Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence.

INTRODUCTION: Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders. METHODS: Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots. RESULTS: Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found. CONCLUSION: This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.

Unmasking Risky Habits: Identifying and Predicting Problem Gamblers Through Machine Learning Techniques.

The use of machine learning techniques to identify problem gamblers has been widely established. However, existing methods often rely on self-reported labeling, such as temporary self-exclusion or account closure. In this study, we propose a novel approach that combines two documented methods. First we create labels for problem gamblers in an unsupervised manner. Subsequently, we develop prediction models to identify these users in real-time. The methods presented in this study offer useful insights that can be leveraged to implement interventions aimed at guiding or discouraging players from engaging in disordered gambling behaviors. This has potential implications for promoting responsible gambling and fostering healthier player habits.

Mapping Youth Awareness of Sports Betting Advertising During the 2022 FIFA World Cup.

Young people are known to be highly engaged in sports betting and therefore may be particularly susceptible to the effects of gambling-related advertising. The purpose of the present study was to examine young people's recall of sports betting advertising during the 2022 FIFA World Cup. The sample consisted of 190 UK residents aged 18-24 who had watched at least one 2022 World Cup match. A cross-sectional survey was conducted to collect data on participants' recall of sports betting advertisements across several media types and for different bets and betting offers, as well as their problem gambling scores. The findings indicated that young people were able to recall a high amount of advertising for various types of bets (95.6%) and betting inducements (89.5%). A high proportion of young people recalled advertising for risky bet types and promotions, such as 64.2% for in-play betting and 68.1% for sign-up offers. Overall, higher-risk gamblers recalled encountering more advertising than lower-risk gamblers. Participants recalled encountering sports betting advertisements on social media the most (10-14 ads per week), then on internet banners and television (5-9 ads per week, respectively). Less than half (46.3%) of respondents were aware of advertising for responsible gambling tools. This study underscores the need for policy measures that limit young people's exposure to gambling advertising, particularly for products that may contribute to gambling-related harm, and that increase the promotion of responsible gambling tools.

Negative and positive mental health characteristics of affected family members: Findings from a cross-sectional Australian general population gambling study.

Despite the impact of problem gambling on affected family members (AFMs), there are limited large-scale population level studies identifying the negative mental health (NMH) and positive mental health (PMH) characteristics of AFMs. Furthermore, no study has explored whether PMH characteristics are protective in the relationships between AFM status and NMH characteristics. This study involved secondary data analysis from the Third Social and Economic Impact Study of Gambling in Tasmania. Using a subsample of 1,869 adults (48.30 % male; meanage = 48.48; 4.67 % AFMs), this study aimed to explore whether: (1) AFM status is associated with NMH (depression, anxiety, panic, post-traumatic stress disorder, social anxiety, binge drinking, tobacco use, and drug use symptoms) and PMH (quality of life [QOL], personal growth/autonomy, interpersonal/social skills, coping skills) characteristics after separately controlling for sociodemographic, problem gambling severity, and other NMH characteristics; (2) PMH characteristics moderate (buffer) the relationships between AFM status and NMH characteristics; and (3) gender influences these relationships. AFM status, defined as exposure to family member gambling problems, significantly positively predicted NMH characteristics (depression, anxiety, panic, PTSD, and tobacco use symptoms) and negatively predicted QOL (physical, social) and planning coping. The strength of these relationships generally attenuated after controlling for various covariates. Gender did not moderate these relationships. Religious coping exacerbated the relationship between AFM status and panic disorder symptoms. These findings can inform the development of intervention initiatives for family members exposed to gambling problems. Future population-representative research is required using a range of affected other types, longitudinal study designs, and more comprehensive measures.

A Double-Edged-Sword Effect of Overplacement: Social Comparison Bias Predicts Gambling Motivations and Behaviors in Chinese Casino Gamblers.

Overconfidence, a widely observed cognitive bias, has been linked to increased gambling motivations and behaviors. However, previous studies have largely overlooked overconfidence under a social comparison context, known as overplacement, i.e., the tendency of individuals to believe that they are better than their similar peers. In the present study, we tested the effect of overplacement on gambling motivations and behaviors though a Pilot Survey of Chinese college students (N = 129) and a Field Survey of Chinese Macao casino gamblers (N = 733). Our results revealed a double-edged sword effect of overplacement: Serving as a risk factor, evaluating one self's earning ability as higher than others was linked to more gambling motivations (ß = 0.18, p = .005) and frequency (ß = 0.18, p = .004); Serving as a protective factor, evaluating oneself as happier than others was linked to less gambling motivations (ß = - 0.32, p < .001) and problem behaviors (ß = - 0.26, p < .001). These findings expand the relationship between overconfidence and gambling from a cognitive bias perspective to a social comparison perspective. Our study not only revealed a typical profile of gambling motivations and behaviors among different demographic groups in Chinese casino gamblers, but also highlighted the importance of considering social factors in the study of the psychological mechanisms of gambling.

