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.

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.

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).

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.

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.

The relationship between media use in the bedroom, sleep habits and symptoms of insomnia.

This postal questionnaire study investigated the use of media in the bedroom and its relationships with sleep habits and symptoms of insomnia. The sample comprised 2500 individuals aged 16-40 years drawn randomly from the Norwegian national register. A total of 816 (34.0%) completed and returned the questionnaire. Respondents were asked how often they used computers, television sets, DVD players, game consoles and mobile telephones and listened to music/radio in their bedrooms. They also reported sleep habits on weekdays and at weekends/days off and symptoms of insomnia. After controlling for gender, age, anxiety and depression, the respondents who used a computer in the bedroom 'often' compared to 'rarely' rose later on weekdays and at weekends/days off, turned off the lights to go to sleep later at weekends/days off, slept more hours at weekends/days off and had a greater discrepancy between turning off the lights to go to sleep on weekdays and at weekends/days off. Respondents who used a mobile telephone in their bedrooms at night 'often' compared to 'rarely' turned off the lights to go to sleep later on weekdays and at weekends/days off, and rose later at weekends/days off. No such differences were found with the use of the other media. There were also no significant differences in symptoms of insomnia. This study indicates that the use of computers and mobile telephones in the bedroom are related to poor sleep habits, but that media use in the bedroom seems to be unrelated to symptoms of insomnia.

Changes Over Time and Predictors of Online Gambling in Three Norwegian Population Studies 2013-2019.

Objectives: To investigate changes over time and identify predictors of online gambling among gamblers by using three Norwegian representative samples covering a 6-year (2013-2019) period. We also aimed to identify different characteristics (including video game participation and video gaming problems) of online compared to offline gamblers. Methods: Data from gamblers (N = 15,096) participating in three cross-sectional surveys (2013, 2015, and 2019) based on random sampling from the Norwegian Population Registry were analyzed. Participants were asked how frequently they engaged in online gambling on different platforms (e.g., mobile phone). Data on sociodemographics, games gambled, gambling problems, gaming, and problem gaming were collected and analyzed by logistic regression analyses. Results: Overall, an increase in online gambling from 2013 to 2015 was found (a larger percentage of gamblers reported having gambled online at least once during the last year), and an increase in online gambling from 2015 to 2019 was found (more gamblers reported having gambled online at least once last year and at least once per week). The increase was largest for gambling on mobile phone. Consistent predictors of online gambling (at least once last year and at least once per week) were male gender, high income, being unemployed, being on disability pension, having work assessment allowance, being a homemaker or retiree, number of games gambled, and gambling problems. Conclusions: Online gambling, especially on mobile phones, has increased significantly during the last 6 years in Norway. Hence, gambling availability seems to have grown, which may pose a risk for development of gambling problems. Compared to offline gamblers, online gamblers were more likely to be men, young, not working or studying, gambling on several games, and having gambling problems. Responsible gambling efforts aiming at preventing or minimizing harm related to online gambling should thus target these groups.

The relationship between aversive conditioning and risk-avoidance in gambling.

This study investigated the relationship between aversive conditioning, heart rate variability suppression, behavioral activation system/behavioral inhibition system and risk-avoidance on the Iowa gambling task (IGT) in a nonclinical sample (29 male, 29 female, mean age = 20.7). A laboratory based Pavlovian aversive conditioning paradigm was used where a 1500 Hz tone (CS+) was followed by a burst of loud white noise (US), and a 850 Hz (CS-) tone was never followed by the US. In a subsequent extinction phase where the CS+ and CS- were presented without the US, conditioned skin conductance responses to the CS+ indicated aversive conditioning. The results showed that the participants who did not show aversive conditioning (N = 26) exhibited significantly less risk-avoidance compared to participants who did show aversive conditioning (N = 32). Regression analysis showed that among the study variables, only aversive conditioning contributed significantly to explaining variance in risk-avoidance. These results may have implications for understanding risk-taking in gambling in general, and may be a starting point understanding the role of aversive conditioning in the development and maintenance of gambling problems.

