Examining the relationship between non-suicidal self-harm and suicidality within the past 12-months and gaming problems in Norwegian full-time students.

BACKGROUND: Although gaming problems are associated with poor mental health, few population-based studies have examined its association with self-harm and suicidality. This study investigates the association between gaming problems, non-suicidal self-harm and suicidality within the past year, stratified by sex among Norwegian full-time students. METHODS: Data derived from the Norwegian Students' Health and Wellbeing Study 2022 (N = 59,544). The respondents were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers based on the Game Addiction Scale for Adolescents. Log-link binomial regression models, stratified by sex, adjusted for age, were used to estimate the risk ratio of non-suicidal self-harm (ideation and behavior) and suicidal behaviors (ideation and attempt) across different levels of gaming problems. RESULTS: Among females, the risk of non-suicidal self-harm and suicidal ideation increased from non-gamer to problem gamer, with no differences between problem and addicted gamers. Among males, the risk of non-suicidal self-harm increased from non-gamers to engaged gamers, but no differences were observed between engaged, problematic, and addicted gamers. No sex × gaming category interaction was observed for suicide attempts. Engaged and addicted gamers had higher risks of suicide attempt than non-gamers and recreational gamers. CONCLUSIONS: Gaming problems are associated with increased risk of non-suicidal self-harm and suicidal ideation among females. Among males, no differences were observed between engaged, problem and addicted gamers. The results highlight sex when studying health related outcomes and their association to level of gaming problems. Longitudinal studies are warranted to uncover the temporal mechanisms between IGD, non-suicidal self-harm and suicidality.

Marital status and gambling disorder: a longitudinal study based on national registry data.

BACKGROUND: Marital status is a robust correlate of disordered gambling, but few studies have examined the direction of this association. METHODS: The present study used a case-control design by including all adults receiving their first gambling disorder (GD) diagnosis between January 2008 to December 2018 (Norwegian Patient Registry, n = 5,121) and compared them against age and gender matched individuals with other somatic/psychiatric illnesses (Norwegian Patient Registry, n = 27,826) and a random sample from the general population (FD-Trygd database, n = 26,695). The study examined marital status before GD, getting divorced as a risk factor for future GD, and becoming married as a protective factor of future GD. RESULTS: The findings indicated an 8-9 percentage points higher prevalence of unmarried people and about a 5 percentage points higher prevalence of separation/divorce among those that subsequently experienced GD compared to controls. Logistic regressions showed that transition through divorce was associated with higher odds of future GD compared to illness controls (odds ratio [OR] = 2.45, 95% CI [2.06, 2.92]) and the general population (OR = 2.41 [2.02, 2.87]). Logistic regressions also showed that transition through marriage was associated with lower odds of future GD compared to illness controls (OR = 0.62, CI [0.55, 0.70]) and the general population (OR = 0.57, CI [0.50, 0.64]). CONCLUSIONS: Social bonds have previously been shown to impact physical and mental health, and the findings of the study emphasize the importance of considering social network history and previous relationship dissolution among individuals with GD.

Relationships Between Exposure to Different Gambling Advertising Types, Advertising Impact and Problem Gambling.

People with gambling problems report more exposure and impact from gambling advertising, although less is known regarding the role of specific advertising types. Data on gamblers (n = 5830, 48.5% women, mean age = 44.27) was collected from a general population cross-sectional survey in Norway (32.7% response rate). We examined if problem gambling was associated with perceived advertising impact (on gambling involvement, awareness, and knowledge) or exposure (via internet, TV, retail outlet, newspaper, and direct advertising). We also investigated if advertising exposure was associated with advertising impact. ANOVAs revealed that problem gambling was associated with increased perceived advertising impact on gambling involvement (ω2 = 0.09, p < .001) and awareness of gambling (ω2 = 0.04, p < .001). Reported exposure to direct advertising increased linearly with problem gambling level (ω2 = 0.04, p < .001), whereas we found small/no differences in exposure to other types of advertising. Multiple regressions revealed that among advertising types, internet advertising was the strongest predictor of perceived advertising impact on gambling involvement (ß = 0.1, p < .001). TV advertising was the strongest predictor of advertising impact on knowledge of gambling forms and operators (ß = 0.28, p < .001) and awareness of gambling (ß = .05, p < .05). Future studies should elucidate how different subtypes of internet advertising impact gambling involvement. Clinicians should assess clients' experiences with direct advertising and devise interventions for coping. Researchers should be aware that internet and direct advertising allow for more tailored content compared to other advertising types.

