Late Acute Stress Effects on Decision-Making: The Magnified Attraction to Immediate Gains in the Iowa Gambling Task.

Previous literature indicates that the later phases of the acute stress response may promote poor decision-making, characterized by riskier choices and a likely inclination towards immediate reward-seeking. However, all studies addressing the effect of this phase have treated decisional capacity as a singular dimension, without analyzing the underlying processes under decision making. Employing the Value-Plus-Perseveration (VPP) RL model, based on Bayesian logic, this study aims to gain specific insights into how late phase of acute stress impacts the cognitive processes underpinning decision-making in the Iowa Gambling Task (IGT), deciphering whether, as expected, gains are processed in a magnified manner. Seventy-three participants were randomly assigned to two groups, stress (N = 35) and control (N = 38). A virtual version of The Trier Social Stress Test (TSST-VR) was employed as a laboratory stressor. Decision-making was evaluated 35minutes after the stressor onset, by means of the IGT. Results showed that stressed participants, in comparison to control group, displayed more perseverant and consistent decision-making, enhanced memory, and reinforcement learning capabilities, yet were guided by a greater attraction to decks offering immediate high gains. These results are analyzed with the understanding that in the IGT, short-term decisions focused on instant rewards are seen as counterproductive. This suggests that stress could limit the ability to switch to strategies that are more cautious and offer greater long-term benefits.

Rethinking cutoff values for the South Oaks Gambling Screen: Sex-specific insights and DSM-5 severity adjustments in Gambling Disorder assessment.

Background and aims: The South Oaks Gambling Screen (SOGS) is a commonly used tool for screening potential gambling problems. The SOGS score has been found to be correlated with the DSM-5 criteria for Gambling Disorder (GD). However, one of its main limitations is the high rate of false positives. The objective of this study was to establish more accurate cutoff points for the SOGS based on the DSM-5 criteria and severity levels, taking into account sex-specific samples. Additionally, we aimed to validate these cutoff points using external measures. Methods: The study sample comprised 4.516 patients (398 women and 4,118 men) who sought treatment for GD. Of these patients, 4.203 met the DSM-5 criteria for GD, while 313 did not meet the threshold for GD diagnosis. Results: The recommended cutoff value for the SOGS is eight for men (Sensitivity (Se): 82.9%, Specificity (Sp): 86.2%) and seven for women (Se: 85.6%, Sp: 77.4%). For moderate severity of GD, the cutoff points are nine for men (Se: 82.1%, Sp: 82.0%) and eight for women (Se: 86.3%, Sp: 73.3%), while for severe cases of GD, the cutoff point is ten for both sexes (Se: 83.0%, Sp: 56.7% for men; Se: 80.0%, Sp: 77.4% for women). These cutoff values are validated by evidence of worse psychopathological states, more dysfunctional personality traits, and risky behaviours commonly associated with GD. Discussion and Conclusions: These findings support adjusting the reference values for the SOGS to eight in males and seven in females to enhance the classification of individuals potentially experiencing GD. The use of higher cutoff values has significant implications for clinical and research purposes, enabling a more precise assessment of the diagnosis and severity of GD.

Efficacy of Social Norm Interventions on Addictive Behaviours-A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Mental health-related behaviours including addictive behaviours contribute significantly to the global burden of disease. Social norm interventions appear to be a cost-effective means of reducing addictive behaviour. We conducted a systematic review and meta-analysis of the efficacy of social norm interventions for addictive behaviours. We searched the databases Medline and PsycInfo from inception to April 2024 as well as reference lists of eligible studies and related systematic reviews for randomised controlled trials (RCTs) comparing the efficacy of social norm interventions for addictive behaviours to control conditions. Out of the 11,515 potentially eligible RCTs, 52 trials with a total of 31,764 adult participants met inclusion criteria, with 45 trials targeting alcohol consumption, three trials targeting Marijuana use, two trials targeting other substance abuse and two trials targeting gambling. Overall, 37 trials were included in the random-effects meta-analysis. The comparison of social norm interventions to control conditions at posttreatment showed a small but statistically significant effect (g = -0.12; 95% CI = -0.22 to -0.02; p < 0.01). Risk of bias was rated low in 37 RCTs, 14 RCTs were rated as having some risk of bias concerns and one RCT was rated as having high risk of bias. Social norm interventions can be an effective intervention method for reducing substance abuse and gambling. Yet, data is largely derived from studies targeting alcohol consumption and current trials suffer from methodological and practical limitations. The small effect sizes need to be appraised in the context of cost-effectiveness of these interventions.