Direct Marketing Experiences Among Individuals With Current and Lifetime Gambling Disorder.

Gambling providers use varied and complex marketing techniques, including marketing that targets the individual directly. Previous research indicates that individuals with gambling disorder are disproportionately influenced by gambling marketing, however, very few studies have examined gamblers' experiences with direct marketing. The current exploratory interview study examined experiences with direct gambling marketing among 12 individuals with either current (n = 5) or lifetime (n = 7) gambling disorder. A broad research question was employed encompassing experiences with different types of direct marketing and corresponding attitudes, influences, and interactions. The interview data were analyzed with thematic analysis using an inductive approach, and the participants reported extensive and varied experiences with direct marketing. Two overarching themes, with two and four subthemes, respectively, were identified. The overarching themes showed that marketing experiences were intimately connected with participants' gambling behaviors and their relationships to their own problems. Overall, direct marketing was experienced as an interactive form of marketing with individually tailored promotions such as free gambling credits, bonuses, and special gifts. Some promotions were experienced as personal, while others were experienced as mass produced. Direct marketing was in some cases experienced as predatory and was reported to hamper the participants' ability to cope with their gambling disorder. Participants' attitudes toward direct marketing varied as a function of the participants' engagement in gambling. During periods of active gambling, direct marketing was experienced as beneficial and positive as the participants took advantage of the offers or actively manipulated how the offers were made. In contrast, when attempting to reduce/abstain from gambling, the participants experienced direct marketing as aggressive, and they reported making considerable efforts to try to limit it. Direct marketing was experienced as a trigger for gambling urges and was reported to induce a conflict between gambling and abstinence. Directly marketed promotions are discussed in relation to ecological factors of access and availability that form a basis for the development of gambling disorder, and variations in experiences are related to stages of change in gambling disorder. Implications for treatment are discussed where the current findings suggest that coping with marketing should be addressed in treatment.

Evaluating an Internet Gaming Disorder Scale Using Mokken Scaling Analysis.

Internet Gaming Disorder (IGD) was recently included as a condition for further study in the fifth and latest version of the Diagnostic and Statistical Manual of Mental Disorders. The present study investigated whether the IGD criteria comprise a unidimensional construct. Data stemmed from a sample of Norwegians aged 17.5 years in 2012 and 19.5 years in 2014 (N = 1258). The study used the Mokken scale analysis to investigate whether the score of the different items on the IGD scale measured a single latent variable and if the scale functions differently for males and females. Correlation analysis was conducted between the scores on the IGD scale (count) and the Gaming Addiction Scale for Adolescents (GASA, categorical), both assessed in 2014. Negative binomial regression analyses were applied in order to investigate how different predictors of mental health assessed in 2012 were associated with IGD assessed in 2014. The Mokken scale analysis showed that all item-coefficients of homogeneity exceeded 0.3 when the whole sample completed the scale and when females completed the scale, indicating that the items reflect a single latent variable. In both cases moderate (H > 0.40) unidimensionality was shown. The item measuring "tolerance" did not exceed 0.3 in the scale when completed by males, indicating that only eight out of nine items reflect a single latent variable when applied to males only. The eight-item scale containing males showed weak (H > 0.30) unidimensionality. The correlation analysis showed a positive correlation between the scores on the IGD scale and the GASA (r = 0.71, p < 0.01) when assessed simultaneously and a positive but lower correlation (r = 0.48, p < 0.01) when assessed longitudinally. Results from the negative binomial regression analysis showed that previous video-game addiction, being male, depression, aggression and loneliness were significant predictors of IGD. The associations were small for all independent variables except previous video game addiction and gender where the associations were large. Although the results from the correlation analysis and regression analysis showed predictive validity of the scale, the results from the Mokken analysis suggest that the IGD scale may not be applied as a unidimensional scale when the tolerance item is included.

A Cross-Lagged Study of Developmental Trajectories of Video Game Engagement, Addiction, and Mental Health.