Aggression and Anabolic-Androgenic Steroid Use Intent in Adolescents: A Longitudinal Study.

Background: There is a dearth of longitudinal studies on risk factors for anabolic-androgenic steroid (AAS) use and intent. Objectives: We conducted a longitudinal investigation of factors associated with AAS use intent from age 18 to 19, examining particularly the role of physical and verbal aggression. A sample of Norwegians completed questionnaires containing demographic, AAS use and intent, other addictions, aggression, and health measures at ages 18 (N = 1333, females = 58.9%) and 19 (N = 1277, females = 61.7%). The data were analyzed using descriptive statistics, correlations, and hierarchical multiple regression. Results: Results show that AAS use prevalence increased from 1 person at age 18 to 4 persons at age 19. Intent to use AAS, being male, living alone, and AAS use (all at 18 years) were associated with higher AAS use intent at 19 years. We found no associations between physical or verbal aggression and AAS use intent from ages 18 to 19. Conclusions: Our findings indicate temporal stability in AAS use intent, as well as the influence of demographic and health factors on AAS use intent from ages 18 to 19. Implications of findings for practice and future research are discussed.

Predictors of Gamblers Beliefs About Responsible Gambling Measures.

Responsible gambling (RG) measures are methods aimed at reducing and preventing negative consequences associated with gambling. Some RG measures are set by authorities or gambling operators while others are available as features for gamblers to use themselves (e.g. budget tools where personal monetary limits are set prior to gambling). The present study is based on a general gambler population and investigates how RG measures with some specific RG features are assessed by the gamblers. The data was collected in 2013 and 2015. The samples were drawn from the Norwegian Population Registry. In total 9129 gamblers participated. Gamblers were asked to state to which degree they agreed that ten specific RG measures help or would help them controlling their gambling. Overall, between 35 and 42% neither agreed nor disagreed, but among those with an opinion, most agreed. A multiple regression analysis identified eleven variables as significant predictors of positive beliefs about RG measures: female gender, young age, playing random games only, being a moderate risk or problem gambler, reporting high impact from gambling advertisements as well as the personality traits agreeableness, openness and neuroticism. Playing low risk games only, reporting a high amount of spending on gambling and the personality trait extraversion were inversely related to positive beliefs about RG measures. The total explained variance was however only 7.1%. Positive beliefs about RG measures can relate to needs for external based countermeasures to minimize or reduce problems. Negative views may reflect a wish to play without obstacles, take risks or to trust in self-control.

Are Video Games a Gateway to Gambling? A Longitudinal Study Based on a Representative Norwegian Sample.

The scope and variety of video games and monetary gambling opportunities are expanding rapidly. In many ways, these forms of entertainment are converging on digital and online video games and gambling sites. However, little is known about the relationship between video gaming and gambling. The present study explored the possibility of a directional relationship between measures of problem gaming and problem gambling, while also controlling for the influence of sex and age. In contrast to most previous investigations which are based on cross-sectional designs and non-representative samples, the present study utilized a longitudinal design conducted over 2 years (2013, 2015) and comprising 4601 participants (males 47.2%, age range 16-74) drawn from a random sample from the general population. Video gaming and gambling were assessed using the Gaming Addiction Scale for Adolescents and the Canadian Problem Gambling Index, respectively. Using an autoregressive cross-lagged structural equation model, we found a positive relationship between scores on problematic gaming and later scores on problematic gambling, whereas we found no evidence of the reverse relationship. Hence, video gaming problems appear to be a gateway behavior to problematic gambling behavior. In future research, one should continue to monitor the possible reciprocal behavioral influences between gambling and video gaming.

Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: an International Perspective.