Characteristics of Gambling Helpline Callers in Macao: A Regional Comparison.

Despite the continued focus on profiling gambling helpline callers, little is known about the characteristics of callers in Macao. To address this gap, this study aims to investigate the characteristics of problem gamblers calling the helpline in Macao and explore the regional differences between callers from Macao, mainland China, and Hong Kong. Specifically, the study examined their demographics, helpline usage, and gambling-related characteristics. The study used data collected by SKHSSCO between 2015 and 2021. The results showed that, at the aggregate level, the helpline callers in Macao were male, young, and full-time employees. The majority used the telephone and reported problems with casino table games. In addition, the referral rate was relatively low, while the rate of suicidal ideation was comparatively high. The results also revealed that callers from Macao, mainland China, and Hong Kong were notably distinct in these characteristics. The findings shed light on how to increase helpline accessibility and create tailored interventions and prevention efforts to better support individuals affected by problem gambling.

Gambling and Migration - The Role of Culture and Family.

Problem gambling (PG) is a public health concern with severe repercussions for the individual, concerned significant others and the society. Foreign borns generally gamble less but are overrepresented among those with PG. Previous research has suggested that other factors, such as socio-economic status, might explain this, but also that cultural factors might play a role in the relationship to gambling and the development of PG. This qualitative study using content analysis investigates the experiences of and opinions about gambling and PG among 12 males living in Sweden with a migrant background in Afghanistan, the Middle East and North Africa. The results were show that the acculturation process could be a factor in developing PG, as well as a cultural values regarding money and wealth. PG was seen as more stigmatized in the origin country, and the family played a more important role in the rehabilitation of PG compared to the general population. The results of this study could be used to inform preventive and clinical programs to better reach people with a migrant background.

Gambling in a U.S. Census Matched Sample: Examining Interactions between Means and Motives in Predicting Problematic Outcomes.

The influence of socioeconomic status (SES) on risk of Problem Gambling (PG) is complex, particularly given recent evidence that SES should be understood in both objective and subjective terms. Likewise, financial gambling motives have been found to be predictive of PG; however, financial motives are less understood in comparison to other gambling motives. Preliminary findings on SES and gambling points towards a pattern of social inequality in which those with the least financial resources (e.g., income) or that feel financially deprived relative to others (e.g., perceived deprivation) experience greater harm and problems. In a weighted, census matched sample of adults in the U.S. (N = 1,348), the present study examined the interaction between financial gambling motives and income and financial gambling motives and perceived deprivation in predicting PG. Findings provided support for both financial gambling motives and perceived deprivation as robust predictors of PG. Further, results provided unique insights into the role subjective economic standing may play in the relationship between financial motives for gambling and risk of PG.

Overtime: Long-Term Betting Trajectories Among Highly-Involved and Less-Involved Online Sports Bettors.

Online sports gambling involvement is discontinuous in nature, with small groups of highly involved gamblers exhibiting betting behavior that is distinctly greater than other gamblers. There is some question about whether these groups, defined by exceedingly high levels of play, also have equivalently high rates of gambling problems, and whether they maintain these play levels over time. The current study builds on past work by examining the long-term trajectories of play and voluntary self-exclusion patterns across two years among a cohort of 32,262 highly-involved and less-involved online sports gamblers. We also examine the relative importance of betting behavior change as a risk factor for gambling problems by testing whether high involvement as compared to escalation of involvement is a better predictor of future self-exclusion. Measures included betting activities, transactional activities, and self-exclusion activities on a European online betting platform between February 2015 and January 2017. Results showed that bettors who were most highly involved in the first 8 months of the study in terms of number of bets and net loss were more likely to continue gambling on the platform in months 9-24 than others. Bettors who were most highly involved in the first 8 months of the study in terms of net loss and amount wagered were more likely to use self-exclusion than others, and more likely to have multiple self-exclusions. Escalations in frequency of play and average bet size within the first 8 months emerged as significant predictors of self-exclusion, even when controlling for high involvement.

Treatment seeking for gambling disorder in nationwide register data - observations around a major shift in legislation.

Background: Treatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities. Methods: Nationwide register data were collected for the years 2005-2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender. Results: The number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change. Conclusion: After the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.

Intrinsic connectivity demonstrates a shared role of the posterior cingulate for cue reactivity in both gambling and cocaine use disorders.