Gambling disorder gender analysis: social strain, gender norms, and self-control as risk factors.

Introduction: Gender differences in problem gambling have attracted much attention in recent gambling literature. However, relatively little is known about how gender norms relate to social strain and self-control in predicting gambling disorder within a spousal context. This study aimed to increase knowledge about gambling disorder in Chinese married couples by assessing the three-way interaction effects between social strain, self-control, and gender norms. Methods: A total of 1,620 Chinese married couples were recruited from a representative sample of households in Hong Kong. Results: The results of the generalized ordered logit model revealed the self-control mitigation effect of composite strain on the propensity for gambling disorder is strong in men who accept traditional gender norms. In contrast, in women who accept traditional gender roles, self-control attenuates the effect of recent stressful life events on the propensity for gambling disorder, but self-control exacerbates the effect of negative relationships with offspring on the propensity for gambling disorder. Discussion: Although reinforcing self-control is a protective factor that can alleviate social strain and disordered gambling for both men and women, the prominent contribution of gender norms to the self-control exacerbation effect deserves close attention for social workers who provide services to these gambling families.

Why You Gamble Matters: A Systematic Review and Meta-analysis of the Association Between Gambling Motivation and Problem Gambling.

The propensity for individuals to experience problem gambling (PG) varies depending on their motivation to gamble. The present meta-analysis assessed the effect sizes associated with various gambling motives identified in representative population samples. Studies were sourced through PsycINFO, PudMed, and databases maintained by the Alberta Gambling Research Institute and the Greo Evidence Insights. Quantitative studies and technical studies were included if they reported on gambling motivation as a correlate of PG; were published in English, French, or Spanish; used valid and reliable measures PG as an outcome variable; and targeted the general adult population. A random effects meta-analysis was conducted to estimate pooled odds ratios. A total of 26 studies were included from 17 jurisdictions, with most studies conducted in Canadian provinces (k = 17) or specific states of the United States (k = 7). Number of participants varied, depending on the gambling motivation analyzed, and ranged from 2,835 to 51,685. Fourteen unique motives were identified with odds ratios ranging from 0.53 (95% CI, 0.45, 0.63) for gambling for charity to 6.20 (95% CI, 3.83, 10.05) for the motive "to be alone", with high study heterogeneity being observed for many gambling motives, given variability in important study characteristics. The results generally indicate that coping motives were associated with large effect sizes, enhancement motives with medium effect sizes, and all other motives with small or nil effects. Coping motives are on par with other strong risk factors such as participation in online gambling or electronic gaming machines, and are therefore important elements to consider when screening for PG or designing public health messages.

Mediating Effect of Perceived Personal Luck in the Relationship Between Narcissism and Problem Gambling in Strategic Gamblers: An Exploratory Study.

Gambling is becoming increasingly frequent among the French population, which has led to an increased number of individuals exhibiting problematic gambling patterns. Studies have found links between narcissism and cognitive distortions in relation to problem gambling, specifically among strategic gamblers, but none has tested perceived personal luck as one type of cognitive distortion in this regard. This study's purpose was to explore the relationship between narcissism, perceived personal luck and problem gambling among strategic gamblers, and to test for the mediating role of perceived personal luck in the relationship between narcissism and problem gambling. A total of 88 regular strategic gamblers were included (mean age = 37.8), with 49 non-problematic gamblers and 39 problematic gamblers. Participants completed the Problematic Gambling Severity Index, the Narcissistic Personality Inventory, and the Personal Luck Usage Scale. Results showed a significant relationship between narcissism and problem gambling, but no significant link between perceived personal luck and problem gambling and no significant mediation effect of perceived personal luck. These results may indicate a strong perception of personal skills compared to a weak perception of personal luck among problem gamblers of strategic games. This study emphasizes the importance of addressing types of gambling and types of cognitive distortions when investigating problem gambling.