Problems related to high levels of gaming and Internet usage are increasingly recognized as a potential public health burden across the developed world. The aim of this review was to present an international perspective on prevention strategies for Internet gaming disorder and related health conditions (e.g., Internet addiction), as well as hazardous gaming and Internet use. A systematic review of quantitative research evidence was conducted, followed by a search of governmental reports, policy and position statements, and health guidelines in the last decade. The regional scope included the USA, UK, Australia, China, Germany, Japan, and South Korea. Prevention studies have mainly involved school-based programs to train healthier Internet use habits in adolescents. The efficacy of selective prevention is promising but warrants further empirical attention. On an international scale, the formal recognition of gaming or Internet use as a disorder or as having quantifiable harms at certain levels of usage has been foundational to developing structured prevention responses. The South Korean model, in particular, is an exemplar of a coordinated response to a public health threat, with extensive government initiatives and long-term strategic plans at all three levels of prevention (i.e., universal, selective, and indicated). Western regions, by comparison, are dominated by prevention approaches led by non-profit organizations and private enterprise. The future of prevention of gaming and Internet problems ultimately relies upon all stakeholders working collaboratively in the public interest, confronting the reality of the evidence base and developing practical, ethical, and sustainable countermeasures.

Aggression Is Associated With Increased Anabolic-Androgenic Steroid Use Contemplation Among Adolescents.

We investigated the relationship between aggression and anabolic-androgenic steroid (AAS) use intent among adolescents. A nationally representative sample of Norwegian 18-year-olds (N = 1,334, females = 58.7%) took part in a survey in 2013 (response rate = 64.9%). Participants completed the physical and verbal subscales of the Short-Form Buss-Perry Aggression Questionnaire, the Intent to use AAS Scale, the Alcohol Use Disorders Identification Test-Consumption, and the Hospital Anxiety and Depression Scale. They also provided demographic information and answered questions about AAS use, gambling participation, as well as cigarette and snus use. Descriptive statistics and multinomial logistic regression were used to analyze the data. Lifetime and past year prevalence of AAS use was 0.1%. Between 0.4% and 1.7% of participants disclosed intent to use while between 1.1% and 2.5% expressed neutral intent to initiate AAS use. Compared to persons low on aggression, individuals high on aggression were more likely to report intent and curiosity towards initiating AAS use. Our findings indicate that aggression is a risk factor for AAS use contemplation among adolescents.

Prevalence and Correlates of Problem Gambling in a Representative Sample of Norwegian 17-Year-Olds.

We report data collected in a representative sample of 17-year-old Norwegians to investigate prevalence rates of non-problem, risk, and problem gambling, as measured by the Problem Gambling Severity Index (PGSI). In addition, we explored the importance of demographic, personality, motivational, social, and health variables explaining variance in adolescent gambling. Prevalence rates of risk and problem gambling were low but similar to those found in previous studies outside of Norway using the PGSI in adolescent samples. With regard to the relative importance of the various covariates, we found that motivational variables (future gambling intentions, attitudes toward gambling, and gambling-related knowledge) distinguished best between those who did not gamble, non-problem gamblers, and risk and problem gamblers. Furthermore, social variables were important covariates of adolescent gambling; significant associations were found for family and friends' approval of gambling, parental monitoring, father's level of education, and having relatives or friends with a history of a gambling disorder. We discuss possible reasons for differences between the covariates with regard to their importance for explaining adolescent gambling and address implications for future research.

The Relationship Between Structural Game Characteristics and Gambling Behavior: A Population-Level Study.

