Suicidality among individuals with gambling problems: A meta-analytic literature review.

Gambling problems have consistently been linked to suicidality, including suicidal ideation, attempts, and suicide. However, the magnitude of the relationship has varied significantly across studies and the potential causal link between gambling problems and suicidality is currently unclear. A meta-analytic literature review was conducted to (a) synthesize pooled prevalence rates of suicidality among individuals with gambling problems; (b) determine if individuals with gambling problems had an increased likelihood of reporting suicidality compared to individuals without gambling problems; and (c) review evidence on causality and directionality. A search in Web of Science, APA PsycInfo, APA PsycNet, Medline, CINAHL, ProQuest, Embase, and Google Scholar electronic databases identified 107 unique studies (N = 4,691,899) that were included for review. Studies were included if they were available in any European language and provided sufficient data for the calculation of prevalence rates or effect sizes. Two researchers extracted the data independently using a predefined coding schema that included the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analyses yielded pooled prevalence rates of 31.6% (95% CI [29.1%, 34.3%]) for lifetime suicidal ideation and 13.2% (95% CI [11.3%, 15.5%]) for lifetime suicide attempts. Individuals with gambling problems had significantly increased odds of reporting lifetime suicidal ideation (OR = 2.17, 95% CI [1.90, 2.48]) and lifetime suicide attempts (OR = 2.81, 95% CI [2.23, 3.54]) compared to individuals without gambling problems. Two studies reported that individuals with pathological gambling had an increased risk of dying by suicide. Metaregression analyses suggested that the risk of study bias was positively related to the prevalence rates of suicidal ideation. Sex proportions were found to moderate the odds of suicidal ideation, but the direction of the effect was inconsistent. For suicide attempts, psychiatric comorbidity and sample size were positively and inversely, respectively, associated with prevalence rates. The synthesis indicates that suicidality is common among individuals with gambling problems and hence should be addressed by help agencies. Inferences on causality and directionality are hampered by a lack of longitudinal studies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Plasma concentration of leptin is related to food addiction in gambling disorder: Clinical and neuropsychological implications.

Background: Data implicate overlaps in neurobiological pathways involved in appetite regulation and addictive disorders. Despite different neuroendocrine measures having been associated with both gambling disorder (GD) and food addiction (FA), how appetite-regulating hormones may relate to the co-occurrence of both entities remain incompletely understood. Aims: To compare plasma concentrations of ghrelin, leptin, adiponectin, and liver-expressed antimicrobial peptide 2 (LEAP-2) between patients with GD, with and without FA, and to explore the association between circulating hormonal concentrations and neuropsychological and clinical features in individuals with GD and FA. Methods: The sample included 297 patients diagnosed with GD (93.6% males). None of the patients with GD had lifetime diagnosis of an eating disorder. FA was evaluated with the Yale Food Addiction Scale 2.0. All patients were assessed through a semi-structured clinical interview and a psychometric battery including neuropsychological tasks. Blood samples to measure hormonal variables and anthropometric variables were also collected. Results: From the total sample, FA was observed in 23 participants (FA+) (7.7% of the sample, 87% males). When compared participants with and without FA, those with FA+ presented both higher body mass index (BMI) (p < 0.001) and leptin concentrations, after adjusting for BMI (p = 0.013). In patients with FA, leptin concentrations positively correlated with impulsivity, poorer cognitive flexibility, and poorer inhibitory control. Other endocrine measures did not differ between groups. Discussion and conclusions: The present study implicates leptin in co-occurring GD and FA. Among these patients, leptin concentration has been associated with clinical and neuropsychological features, such as impulsivity and cognitive performance in certain domains.

Marco conceptual del juego de apuestas y sus daños asociados / Conceptual framework of gambling and gambling-related harms

El juego de apuestas es una actividad de ocio legítima en muchos países, la cual muchas personas utilizan. Sin embargo, algunas de ellas experimentan daños significativos como resultado de estos juegos de apuestas. Estos daños, que pueden ser de carácter económico, social o de salud física y mental, no solo los sufre el individuo que juega, sino que afectan a la familia, a la comunidad y a toda la sociedad. El objetivo de este texto es proponer un marco conceptual para comprender los determinantes del juego de apuestas y sus daños asociados, que ayude a desarrollar políticas de prevención para reducir su impacto en la salud. El marco planteado en este manuscrito sitúa la evidencia actual en el modelo de desigualdades en salud y analiza la importancia del contexto socioeconómico y político, de los ejes de desigualdad, de los factores individuales y sociales, y del sistema sanitario en la desigualdad en salud asociada al juego de apuestas que sufren los grupos más vulnerables. La evidencia que se recoge en este marco sugiere que los determinantes de salud conllevan a una desigualdad en salud en relación con los juegos de apuestas y sus daños asociados.(AU)