Objectives: Video game addiction has been associated with an array of mental health variables. There is a paucity of longitudinal studies investigating such associations, and studies differentiating addicted gaming from problem and engaged (i.e., frequent but non-problem) gaming. The current explorative study investigate the natural course of gaming behavior in three sub-studies. The aim of study 1 was to investigate antecedents and consequences of video game addiction measured as a unidimensional construct (pathological gaming). Aim of study 2 was to investigate the same associations in terms of typologies of gamers ("engaged," "problem," "addicted"). Furthermore, study 3 aimed to investigate the estimated stability and transitions occurring between the aforementioned typologies, and a non-pathological gaming group. Methods: A nationally representative sample of 3,000 adolescents aged 17.5 years was drawn from the population registry of Norway in 2012 and invited to participate in annual surveys spanning 3 years (NT1 = 2,059, NT2 = 1,334, NT3 = 1,277). The respondents completed measures of video game addiction, depression, anxiety, loneliness, aggression, and alcohol use disorder. Statistical analysis comprised cross-lagged path modeling, Satorra-Bentler chi square test (study 1), regression analyses (study 2), hidden Markov model of transition probabilities (study 3). Results: Findings in study 1 showed that depression and loneliness were reciprocally associated with pathological gaming. Physical aggression was identified as an antecedent, and anxiety was a consequence of pathological gaming. Investigation of the three typologies of gamers (study 2) identified loneliness and physical aggression as antecedents, and depression as a consequence of all typologies. Depression was found to be an antecedent of problem and engaged gamers. Loneliness was found as a consequence of problem gamers, and anxiety was a consequence of addicted gamers. High alcohol consumption was found antecedent to addicted gamers, and low alcohol consumption was found antecedent to problem gamers. The estimated stability of video game addiction was 35%. Conclusion: A reciprocal relationship between pathological gaming and measures of mental health problems seems to exist. The stability of video game addiction indicates a condition that for a substantial number of people does not resolve spontaneously over the course of 2 years.

The effectiveness of a parental guide for prevention of problematic video gaming in children: A public health randomized controlled intervention study.

Background and aims Excessive use of video games among children and adolescents is a growing concern. The aim of this study was to investigate the effectiveness of a brief parental guide with advices and strategies for regulating video gaming in children. Methods A random sample of guardians of children between the age of 8-12 years old (N = 5,864) was drawn from the Norwegian Population Registry and equally randomized into an intervention and a control condition. A parental guide based on clinical and research literature was distributed by postal mail to those in the intervention condition. A 4-month follow-up survey comprising questions about problematic video gaming, gaming behavior, sleep activity, and parental video game regulation behavior was administered. Results Independent t-tests revealed no significant differences between the two conditions (N = 1,657, response rate 30.1%) on any outcome measure. An ANOVA with planned comparisons showed that respondents who reported that they had read and followed the parental guide reported more video game problems and used more parental mediation strategies than those who did not read and follow the guide. Conclusions We found no evidence for the effectiveness of the psychoeducational parental guide on preventing problematic video gaming in children. However, the guide was read and positively assessed by a significant proportion of guardians. Differences between those who studied the guide and those who did not may indicate that parental guides are better aimed at providing important information to those who already have problems rather than as a mean of primary prevention.

Not good enough? Further comments to the wording, meaning, and the conceptualization of Internet Gaming Disorder.

In their commentary, Kuss, Griffiths, and Pontes (2016) criticize the use of the term "Internet" in the recently proposed diagnosis for Internet Gaming Disorder (IGD) and its use as one of the included diagnostic criteria. We agree with the exclusion of the term "Internet" in the diagnosis, but have some considerations to the comments regarding the nine criteria for IGD. Specifically, we discuss the meaning, the wording, and the importance of the criteria, as well as the importance of distress or functional impairment in the proposed diagnosis. We also address the possibility of categorizing IGD as a subtype of a general behavioral addiction diagnosis.