The aim of this study was to examine the relationship between the structural characteristics and gambling behavior among video lottery terminal (VLT) gamblers. The study was ecological valid, because the data consisted of actual gambling behavior registered in the participants natural gambling environment without intrusion by researchers. Online behavioral tracking data from Multix, an eight game video lottery terminal, were supplied by Norsk-Tipping (the state owned gambling company in Norway). The sample comprised the entire population of Multix gamblers (N = 31,109) who had gambled in January 2010. The individual number of bets made across games was defined as the dependent variable, reward characteristics of a game (i.e., payback percentage, hit frequency, size of winnings and size of jackpot) and bet characteristics of a game (i.e., range of betting options and availability of advanced betting options) served as the independent variables. Control variables were age and gender. Two separate cross-classified multilevel random intercepts models were used to analyze the relationship between bets made, reward characteristics and bet characteristics, where the number of bets was nested within both individuals and within games. The results show that the number of bets is positively associated with payback percentage, hit frequency, being female and age, and negatively associated with size of wins and range of available betting options. In summary, the results show that the reward characteristics and betting options explained 27% and 15% of the variance in the number of bets made, respectively. It is concluded that structural game characteristics affect gambling behavior. Implications of responsible gambling are discussed.

Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis.

The prevalence of gaming disorder is assumed to be between 2%-5%. The treatment effect of different therapeutic interventions of gaming disorder has not been studied extensively. This systematic review and meta-analysis sought to identify all intervention studies on gaming disorder with a control group, determine the effect of the interventions, and examine moderators. Studies applying a therapeutic intervention and using an appropriate comparison group were identified by searching electronic databases, previous reviews, and reference lists. Data on type of treatment, name of outcome measurement, symptom level and other study characteristics were extracted and analyzed using meta-analysis and meta-regression. A total of 38 studies and 76 effect sizes, originating from 9524 participants were included. RoB2 and ROBINS-I risk of bias tools were used to assess within-study risk of bias. Correlational hierarchical models with robust variance estimation were fitted to effect size data and yielded a moderate summary estimate. Egger's sandwich test, funnel plot inspections, and other tests were conducted to assess risk of bias between studies. Results indicate that there may be an overall effect of therapeutic interventions for gaming disorder, but confidence in these findings is compromised by small-study effects, possible publication bias, a limited study pool, and a lack of standardization. The field needs more higher quality studies before the evidence-base can support reliable meta-analytic estimates.

Attentional bias in problem gambling: a systematic review.

Attentional bias has been the subject of extensive empirical investigation in connection with chemical addictions, and it has been demonstrated in users of several different substances. The findings show that substance users seem to notice and attend to substance-related stimuli more readily than non-substance-related stimuli. Less is known, however, about attentional bias in pathological gambling. This systematic review investigates the existing empirical evidence on attentional bias in problem and pathological gamblers. Eleven studies were identified and evaluated following a literature search. Key findings are that problem and pathological gamblers seem to exhibit attentional bias toward gambling-related stimuli across different measuring paradigms, although some negative findings were reported. Recommendations aimed at improving research on this topic include better validation of measures, the inclusion of manipulations of craving level, and adding variations in gambling severity as a variable, as well as gambling preference. Research on therapeutic procedures aimed at reducing attentional bias is also recommended.

Telescoping and gender differences in high-risk gambling: Loss limit behavior in a population of electronic gaming machine players.

OBJECTIVE: Telescoping refers to the accelerated progression from starting a potentially addictive behavior to reaching a disordered level. For disordered gambling, telescoping has been reported for women compared to men. Most previous studies on telescoping have used clinical samples and retrospective reports, but this study examined a nonclinical population of gamblers using electronically tracked gambling behavior. METHOD: The sample consisted of Norsk Tipping's Multix electronic gaming machine (EGM) customers during the period of March 2013-December 2018 (n = 184,113, 27.0% women, age range from 18 to 103 years, M = 41, SD = 16). We hypothesized that women would be older than men when first playing Multix and that the time between first playing Multix to reaching first loss limit (money one is allowed to lose) would be shorter for women compared to men. RESULTS: Welch two-sample t tests revealed that women were older than men at Multix gambling onset (Women: M = 46, SD = 17; Men: M = 40, SD = 15; p < .001). Kaplan-Meier revealed a median survival time of 46 months, 95% CI [45, 47], for women and 55 months, 95% CI [54, 56], for men before the first loss limit. Cox regression showed higher risk for meeting the loss limit for women compared to men, HR = 1.22, 95% CI [1.20, 1.25], p < .001, when controlling for age. CONCLUSION: Prevention efforts should consider that adult women playing EGMs appear to be at risk for developing high-risk gambling faster than men. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between problem gambling and personality traits: a longitudinal study among the general Norwegian population.