Gambling is a legitimate leisure activity in many countries that many people use. However, some of them suffer significant harm because of gambling. This may involve economic, social, physical or mental harm. These harms are not only suffered by the individual gambler, but affect the family, the community and society. The aim of this text is to propose a conceptual framework for understanding the determinants of gambling and its related harms and thus, contribute to the development of prevention policies to reduce its impact on health. The framework proposed in this manuscript places present evidence in the model of health inequalities, analyzing the effect of the socioeconomic and political context, the axes of inequalities, individual and social factors, and the health system in generating the health inequalities of gambling suffered by the most vulnerable groups. The evidence gathered in this framework suggests that health determinants lead to health inequality in relation to gambling and its associated harms.(AU)

Longitudinal associations between psychiatric comorbidity and the severity of gambling disorder: Results from a 36-month follow-up study of clients in Bavarian outpatient addiction care.

Background and aims: Individuals with gambling disorder (GD) often suffer from psychiatric comorbidities. Previous studies demonstrated greater severity of GD among gamblers with psychiatric comorbidities. However, evidence on the association between psychiatric comorbidity and course of GD severity during and after outpatient treatment is sparse. This study analyses data from a longitudinal one-armed cohort study on outpatient addiction care clients over three years. Methods: We investigated the course of GD severity using data from 123 clients in 28 outpatient addiction care facilities in Bavaria using generalized estimation equations (GEE). We applied time* interaction analyses to examine different development profiles in participants with and without (1) affective disorders, or (2) anxiety disorders, and (3) to account for the co-occurrence of both. Results: All participants benefitted from outpatient gambling treatment. Improvement in GD severity was poorer in participants with anxiety disorders compared to participants without anxiety disorders. The co-occurrence of affective and anxiety disorders was linked to a less favourable course of GD than the presence of affective disorders alone. However, the combined occurrence of both disorders was more favourable than the presence of anxiety disorders alone. Discussion and conclusions: Our study suggests that clients with GD, with and without psychiatric comorbidities, benefit from outpatient gambling care. Psychiatric comorbidity, especially comorbid anxiety disorders, seems to be negatively associated with the course of GD within outpatient gambling care. Addressing psychiatric comorbidity within the treatment of GD and offering individualised help are required to meet the needs of this clientele.

Relationship of gambling disorder with traumatic life events and emotion regulation in adolescents and young adults.

Introduction: Traumatic life events (TLE) and difficulties in emotion regulation (ER) can be considered risk factors for the development of gambling disorder in adolescents and young adults. Methods: The aim of the present study was to examine the differences in TLE, ER strategies, positive and negative affect, and gambling severity in a clinical sample of individuals undergoing treatment for gambling disorder (92.8% males; Mage = 24.83, SD = 3.80) and a healthy control group (52.4% males; Mage = 15.65, SD = 2.22). The relationship between the variables was assessed and the mediating role of ER in the relationship between TLE and gambling in the clinical sample was analysed. Results: The results showed higher scores in gambling severity, positive and negative affect, ER strategies and TLE in the clinical sample. In addition, the severity of gambling was positively correlated with TLE, negative affect and with rumination. TLE were also correlated positively with negative and positive affect, rumination ER strategies, plan focus, positive reinterpretation, and catastrophizing. Finally, rumination mediated the relationship between TLE and gambling severity. Conclusions: These findings may have relevant implications for the prevention, understanding and treatment of gambling disorder.

Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review.

Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce.Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD.Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted.Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD.Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation.HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD).There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans.Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.

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

BACKGROUND: The limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches. METHODS: This is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients' medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population. DISCUSSION: A better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians' and researchers' awareness and serve as the basis to adapted treatments that will better support recovery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

Adult ADHD Diagnosis, Symptoms of Impulsivity, and Emotional Dysregulation in a Clinical Sample of Outpatients Consulting for a Behavioral Addiction.

