: Prevalence, Related Variables and Psychiatric Correlations

The exponential increase in Internet use has been associated with dangers and harms. Recently, the prevalence of online gambling is increasing in various countries. Online gambling can be a prelude to gambling disorder. No study has been conducted in this field in Iran yet. The aim of this study was to investigate the prevalence of online gambling (without disorder and pathological), and its relationship with demographic variables and psychiatric symptoms. 3252 people participated in this study online. Research tools included gambling disorder screening questionnaire-Persian (GDSQ-P), brief symptom inventory (BSI), Young's addiction questionnaire, and Demographic questionnaire. The prevalence of online gambling was 8.9%. 26.6% of online gamblers experience moderate to severe degrees of pathological gambling. 74.7% of online gamblers were male. Online gamblers have a lower mean age than non-online gamblers (p < 0.001). Online gamblers were equally from all economic classes. The most common methods of gambling were CRASH game and sports betting. Online gamblers had no significant difference in the rate of face-to-face (physical) gambling history, compared to non-online gamblers (6.9% vs 5.6%), (p > 0.05). In BSI-assessed psychiatric symptoms, online gamblers showed higher scores on anxiety and obsession, and lower scores on paranoid ideation, compared to the control group (p < 0.05). Also, Internet addiction and daily use of the Internet as entertainment were significantly higher in online gamblers than non-online gamblers (p < 0.05). Also, a positive and significant correlation was found between the severity of gambling and the severity of Internet addiction, severity of depression, severity of anxiety, and severity of obsession in online gamblers (p < 0.05). Overall, online gambling is common in Iran and is associated with psychiatric problems. Health professionals and the government should pay special attention to online gambling and its related problems.

Changes of Gambling Patterns during COVID-19 in Sweden, and Potential for Preventive Policy Changes. A Second Look Nine Months into the Pandemic

Gambling has been suggested as one of the potential mental health consequences of the COVID-19 pandemic. In earlier self-report studies, increased gambling has been reported by a limited proportion of respondents characterized with a high degree of problem gambling. The present study, carried out with the same methodology and in the same geographical setting, around seven months later in the pandemic, aimed to repeat and to extend the understanding of potential gambling changes in the population during COVID-19. An anonymous sample of web panel members was assessed, altogether 2029 individuals (52% women, 10% moderate-risk or problem gamblers). Results indicated that 6% reported increased gambling, and 4% reported decreased gambling during the pandemic. Having increased gambling was associated with more severe gambling problems (OR 2.78, 95% confidence interval 2.27–3.40), increased alcohol consumption (OR 2.92, 1.71–4.98), and psychological distress (OR 3.38, 1.83–6.23). In the group reporting increased gambling during COVID-19, moderate-risk/problem gambling was very common (62%). Recent governmental policy interventions in the area were known to a minority (30%) of respondents, but awareness of the regulations was markedly more common in individuals with at least moderate-risk gambling (56%) and in self-excluders (78%). Reporting of any perceived influence from policy changes was low (3%), and divided between those reporting an increasing and decreasing effect, respectively. Increased gambling may be a consequence of COVID-19-related changes in everyday lives of individuals with problematic gambling patterns. Thus, a vulnerable group demonstrates higher rates of gambling migration and psychosocial problems, and may require particular attention in screening and treatment contexts, and further scientific evaluations.

No Apparent Increase in Treatment Uptake for Gambling Disorder during Ten Months of the COVID-19 Pandemic-Analysis of a Regional Specialized Treatment Unit in Sweden

The COVID-19 pandemic and its impact on society has been suspected to affect gambling behaviors. Potentially, the pandemic crisis may result in increased problem gambling, for example, due to COVID-19-related psychological distress, unemployment, and financial difficulties. In addition, the cancellation of sports in early parts of the crisis has been suspected to alter gambling behaviors. Policy makers have called for action and, in some cases, have changed regulations, and media have reported possible increases in treatment seeking. However, research data are hitherto lacking. The present study assessed the treatment uptake at a regional specialized gambling-disorder unit in the healthcare system of Region Skåne, Sweden. Number of patients, treatment contacts, and patterns of rescheduling or cancellations of appointments were quantified for each month, January–December 2020, and compared to corresponding months of 2018 and 2019. Possible trends were analyzed, using an interrupted time-series analysis. Results did not indicate an increase in treatment uptake for gambling disorder during the months of COVID-19 impact in Sweden. The proportion of digital treatment increased, but total treatment uptake was unaffected by the pandemic. In conclusion, during the first ten months of the pandemic in Sweden, no obvious increase in treatment uptake for gambling disorder could be seen. Moreover, longer follow-up may be necessary in order to see if effects of worsening socioeconomic conditions may be a possible long-term risk factor of increased gambling after COVID-19.

Gambling in COVID-19 Lockdown in the UK: Depression, Stress, and Anxiety

To combat the spread of COVID-19, the UK Government implemented a range of "lockdown" measures. Lockdown has necessarily changed the gambling habits of gamblers in the UK, and the impact of these measures on the mental health of gamblers is unknown. To understand the impact of lockdown on gamblers, in April 2020, after ~6 weeks of lockdown, participants (N = 1,028, 72% female) completed an online questionnaire. Gambling engagement data was collected for pre-lockdown via the Brief Problem Gambling Screen (BPGS) allowing participants to be classified as Non-Gamblers (NG), Non-Problem Gamblers (NPG) or Potential Problem Gamblers (PPG). The Depression, Stress, and Anxiety Scale (DASS21) was used to measure depression, stress, and anxiety scores both pre- and during-lockdown. Results indicate that depression, stress and anxiety has increased across the whole sample. Participants classified in the PPG group reported higher scores on each sub scale at both baseline and during lockdown. Increases were observed on each DASS21 subscale, for each gambler group, however despite variable significance and effect sizes, the magnitude of increases did not differ between groups. Lockdown has had a significant impact on mental health of participants; whilst depression stress and anxiety remain highest in potential problem gamblers, pre-lockdown gambler status did not affect changes in DASS21 scores.