Objective: The present study investigates the longitudinal relationship between problematic gambling (PG) and the five factor model's personality traits using autoregressive cross-lagged models. Methods: The data used in the current study was collected by a national survey in 2013 (n = 10,081) and a follow-up study (n = 5,848) in 2015. PG was measured using Canadian Problem Gambling Index (CPGI) while personality was assessed using Mini-International Personality Item Pool (MINI-IPIP). Participants who completed the CPGI and all the personality items during both waves (n = 2,702) were analysed. Results: The results show that neuroticism had positive cross-lagged associations with CPGI. In contrast, conscientiousness and agreeableness in 2013 were found to have inverse cross-lagged effect on CPGI in 2015. Finally, openness and extraversion did not have any cross-lagged associations with CPGI. Conclusion: PG poses serious negative implications for the involved individuals as well as their associated close social circle. Hence, it is important to understand predictors of PG for prevention purposes. Personality traits are one of the influential frameworks for examining uncontrolled psychopathological behaviors like PG. The study findings offer significant theoretical as well as practical implications.

Ethnicity as a risk factor for gambling disorder: a large-scale study linking data from the Norwegian patient registry with the Norwegian social insurance database.

BACKGROUND: The study investigated ethnicity as a risk factor for gambling disorder (GD), controlling for demographics, citizenship, and years of residency in Norway. METHODS: The sample comprised 65,771 individuals from a national patient registry (n = 35,607, age range 18-88 years) and a national social insurance database in Norway (n = 30,164, age rage 18-98 years). The data covered the period from 2008 to 2018. RESULTS: The results showed that when controlling for age and sex, ethnic minorities were overall less likely than those born in Norway to be diagnosed with GD (odds ratio [OR] ranging from 0.293 to 0.698). After controlling for citizenship and years of residency in Norway, the results were reversed and indicated that ethnic minorities were overall more likely to be diagnosed with GD (OR ranging from 1.179 to 3.208). CONCLUSION: The results suggest that citizenship and years of residency are important variables to account for when assessing the relationship between ethnicity and being diagnosed with GD. Our results may be explained by people from ethnic minority groups being more likely to experience gambling problems but less likely to seek contact with healthcare services for gambling problems.

An empirical study on attitudes toward gambling when sportswashing is involved.

Sportswashing is defined as individuals, groups, companies, or countries/regimes' involvement in sports to improve their own reputation and/or to distract from or normalize wrongdoing. This cross-sectional survey is the first empirical study on sportswashing in relation to gambling. The sample consisted of United Kingdom residents who reported past 12-month gambling (N = 786, 50% women, mean age = 45.6, SD = 15.2). We investigated how many were familiar with sportswashing and their attitudes toward gambling when sportswashing is involved. Exploratory and confirmatory factor analysis (CFA) were conducted on the attitudes scale that was developed for the current study. Multiple regressions were used to examine if individual differences in terms of age, gender, personality, moral foundations, political trust and efficacy, and/or gambling risk were associated with such attitudes. Finally, we examined the percentage of people who avoid gambling on teams/events when sportswashing is involved, including group differences in avoidance and motivations for avoidance according to gambling risk. The results showed that only 32% had heard about sportswashing prior to the survey. CFA indicated that attitudes toward sportswashing and gambling as conceptualized in the scale used in the current study can broadly be categorized into two dimensions: How individuals relate to sportswashing when gambling ("self-factor") and how individuals think gambling companies and regulators should regulate sportswashing and gambling [an "external-factor," p < 0.001, CFI = 0.0.996, RMSEA = 0.090, 90% CI (0.077, 0.104)]. Multiple regressions indicated that measures of individual differences explained a significant amount of variance in self-oriented (F (17, 765) = 7.19, p < 0.001, adjusted R2 = 0.12) and external-oriented (F (17, 765) = 8.40, p < 0.001. adjusted R2 = 0.14) attitude toward gambling and sportswashing. Avoidance of betting when sportswashing is involved was reported by 43%. The proportion was lower among those with moderate gambling risk/problem gambling (35%) compared to those with no/low gambling risk (45%). It is concluded that further scale development could help elucidate individual differences in attitudes toward sportswashing and gambling. Sportswashing remains an important social issue, and the present study indicates that this has high relevance for the gambling field.