OBJECTIVE: This study aimed to investigate ADHD in adult outpatients seeking treatment for a behavioral addiction and to identify the specificity of psychopathological features if the behavioral addiction cooccurs with adult ADHD. METHOD: Sixty-five outpatients consulting for a behavioral addiction were assessed for ADHD (DIVA-5), addictive disorder (alcohol, tobacco, cannabis, gambling, gaming, food, and sex), impulsivity (UPPS-P), and emotion dysregulation (DERS-36). RESULTS: In our sample of outpatients seeking treatment for a behavioral addiction, adult ADHD was independently associated with higher compulsive sexual behavior disorder severity, "sensation seeking," "positive urgency," difficulties in "goal-directed behavior," "impulse control," and use of "emotion regulation strategies" in the context of intense emotions. A 29% of the sample was diagnosed for adult ADHD. CONCLUSION: The association of adult ADHD with specific dimensions of impulsivity and emotion dysregulation, pave the way for future clinical and research perspectives.

Juegos de azar en adolescentes y jóvenes de la Comarca del Río Mula, Región de Murcia / Gambling in adolescents and young persons from the Comarca del Río Mula, Region of Murcia

Objetivo: determinar la prevalencia de uso de juegos de azar y apuestas de jóvenes y adolescentes matriculados en centros públicos en la Comarca del Río Mula de la Región de Murcia, España. Método: estudio descriptivo transversal realizado entre octubre y noviembre de 2020. La población de estudio la conformaron 494 estudiantes de dos institutos públicos (de 13 a 25 años). Se midieron variables sociodemográficas, académicas, de consumo de sustancias, juegos de azar utilizados, motivos de juego [cuestionario GMQ (emociones positivas, afrontamiento del estrés, causa social)] y problemas de juego [escala SOGS-RA (no jugador o no problemático; jugador de riesgo; problema de juego)]. Se realizaron análisis descriptivo y bivariante. Resultados: participaron 147 estudiantes (65,3% mujeres; 82,3% de 13 a 18 años). El 37,7% había jugado alguna vez; los juegos más frecuentes fueron loterías, quinielas y rascas (32,7%), bingo (19,7%). El juego en línea fue ≤ 3,4%. El motivo de juego con mayor media fue la búsqueda de emociones positivas (= 5,48 sobre 15 puntos). Según la escala SOGS-RA un 3,4% era jugador de riesgo y un 2,1% tenía problemas de juego. Se encontró una proporción superior de problemas o riesgo de problemas con el juego en hombres y en quienes consumían sustancias recreativas. Conclusión: un alto porcentaje de adolescentes y jóvenes se han iniciado en el juego, una parte de los cuales están en riesgo o han desarrollado un problema de adicción. El juego es accesible a pesar de la prohibición legal. Es necesaria la actuación sobre estos problemas.(AU)

Objective: to determine the prevalence of gambling and betting activities among young persons and adolescents enrolled in public centres from the Comarca del Río Mula of the Region of Murcia, Spain. Method: a descriptive cross-sectional study conducted between October and November 2020. The study population consisted of 494 students from public secondary schools (13 to 25 years old). Sociodemographic and academic variables were measured, as well as substance use, games of chance used, reasons for gambling [GMQ questionnaire (positive emotions, coping with stress, social causes)] and gambling problems [SOGS-RA scale (not gamblers or non-problem; at risk; gambling problem)]. Descriptive and bivariate analyses were conducted. Results: the study included 147 students (65.3% female; 82.3% from 13 to 18 years old). Of these, 37.7% had gambled at some point; the most frequent games were lotteries, betting games and scratch cards (32.7%), and bingo (19.7%). Online gambling was ≤ 3.4%. The reason for gambling with the highest mean value was the search for positive emotions (= 5.48 over 15 scores). According to the SOGS-RA scale, 3.4% were gamblers at risk and 2.1% had gambling problems. A higher proportion of problems or risk of problems with gambling was found in men and in those using recreational substances. Conclusion: a high proportion of adolescents and young persons have started gambling, and part of them are at risk or have developed a gambling problem. There is access to gambling regardless of the legal prohibition. It is necessary to act upon these problems.(AU)

Risk Factors for Excessive Social Media Use Differ from Those of Gambling and Gaming in Finnish Youth.