Engagement in New Gambling Practices and its Association with Gambling Disorder, Impulsivity, and Cognitive Distortions: Findings from a Nationally Representative Sample of Spanish Gamblers.

Most epidemiological surveys focus on adult gambling behaviors related to traditional gambling forms, while studies on novel forms often focus on loot boxes and cryptocurrency trading individually. This study examines the co-ocurrence of emergent gambling and gambling-like practices, analyzing the demographic and psychological characteristics of involved gamblers. A cross-sectional study surveyed 1429 Spanish individuals aged 18-65, using a web-based questionnaire. The survey assessed participation in 19 gambling (e.g., lotteries, sports betting) and gambling-like activities (e.g., trading of cryptocurrencies and other assets, buying loot-boxes), along with sociodemographic and substance use. Problem gambling (PGSI), Impulsivity (UPPS-P), and cognitive distortions (Labrador's cognitive distortions scale) were also assessed. Participants who gambled over the past year (n = 921) were classified into four groups: traditional gambling (TG) only (64.5%, n = 594), TG with trading activities (27.5%, n = 253), TG with gambling withing video games or streaming platforms (2.5%, n = 23), and TG with both trading and video gambling (5.5%, n = 51). Most gamblers engaged exclusively in traditional formats, but 35.5% also participated in novel gambling forms. Those involved in both trading and video gambling were generally younger, male, with higher levels of impulsivity and gambling-related cognitive distortions compared to TG-only gamblers (p < 0.001). This group also exhibited higher rates of problem gambling and substance use (p < 0.001). This study emphasize the importance of including emerging gambling activities, which are particularly prevalent among high-risk gamblers, in epidemiological surveys. Identifying new gambling patterns and associated risk factors could help optimize public policies and develop more effective regulatory and prevention strategies.

Who is Getting the Message? Sociodemographic Factors and Gambling Behavior Associated with Awareness of the Swedish National Self-Exclusion Registry Spelpaus.se.

Awareness and utilization of health interventions can be influenced by sociodemographic factors. These factors play a role in information processing, particularly regarding health messaging. The aim of this study is to analyze how different sociodemographic factors and gambling behaviors are associated with awareness of a (Swedish) gambling self-exclusion register. The study used data from the Swedish longitudinal gambling study (Swelogs) and analyzed n = 6720 participants from a stratified random sample of the Swedish population aged 18-84 years. Logistic regressions were conducted to analyze associations between sociodemographic characteristics, gambling behavior and awareness. Males with middle (OR = 1.70, 95% CI = 1.32-2.19) and high income (OR = 1.58, 95% CI = 1.19-2.09) and females with high (OR = 1.35, 95% CI = 1.03-1.76) and middle-level education (OR = 1.35, CI = 1.04-1.76), had higher awareness of Spelpaus.se. Online gamblers with problematic gambling behavior were three times (OR = 3.69, 95% CI = 2.15-6.37) more likely to be aware than non-gamblers. Online gamblers born in Sweden were twice (OR = 1.95, 95% CI = 1.19-3.19) as likely to be aware compared to those born outside of Europe. Males with high level of awareness had higher PGSI scores compared to women. Education could increase awareness of potential health risks and opportunities for intervention, particularly among women. Future interventions should be tailored to cater to the specific needs of individuals with lower levels of awareness, to facilitate enhancing their awareness and ultimately promoting a more equitable utilization of self-exclusion measures.

Digitalisation of gambling harm? Gambling consumption, negative consequences, and clinical characteristics among Swedish help-seekers.