Measuring loot box consumption and negative consequences: Psychometric investigation of a Swedish version of the Risky Loot Box Index.

Loot boxes are products in videogames that is earned by playing a video game or by buying them. Loot boxes has similar mechanisms as a lottery and there is an ongoing debate if loot boxes are gambling. However, to understand the potential harm of loot boxes valid instruments are needed. An English study psychometrically evaluated an instrument focused on risky loot box use called the Risky Loot Box Index. The study evaluated 12 item scale and based on a factor analysis it was reduced to a five-item scale. The aim of our study is to evaluate a Swedish version of the 12-item instrument from a psychometric perspective. Two samples recruited via an online survey were used. The first sample was recruited from the gambling site Unibet. A mail with an invitation to participate was sent to esports bettors and sport bettors at the gambling site. The second sample was recruited from a Facebook forum focused on e-sports. An invitation was posted on the forum to partake in the study. A total of 195 of respondents (96% men and 4% women) with a mean age of 33.76 (SD = 12.34) answered the Unibet survey and 169 respondents (96% men and 4% women and non-binary) with a mean age of 23.89 (SD = 5.52) answered the Facebook survey. An exploratory factor analysis yielded a two-factor seven item solution. The factors were overconsumption regarding time spent on loot boxes and the other factor was focused on overconsumption of loot boxes in terms of spending money. The confirmatory factor analysis conducted in the Facebook sample validated the result from the exploratory factor analysis. The conclusion of the study is that the Swedish version of the Risky Loot Index has good psychometric properties and can used to measure risky loot box consumption.

Different Typologies of Gamers Are Associated with Mental Health: Are Students DOOMed?

(1) Background: The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) led to a rapid development of assessment instruments based on the suggested diagnosis. However, previous studies suggest that some of the symptoms in the diagnosis reflect engagement in gaming rather than a disorder or addiction. The aim of the present cross-sectional study was to investigate mental health associations with different typologies of gamers. (2) Methods: Data stemmed from a large national survey of students (SHoT2022) that was conducted between February and April 2022 (N = 59,544). Participants were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers. Logistic regression models adjusted for age were analyzed with and without gender-stratification for mental distress and life satisfaction as dependent variables across gaming categories. (3) Results: The proportion reporting case-level mental distress was lower for recreational gamers compared to non-gamers, indicating fewer mental health problems for recreational gamers. However, after stratifying the analysis by gender, female recreational gamers had higher levels of mental distress compared to female non-gamers, reflecting Simpson's paradox. (4) Conclusions: Future studies investigating mental health and gaming should include a gender perspective.

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

Background: Previous research has suggested empirically based gambling loss limits, with the goal of preventing gambling related harm in the population. However, there is a lack of studies relating gambling loss limits to individual factors such as income. The current study examines whether gambling loss limits should be income-specific. Materials and methods: The dataset was derived from three representative cross-sectional surveys of the Norwegian population and consisted of 14,630 gamblers. Four income groups, based on a quartile approximation, were formed. Gambling related harm was measured with the Problem Gambling Severity Index (PGSI), and precision-recall (PR) analyses were used to identify loss limits for the different income groups at two levels of gambling severity: moderate-risk gambling and problem gambling. Results: For both levels of gambling severity, we found the lowest income group to have the lowest gambling loss limits, and the highest income group to have the highest loss limits, which compared to the loss limits for the total sample, were lower and higher, respectively. Calculating the cut-offs for moderate-risk gamblers, we found a consistently ascending pattern from the lowest to the highest income group. Calculating the cut-offs for problem gamblers, we found a similar pattern except for the two middle income groups. Conclusion: The results suggest that income moderates empirically derived gambling loss limits. Although replication is required, income-based gambling loss limits may have higher applied value for preventing gambling related harm, compared to general loss limits aimed at the entire population.