PURPOSE: Adolescents' excessive social media use has characteristics similar to other addictive behaviours. This study aims to explore whether the same risk factors are associated with excessive social media use as with excessive gaming and gambling among Finnish adolescents. METHODS: Multinomial logistic regression analyses were carried out using the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15-16 in 2019 (n = 4595). RESULTS: Excessive use of social media was more common among girls (reported by 46% of respondents) than boys of the same age (28%), whereas boys reported both excessive gaming (23%) and gambling (6%) more often than girls (4% and 1%, respectively). All differences between genders were statistically significant (p < 0.0001). Daily smoking was associated with a high risk of excessive gambling (AOR = 3.23) and low risk of excessive gaming (AOR = 0.27) but had no significant effect on excessive social media use. Cannabis use in the past 12 months was positively associated only with excessive gambling (AOR = 2.39), while past 12 months alcohol consumption increased the risk for excessive social media use (AOR = 1.25). CONCLUSIONS: Adolescent girls are at greater risk of excessive social media use than boys, while boys are at greater risk of excessive gaming and gambling. The associations with known risk factors are somewhat different for excessive use of social media as compared to excessive gambling and gaming and should be acknowledged when developing preventive measures for adolescents.

Computational basis of decision-making impairment in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is commonly associated with decision-making, neurocognitive impairments, and mood and motivational symptoms. However, their relationship may be obscured by traditional scoring methods. OBJECTIVES: To study the computational basis underlying decision-making impairments in MS and their interaction with neurocognitive and neuropsychiatric measures. METHODS: Twenty-nine MS patients and 26 matched control subjects completed a computer version of the Iowa Gambling Task (IGT). Participants underwent neurocognitive evaluation using an expanded version of the Brief Repeatable Battery. Hierarchical Bayesian Analysis was used to estimate three established computational models to compare parameters between groups. RESULTS: Patients showed increased learning rate and reduced loss-aversion during decision-making relative to control subjects. These alterations were associated with: (1) reduced net gains in the IGT; (2) processing speed, executive functioning and memory impairments; and (3) higher levels of depression and current apathy. CONCLUSION: Decision-making deficits in MS patients could be described by the interplay between latent computational processes, neurocognitive impairments, and mood/motivational symptoms.

Transdiagnostic Perspective of Impulsivity and Compulsivity in Obesity: From Cognitive Profile to Self-Reported Dimensions in Clinical Samples with and without Diabetes.

Impulsive and compulsive behaviors have both been observed in individuals with obesity. The co-occurrence of obesity and type 2 diabetes (T2D) is more strongly associated with impulsivity, although there are no conclusive results yet. A multidimensional assessment of impulsivity and compulsivity was conducted in individuals with obesity in the absence or presence of T2D, compared with healthy, normal-weight individuals, with highly impulsive patients (gambling disorders), and with highly compulsive patients (anorexia nervosa). Decision making and novelty seeking were used to measure impulsivity, and cognitive flexibility and harm avoidance were used for compulsivity. For impulsivity, patients with obesity and T2D showed poorer decision-making ability compared with healthy individuals. For compulsivity, individuals with only obesity presented less cognitive flexibility and high harm avoidance; these dimensions were not associated with obesity with T2D. This study contributes to the knowledge of the mechanisms associated with diabetes and its association with impulsive-compulsive behaviors, confirming the hypothesis that patients with obesity and T2D would be characterized by higher levels of impulsivity.

Association patterns of cannabis abuse and dependence with risk of problematic non-substance-related dysregulated and addictive behaviors.

Co-occurrence of drug misuse with other dysregulated behaviors is common. This study was aimed at exploring the associations between the risk of presenting a clinically relevant condition involving non-substance-related addictive or dysregulated behaviors (as measured by the MultiCAGE CAD-4 screening), and cannabis abuse/dependence (CAST/SDS) scores, and the role of gender therein. Participants were recruited using stratified probabilistic sampling at the University of Granada. Mann-Whitney's U tests were used to compare male and female students in SDS and CAST scores. Associations between gender and MultiCAGE scores were estimated using the γ ordinal correlation index, and tested with χ2. For each MultiCAGE dimension, a Poisson-family mixed-effects model was built with either SDS or CAST as the main input variable, while controlling for nicotine and alcohol dependence, and relevant sociodemographic variables. Incidence rate ratios (IRR) were computed for SDS/CAST effects, and the significance threshold was family-wise Bonferroni-corrected. Gender differences were significant for cannabis dependence/abuse and all MultiCAGE scores for non-substance-related conditions, with males showing higher risk scores for excessive gambling, excessive internet use, excessive video gaming, and hypersexuality, and females presenting higher scores in dysregulated eating and compulsive buying. Cannabis dependence and abuse were significantly associated with a higher risk of problematic video gaming. These associations were mostly driven by males. Importantly, although risk of problematic video gaming was specifically associated with cannabis abuse/dependence, there was only a weak non-significant association between problematic video gaming and alcohol use scores. Risk of alcohol use problems, in turn, was strongly associated with all other non-substance-related problems (problematic gambling, excessive Internet use, dysregulated eating, compulsive buying, and hypersexuality). These differential associations can cast light on the etiological similarities and dissimilarities between problematic substance use and putative addictive behaviors not involving drugs.