Gambling is connected to a range of harms and negative consequences. Gambling is also evolving at a fast pace, particularly in digital environments. Understanding the effects of this on-going change and digitalisation of gambling markets requires systematic measuring of gambling consumption patterns, clinical characteristics, and gambling-related harms. The current study compares two cohorts of help-seekers for gambling in Sweden (2019; 2023), recruited via the Swedish national helpline. The aim is to assess harms and consumption across the two cohorts at a time of increased offer of digital gambling in Sweden. We used eight different screens to measure gambling-related behaviours and consequences, including the Gambling Disorder Identification Test (GDIT). Results were analysed using descriptive statistics, and differences across the two cohorts were tested for statistical significance. The results show that across 2019-2023, gambling consumption has intensified. Online EGMs are by far the most prevalent form of gambling among help-seekers. We also found that the experience of co-morbidities as well as most gambling-related harms were common in both cohorts, with some statistically significant increases in 2023. Harms were more commonly experienced amongst those who engaged in online EGM gambling in comparison to those who did not. The results suggest that the digitalisation of gambling and gambling products appears to be associated with a variety of harmful consequences. The results also show the importance of systematic and comprehensive measurement to capture different severity levels of harms and their wide range amongst those who gamble.

Spanish Validation of the Brief Pornography Screen Within a Clinical Sample of Individuals with Gambling Disorder.

Problematic pornography use (PPU) shares characteristics with behavioral addictions, such as gambling disorder (GD), and PPU and GD may frequently co-occur. In order to fill existing gaps in screening instruments for PPU validated in GD, the study examined the psychometric properties of the Spanish version of the Brief Pornography Screen (BPS) within a clinical sample of individuals with GD. A total of 200 individuals seeking treatment for GD were consecutively recruited. The psychometric properties of the BPS were examined by performing confirmatory factor analysis (CFA) and testing for evidence of convergent and discriminant validity. The CFA supported a one-factor solution showing high internal consistency (α = 0.81). The BPS showed convergent validity and correlated with psychological distress, general psychopathology, impulsive tendencies, and low self-directedness. The BPS demonstrated adequate psychometric properties and is therefore recommended as a brief screening tool for identifying probable PPU in individuals seeking treatment for GD.

Trends in Lower-Risk Gambling by Age and Net Income among Finnish Men and Women in 2011, 2015, and 2019.

Lower-risk Gambling Guidelines (LRGGs) were developed in Canada to reduce the risk of gambling-related harm. The LRGGs, published in 2021, consist of three limits: gamble no more than 1% of household income per month; gamble no more than four days per month; and avoid regularly gambling at more than two types of games. All three limits should be followed at the same time. This study focuses on the situation in Finland before the LRGGs were published. The aim of this study is to investigate trends in lower-risk gambling by age and net income among men and women in the Finnish adult population in 2011, 2015, and 2019. Data were drawn from cross-sectional Finnish Gambling population surveys, including permanent residents in Mainland Finland aged 15-74 with Finnish, Swedish or Sámi as their mother tongue (2011; n = 4,484, 2015; n = 4,515, and 2019; n = 3,994). The results showed an increase in the prevalence of lower-risk gambling, rising from 29% in 2011 to 39% in 2019. This upward trend was observed among both men and women, with the prevalence among men increasing from 23 to 33%, and among women from 34 to 45%. The lowest prevalence of lower-risk gambling was found among individuals aged 60-74, especially regarding expenditure guidelines, as well as among women in the lowest income tertile. In conclusion, although the prevalence of lower-risk gambling has increased in Finland, there is still potential for further improvement to minimize harm.

Spatio-temporal EEG dynamics during decision-making in online poker players with problem gambling.