Responsible Gambling Telephone Intervention to High-Risk Gamblers by a State-Owned Gambling Operator in Sweden: Study Protocol for a Study on Effectiveness, User Satisfaction, and Acceptability

Gambling disorder is associated with severe financial, social, and psychological consequences, but treatment-seeking rates have been described to be low. Apart from formal treatment, motivational interventions in nontreatment-seeking high-risk gamblers have been shown to be promising. However, little is known about the effectiveness and acceptability of such motivational interventions carried out by a gambling operator as part of the company’s responsible gambling policies. Early experiences of such interventions are limited by the risk that gambling in individuals reached with the intervention may continue with a different gambling operator. The present study aims to evaluate effectiveness and user acceptability of a responsible gambling intervention continuously carried out by the Swedish state-owned gambling operator Svenska Spel Sport & Casino. This intervention for high-risk gamblers, identified either through substantial monetary losses or through a voluntary self-test by the gambler, includes a motivational telephone intervention aiming to encourage the gambler to set deposit limits, practice self-exclusion, or seek help. This protocol paper describes the two-tailed evaluation of this intervention: (1) A retrospective, register-based study of the effectiveness of the motivational intervention on gambling expenditures, deposit limits, and self-exclusions in comparison to control individuals not reached by the intervention, including all clients reached or attempted to be reached during September 2019–April 2020 (total n = 3626), as well as a one-to-one matched comparison of clients reached (n = 1404) and not reached; and (2) a prospective web survey study in individuals reached by the same ongoing telephone intervention practice from November 2020 (target n = 200), measuring clients’ attitudes to the intervention, perceived effects of the intervention on gambling, and their self-reported gambling on all operators after the intervention.

Gambling Despite Nationwide Self-Exclusion-A Survey in Online Gamblers in Sweden

Background: Voluntary self-exclusion is a well-known harm reduction intervention in problem gambling, although primarily in operator-specific or venue-based systems. A nationwide overall self-exclusion system ("Spelpaus") for all licensed gambling was introduced in Sweden in 2019. However, gambling in overseas companies despite national exclusion may be a concern in online gamblers. The present web survey study aimed to study self-reported self-exclusion and gambling despite exclusion in a nationwide multi-operator land-based/online exclusion system. Methods: Web survey in web panel members of a market survey company, carried out in May, 2020 (co-occurring with the COVID-19 pandemic). Past-year online gamblers (n = 997) answered questions about gambling patterns, gambling problems, psychological distress, self-exclusion since "Spelpaus" introduction, and gambling despite self-exclusion. Results: Seven percent reported ever self-excluded at Spelpaus, and this was associated with younger age, female gender, gambling problems, and chance-based games and online poker. In logistic regression, Spelpaus remained strongly associated with past-year online casino gambling, gambling problems, and absence of past-year sports betting. Among those having self-excluded, 38 percent reported gambling despite self-exclusion, most commonly online casino. Conclusions: In online gamblers in a setting with a nationwide self-exclusion system, using this was associated with past-year online casino gambling and gambling problems. Gambling despite self-exclusion appears to be common, and more commonly involves online casino. Stakeholders should aim to increase rates of self-exclusion in high-risk online gamblers, both during and beyond the COVID-19 situation in which the study was carried out. Also, policy makers should use gambling regulation in order to decrease the risk of breaching self-exclusion online, such as through the prohibition of non-registered gambling operators. Further research should focus on in-depth analysis of the reasons for gamblers to enroll or not enroll in multi-operator self-exclusion.

Effects on Gambling Activity From Coronavirus Disease 2019-An Analysis of Revenue-Based Taxation of Online- and Land-Based Gambling Operators During the Pandemic

Background: Concerns have been raised about increased gambling problems during the coronavirus disease (COVID-19) crisis, particularly in settings with high online gambling and risks of migration from land-based to riskier online-based gambling types. However, few non-self-reported data sources are hitherto available. The present study aimed to assess changes in the online- and land-based gambling markets in Sweden during the first months affected by the societal impact of COVID-19. Methods: Data were derived from national authority data describing monthly taxations of all licensed Swedish gambling operators, whose monthly tax payments are directly based on gambling revenue. Subdivisions of the gambling market were followed monthly from before COVID-19 onset in Sweden (mainly February 2020) through June 2020, when the sports market was restarted after COVID-19 lockdown. Results: Overall revenue-based taxations in the licensed gambling decreased markedly from February to March, but stabilized onto an overall modest decrease through June. Commercial online casino/betting, despite some decrease in March, was maintained on a relatively stable level through June. However, within this category, horse betting increased steeply during the pandemic but returned to prepandemic levels later during the period. The state-owned operator in betting/online casino decreased markedly throughout the pandemic. The remaining commercial operators, mainly in online casino and online betting, demonstrated no change during the pandemic and ended on a June level 14% above the February level. Throughout the pandemic, the smaller restaurant casinos decreased markedly, while major state-owned casinos also closed entirely. State-owned lotteries and electronic gambling machines decreased markedly but were rapidly normalized to prepandemic levels. Conclusions: Commercial online gambling operators' revenues remained stable throughout the pandemic, despite the dramatic lockdown in sports. Thus, chance-based online games may have remained a strong actor in the gambling market despite the COVID-19 crisis, in line with previous self-report data. A sudden increase in horse betting during the sports lockdown and its decrease when sports reopened confirm the picture of possible COVID-19-related migration between gambling types, indicating a volatility with potential impact on gambling-related public health.