Gambling motives, problem gambling predictors and differences from problematic alcohol use / Motivos de juego, predictores del juego problemático y diferencias con el consumo problemático de alcohol

Despite the seriousness of problem gambling, its relationship with many factors has not yet been studied. This investigation sought, on the one hand, to verify the predictability of improvement over problem gambling, with irresponsible gambling being a mediator in this relationship. In addition, we sought to analyze whether predictors of problem gambling are related to problematic alcohol use. The sample consisted of 258 adults (59.5% women) with an average age of 20.95 years (SD = 2.19). Questionnaires were applied to measure gambling addiction, alcohol addiction, reasons for gambling, depression, coping with stress, prosocial behavior, and susceptibility to framing; and correlations, multiple linear regressions and a simple mediation model were analyzed. Results indicated on the one hand that 32.45% of variance in problem gambling is explained by reasons for gambling, with the maximum amount of money bet mediating this relation. On the other hand, an integrative model that explains 16.8% of problem gambling does not work for alcohol addiction. The results provide a new explanatory model of problem gambling and emphasize the need for interventions in problem gambling to be developed in accordance with the special characteristics of this addiction. These findings are relevant in the field of health psychology for their potential contribution to prevention and intervention programs. (AU)

A pesar de la gravedad del juego problemático, la relación que guarda con muchos factores todavía no ha sido estudiada. Esta investigación perseguía, por un lado, comprobar la capacidad predictora del motivo de mejora sobre el juego problemático, siendo el juego irresponsable un mediador en esta relación. Por otro lado, analizar si los factores predictores del juego problemático lo son del consumo problemático de alcohol. La muestra estuvo compuesta por 258 adultos (59.5% mujeres) con una edad media de 20.95 años (SD= 2.19). Se aplicaron cuestionarios para medir los problemas de juego, los problemas con el alcohol, los motivos para jugar, la depresión, el afrontamiento del estrés, la conducta prosocial y la susceptibilidad al efecto marco; y se analizaron las correlaciones, regresiones lineales múltiples y un modelo de mediación simple. Los resultados indican por un lado que el 32.45% de la varianza de los problemas con el juego es explicada por los motivos de juego, mediando la cantidad máxima de dinero apostado esta relación; por otro lado, un modelo integrador que explica el 16.8% de los problemas de juego, no funciona en la adicción al alcohol. Los resultados aportan un nuevo modelo explicativo del juego problemático y recalcan la necesidad de que la intervención en estos problemas se desarrolle atendiendo a las características propias de esta adicción. Estos hallazgos resultan de relevancia en el campo de la salud por su aportación a los programas de prevención e intervención. (AU)

Motivos de juego, predictores del juego problemático y diferencias con el consumo problemático de alcohol / Gambling motives, problem gambling predictors and differences from problematic alcohol use

A pesar de la gravedad del juego problemático, la relación que guarda con muchos factores todavía no ha sido estudiada. Esta investigación perseguía, por un lado, comprobar la capacidad predictora del motivo de mejora sobre el juego problemático, siendo el juego irresponsable un mediador en esta relación. Por otro lado, analizar si los factores predictores del juego problemático lo son del consumo problemático de alcohol. La muestra estuvo compuesta por 258 adultos (59.5% mujeres) con una edad media de 20.95 años (SD= 2.19). Se aplicaron cuestionarios para medir los problemas de juego, los problemas con el alcohol, los motivos para jugar, la depresión, el afrontamiento del estrés, la conducta prosocial y la susceptibilidad al efecto marco; y se analizaron las correlaciones, regresiones lineales múltiples y un modelo de mediación simple. Los resultados indican por un lado que el 32.45% de la varianza de los problemas con el juego es explicada por los motivos de juego, mediando la cantidad máxima de dinero apostado esta relación; por otro lado, un modelo integrador que explica el 16.8% de los problemas de juego, no funciona en la adicción al alcohol. Los resultados aportan un nuevo modelo explicativo del juego problemático y recalcan la necesidad de que la intervención en estos problemas se desarrolle atendiendo a las características propias de esta adicción. Estos hallazgos resultan de relevancia en el campo de la salud por su aportación a los programas de prevención e intervención. (AU)