Background and aims: Gambling activity evolves along a continuum from recreational to Gambling Disorder (GD) and a particular challenge is to identify whether there are some neurophysiological particularities already present in gamblers at an early stage. Our main goal was to determine whether, in the gamblers' population, neural responses generated during uncertain decisions were different depending on problematic gambling risk defined by the Canadian Problem Gambling Index (CPGI). We tested the following hypothesis, that the Problem Gambling group would show a different brain activity related to outcomes processing than people with low risk. Methods: For this purpose, we established a relatively homogeneous population of Online Poker Players divided into two groups according to the CPGI (Low Risk and Problem Gambling). By means of high-density EEG, we compared the spatio-temporal dynamics generated during the completion of the Iowa Gambling Task. Results: One specific topographic map was observed between 150-175 ms after a negative outcome for both groups, whereas it was displayed in the win condition only for the Problem Gambling group. We found that the Global Field Power of this map was negatively correlated with participants' adherence to a strategy. Source localization identified Anterior Cingulate Cortex and Temporal regions as generators of this map. Discussion and conclusions: Reward hypersensitivity EEG responses identified in the early outcome process could constitute a potential biomarker of problematic gambling.

Gender Differences in Gambling Disorder: Results from an Italian Multicentric Study.

Objective: Although gender-specific evidence on Gambling Disorder (GD) is still limited, some studies reported specific differences, mainly in psychopathological profiles, gambling behavior patterns, and pathogenesis. In order to further examine the role of gender in GD, we conducted a multicenter investigation in a sample of Italian outpatients. Method: One hundred-four outpatients with a diagnosis of GD based on DSM-5 criteria were consecutively recruited at two clinics based in Milan. Socio-demographic and clinical variables were collected for the whole sample and analyzed for the effect of gender. The severity of illness was assessed using the Canadian Problem Gambling Index and the Gambling Attitudes and Beliefs (GABS). Results: Among females, a significantly higher mean age (52.23 ± 10.95 vs. 40.96 ± 15.76; p=0.005) and older age at illness onset emerged (43.5 ± 11.92 vs. 29.22 ± 14.26; p<0.001). Females showed a significantly higher rate of psychiatric comorbidities, lifetime suicide ideation, stressful events at GD onset, and positive family history for GD compared to males. A predictive effect of male gender was found for the GABS questionnaires by performing a linear regression model, with males showing a higher risk to reach higher scores compared to females (B= 11.833; t=2.177; p=0.034). Conclusions: Our study seems to confirm the hypotheses that gender in GD may influence psychopathological profiles, course, and comorbidity. GD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to males. Identifying specific clinical factors by gender may prompt more focus on the public health of women in relation to gambling, while still recognizing that males are at-risk of earlier gambling problems. These findings should be considered in therapeutic perspectives.

Prevalence of schizophrenia spectrum and other psychotic disorders in problem gambling: A systematic review and meta-analysis.

BACKGROUND: High rates of psychiatric comorbidities have been found in people with problem gambling (PBG), including substance use, anxiety, and mood disorders. Psychotic disorders have received less attention, although this comorbidity is expected to have a significant impact on the course, consequences, and treatment of PBG. This review aimed to estimate the prevalence of psychotic disorders in PBG. METHODS: Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of Science, and ProQuest were searched on November 1, 2023, without language restrictions. Studies involving people with PBG and reporting the prevalence of schizophrenia spectrum and other psychotic disorders were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for systematic reviews of prevalence data. The pooled prevalence of psychotic disorders was calculated using a random effects generalized linear mixed model and presented with forest plots. RESULTS: Of 1,271 records screened, 22 studies (n = 19,131) were included. The overall prevalence of psychotic disorders was 4.9% (95% CI, 3.6-6.5%, I2 = 88%). A lower prevalence was found in surveyed/recruited populations, compared with treatment-seeking individuals and register-based studies. No differences were found for factors such as treatment setting (inpatient/outpatient), diagnoses of psychotic disorders (schizophrenia only/other psychotic disorders), and assessment time frame (current/lifetime). The majority of included studies had a moderate risk of bias. CONCLUSIONS: These findings highlight the relevance of screening problem gamblers for schizophrenia spectrum and other psychotic disorders, as well as any other comorbid mental health conditions, given the significant impact such comorbidities can have on the recovery process.

Emotional Working Memory Training Treatment for Young Adult Problem Online Sports Bettors: A Preliminary Randomized Controlled Trial.

One of the key features of gambling disorder (GD) is impairment in cognitive-emotional control. Considering the negative consequences of GD, the present study investigated the effectiveness of emotional working memory training (eWMT) in improving cognitive control, attention, working memory capacity, and cognitive emotion regulation strategies (CERS) among young adults with GD compared to a placebo group. Following the initial assessment in the pre-test phase, eligible participants were randomly assigned to one of two groups: experimental (n = 34) and placebo (n = 30). These groups completed eWMT and a feature matching task for 20 sessions respectively. The post-test and follow-up measures indicated that eWMT significantly improved cognitive control, attention, working memory capacity, and the use of maladaptive cognitive emotion regulation strategies, but it had no significant effect on adaptive CERS. The promising results of the present study suggest the use of eWMT as a new intervention to improve cognitive-emotional control among individuals with online gambling problems.

Gaming Disorders: Navigating the Fine Line between Entertainment and Addiction-Gaming History, Health Risks, Social Consequences, and Pathways to Prevention.

The number of people immersed in excessive gaming has increased in this age of rapid digitalization. The World Health Organization and American Psychiatric Association Organization recognize a gaming disorder as a condition that results in significant problems in daily life as a result of excessive gaming. Both organizations emphasize the similarities to behavioral addictions such as gambling. We examined the appropriate usage of video games from the perspectives of health and management in this study. For the general population, video games provide positive impacts such as stress alleviation and memory improvement. Game playing leads to a loss of time and money for the individual. It also has a negative impact on the individual's family and social life, evolving into a social problem. Gaming addiction is often accompanied by psychological disorders and other addictions, and long-term medical treatment, including approaches to the individual's psychological background and cognitive-behavioral therapy, is necessary. Therefore, the prevention of gaming disorder is essential. From a societal standpoint, action is required in three contexts: the government, game developers, and within the household as a whole. Simultaneously, the public needs to understand the positive potential of gaming, such as e-sports.

Dopamine mediates a directionally opposite correlation between empathy and the reinforcing effects of amphetamine and gambling in people with gambling disorder vs. healthy controls.

Understanding the relationship between empathy, subjective effects of addictive reinforcers and dopamine function in people with gambling disorder (PGD) vs. healthy controls (HCs) may inform GD treatment. The current investigation addressed this issue via retrospective analysis of data from three studies using amphetamine and a slot machine (SLOTS) as reinforcers in PGD and HCs. The Empathy scale of Eysenck's Impulsiveness Questionnaire assessed trait Empathy. The Gamblers Beliefs Questionnaire assessed cognitive distortions. The Eysenck Lie scale assessed socially desirable responding. PET scans quantified dopamine receptor expression and amphetamine-induced dopamine release in Study 1. Pre-treatment with the D2-receptor (D2R)-preferring antagonist, haloperidol or D1R-D2R antagonist, fluphenazine before SLOTS tested the role of D2 autoreceptors and post-synaptic D2R in Study 2. Pre-treatment with the multi-system indirect dopamine agonist, modafinil before SLOTS assessed the reliability of correlations in PGD. Striatal D2R expression predicted greater Empathy and lower amphetamine 'Liking' in HCs, and predicted greater symptom severity in PGD. Empathy predicted lower 'Exciting' effects of SLOTS under placebo in HCs; no correlation emerged under either antagonist. Relative to placebo, haloperidol decreased, whereas fluphenazine increased, the positive correlation between Empathy and Exciting effects of SLOTS in PGD. Modafinil markedly reduced the positive correlation between Empathy and Exciting effects of SLOTS seen under placebo in PGD. Empathy predicted greater cognitive distortions in PGD in all studies. Lie scale variance influenced several primary effects. Prior research linking the insula with Empathy, reactivity to interoceptive signals for risky rewards (uncertainty), and cognitive distortions, provides a parsimonious account for these results.