Despite the seriousness of problem gambling, its relationship with many factors has not yet been studied. This investigation sought, on the one hand, to verify the predictability of improvement over problem gambling, with irresponsible gambling being a mediator in this relationship. In addition, we sought to analyze whether predictors of problem gambling are related to problematic alcohol use. The sample consisted of 258 adults (59.5% women) with an average age of 20.95 years (SD = 2.19). Questionnaires were applied to measure gambling addiction, alcohol addiction, reasons for gambling, depression, coping with stress, prosocial behavior, and susceptibility to framing; and correlations, multiple linear regressions and a simple mediation model were analyzed. Results indicated on the one hand that 32.45% of variance in problem gambling is explained by reasons for gambling, with the maximum amount of money bet mediating this relation. On the other hand, an integrative model that explains 16.8% of problem gambling does not work for alcohol addiction. The results provide a new explanatory model of problem gambling and emphasize the need for interventions in problem gambling to be developed in accordance with the special characteristics of this addiction. These findings are relevant in the field of health psychology for their potential contribution to prevention and intervention programs. (AU)

The societal costs of problem gambling in Sweden.

BACKGROUND: Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. METHODS: A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. RESULTS: The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. CONCLUSIONS: Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Suicidio y Juego Patológico: factores de riesgo y direcciones futuras / Suicide and Pathological Gambling: risk factors and future directions

El Juego Patológico o Ludopatía es considerado en la actualidad como un problema de salud pública. Entre las muchas consecuencias adversas potenciales de los juegos de azar, la más grave es el comportamiento suicida, ya que el 20% de los jugadores patológicos intentarán suicidarse durante su vida. El objetivo de este artículo es resaltar la importancia del suicidio en jugadores patológicos con el fin de hacer visible esta problemática. Para ello, se ha analizado la literatura actual que relaciona ambos aspectos extrayéndose la necesidad de analizar las patologías que concurren con el juego patológico como aspectos relevantes a la hora de predecir el suicidio. Además, el estrés financiero, la personalidad o el sexo serían aspectos que habría que tener en cuenta para hacer una prevención efectiva del mismo. Finalmente, se proponen unas direcciones futuras para su estudio y su tratamiento clínico

Pathological gambling is now considered a public health problem. Among the many potential adverse consequences of gambling, the most serious is suicidal behaviour, as 20% of pathological gamblers will attempt suicide during their lifetime. The aim of this article is to highlight the importance of suicide in pathological gambling to make this problem visible. For it, the current literature that relates both aspects have been analysed extracting the necessity to analyse the pathologies that concur with the pathological gambling like relevant aspects for suicide prevention. In addition, financial stress, personality, or sex would be aspects that should be considered to make an effective prevention. Finally, some future directions for its study and clinical treatment are proposed

Tilt in Online Poker: Loss of Control and Gambling Disorder.

Online poker is a form of gambling where an element of skill may influence the outcome of the game. 'Tilt' in poker describes an episode during which the player can no longer control their game by rational decisions. It leads to a loss of control over the game, a loss of emotional regulation, higher cognitive distortion, and a loss of money. This phenomenon, experienced by most players, could be the gateway to excessive gambling. The aim of this study was to assess the links between the frequency of tilt episodes, cognitive distortion, anxiety, depression, sensation seeking and excessive online poker gambling. Our sample is composed of 291 online poker players, with a mean age of 33.8 years (SD = 10.6). Participants completed an online self-assessment questionnaire, measuring the frequency of tilt episodes, cognitive distortion, anxiety, depression and impulsivity. The findings indicated that the frequency of tilt episodes and cognitive distortion were the only significant predictors of excessive online gambling (respectively, r = 0.49 and r = 0.20). Tilt frequency and cognitive distortion were strongly correlated (GRCS, r = 0.60), moderate to low correlations were found for tilt and anxiety (HADS, r = 0.40), and positive and negative urgency (UPPS, r = 0.27). To date, tilt has seldom been studied, and could improve our understanding of online poker gamblers. It could be a new means of identifying at risk gamblers, and thus facilitating preventive measures specifically adapted to this population.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder.

BACKGROUND AND AIMS: Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood. METHODS: Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables. RESULTS: Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22). CONCLUSION: Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.