The influence of age on gambling problems worldwide: A systematic review and meta-analysis of risk among younger, middle-aged, and older adults.

Background and Aims: Problem gambling (PG) represents a significant public health concern with widespread effects in various cultures and regions globally, with younger individuals and males at a particularly higher risk. This disparity is attributed to a mix of cultural, developmental, and biological influences. To date, there has not been a comprehensive examination to determine whether this risk pattern holds consistently across different jurisdictions. Methods: We performed a systematic review and meta-analysis using the PRISMA framework, identifying 21 eligible studies from 18 countries, encompassing 156,249 participants (47.6% male and 52.4% female). Results: The studies varied considerably by region (Asia: 19%, Europe: 52%, Oceania: 19%, North America: 10%), the diagnostic criteria for PG, and participation rates in gambling (ranging from 12% to 92%). Data on PG prevalence was categorised by gender and three age groups (young: 18-35, middle: 30-55, and older: 45-65). Using a random-effects meta-analysis, we found a global PG prevalence of 1.9%. Europe reported a significantly lower prevalence (1.3%) compared to North America (5.3%). Men were found to be 3.4 times more likely than women to engage in problem gambling, although the gap narrows in North America. The young demographic showed a 1.51 times higher likelihood of reporting PG compared to the middle-aged group, whereas older adults were 0.80 times less likely to report PG. Notably, age-related effects varied significantly across regions. Conclusions: Our findings confirm that age and gender significantly influence PG risk across cultures, with significant heterogeneity observed across jurisdictions.

Unemployment as a risk factor for gambling disorder: A longitudinal study based on national registry data.

Background and aims: Unemployment rates are elevated among individuals with disordered gambling, yet the directionality of the relationship remains unclear. The present study investigated paid and unpaid unemployment as risk factors for future gambling disorder (GD). Methods: The study employed a case-control design, including all adult Norwegians receiving a GD diagnosis within specialist health services from January 2008 to December 2018 (n = 5,131). These individuals were compared with age- and sex-matched controls from the general population (n = 30,164), as well as controls with somatic and psychiatric diagnoses (n = 30,476). Results: Logistic regressions showed that those in the highest quartile of unpaid unemployment days had more than double the odds (odds ratio [OR] 2.23 (95% CI [1.96, 2.52]) of developing GD compared to those with no unpaid unemployment days. Similarly, higher levels of paid unemployment were also found to increase the odds for GD, with those in the highest quartile having an OR of 1.86 (95% CI [1.50, 2.28]) compared to those with no paid unemployment days. Moreover, an interaction analysis indicated that the association between paid unemployment days and GD was significantly stronger among men compared to women. Conclusions: The present study suggests that both paid and unpaid unemployment constitute risk factors for GD. Programs aiming at obtaining and sustaining work have been found to improve health and future studies should examine if the risk for GD can be similarly mitigated.

The effects of threat on complex decision-making: evidence from a virtual environment.

Individuals living and working in dangerous settings (e.g., first responders and military personnel) make complex decisions amidst serious threats. However, controlled studies on decision-making under threat are limited given obvious ethical concerns. Here, we embed a complex decision-making task within a threatening, immersive virtual environment. Based on the Iowa Gambling Task (IGT), a paradigm widely used to study complex decision-making, the task requires participants to make a series of choices to escape a collapsing building. In Study 1 we demonstrate that, as with the traditional IGT, participants learn to make advantageous decisions over time and that their behavioural data can be described by reinforcement-learning based computational models. In Study 2 we created threatening and neutral versions of the environment. In the threat condition, participants performed worse, taking longer to improve from baseline and scoring lower through the final trials. Computational modelling further revealed that participants in the threat condition were more responsive to short term rewards and less likely to perseverate on a given choice. These findings suggest that when threat is integral to decision-making, individuals make more erratic choices and focus on short term gains. They furthermore demonstrate the utility of virtual environments for making threat integral to cognitive tasks.