Cue reactivity is relevant across addictive disorders as a process relevant to maintenance, relapse, and craving. Understanding the neurobiological foundations of cue reactivity across substance and behavioral addictions has important implications for intervention development. The present study used intrinsic connectivity distribution methods to examine functional connectivity during a cue-exposure fMRI task involving gambling, cocaine and sad videos in 22 subjects with gambling disorder, 24 with cocaine use disorder, and 40 healthy comparison subjects. Intrinsic connectivity distribution implicated the posterior cingulate cortex (PCC) at a stringent whole-brain threshold. Post-hoc analyses investigating the nature of the findings indicated that individuals with gambling disorder and cocaine use disorder exhibited decreased connectivity in the posterior cingulate during gambling and cocaine cues, respectively, as compared to other cues and compared to other groups. Brain-related cue reactivity in substance and behavioral addictions involve PCC connectivity in a content-to-disorder specific fashion. The findings suggesting that PCC-related circuitry underlies cue reactivity across substance and behavioral addictions suggests a potential biomarker for targeting in intervention development.

A Longitudinal Investigation of Lower-Risk Gambling Limits in the Canadian National Study.

Recent years have seen increased attention given to identifying and describing the levels of gambling participation that confer a risk of harm in order to generate public health advice regarding lower-risk gambling. However, most of the existing literature has failed to explicitly assess these limits in a prospective manner. The purpose of this study is to employ a methodology consistent with prior investigations to evaluate the level of gambling participation associated with an increased risk of future gambling-related harm. Using data from the Alberta Gambling Research Institute's National Project Online Panel Survey, risk ratios and Receiver Operating Characteristic (ROC) analyses were used to determine the relative risk of gambling-related harm associated with participating in a greater number of gambling formats, gambling more days per month, and spending a greater proportion of income gambling. Prospective lower-risk limits were largely consistent with those identified in previous cross-sectional analyses (e.g., no more than two gambling formats, no more than once a week), with the exception that higher limits were found for the percent of household income spent gambling (3.4-6.4% vs. 1%). We advise that future research on lower-risk gambling limits consider the use of more granular assessment instruments and prospective methods to more closely evaluate the association between gambling participation and gambling harm.

Exploring the Differences in Positive Play among Various Sports Wagering Behaviors.

Recent technological advances and legislative changes have led to an increase of sports wagering across the United States, raising concerns about possible increases in problem gambling behaviors. This, in turn, points to an increased need to understand responsible gambling and how it relates to sports gambling behaviors. The present work utilizes the Positive Play Scale (PPS), a recent scale designed to measure the increasingly popular responsible gambling concept of Positive Play, to assess how various aspects of sports gambling relate to responsible gambling. Participants were recruited by YouGov Opinion polling and taken from two U.S. samples, and the present analyses look only at those who self-identified as sports gamblers (n = 561, Mage = 50.7). Gamblers' location of gambling, types of bets wagered on, timing of gambling, and website used to gamble were assessed. Those who bet online in any capacity, as well as participating in in-game wagering, were found to be significantly less positive in their gambling behaviors. In addition, certain types of sports wagers such as moneylines appeared to be associated with higher positive play, while other types such as parlays were associated with less positive play. Finally, certain websites, particularly offshore websites, were associated with lower positive play behavior. Collectively, these results suggest that there are various aspects of sports wagering behaviors that are associated with positive play variations in gambling.

Problem Gambling and Suicidal Behaviours in Young Adult men in Ghana: A Moderated Mediation Model of Psychological Distress and Social Support : Journal of Gambling Studies.

Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours.

Skill-Based Electronic Gaming Machines: Features that Mimic Video Gaming, Features that could Contribute to Harm, and Their Potential Attraction to Different Groups.

New gambling products have been developed over time as technology permits. For example, early mechanical slot machines were later replaced by electronic gaming machines (EGMs), which enabled a faster speed of play and more immersive experience. EGMs have in the decades since their invention become one of the main drivers of gambling expenditure worldwide and are one of the gambling products most strongly associated with harm. This literature review considers research relevant to a new subcategory of EGM, 'skill-based' EGMs, termed 'SGMs' here. SGMs can be highly varied in content, with some representing a minimal departure from EGMs, where the typical bonus round is replaced by some skill-based activity, such as a simple video game, which could increase the machine's appeal. Other SGMs feature more radical departures from conventional EGMs, such as multiplayer games using intellectual property from popular TV shows or video games. These skill-based elements could tap into common gambling fallacies such as the illusion of control, and therefore facilitate harmful engagement. SGMs could also be less harmful than current EGMs, if skill-based elements break the dissociative states associated with EGM gambling. The intellectual property used in SGMs may increase their appeal among people who generally do not gamble, and the skill-based elements could increase their interest among gamblers who predominately prefer skill-based gambling formats such as sports betting. The novelty and varied content of SGMs present many open questions, which research should aim to address in future.

Keeping you connected or keeping you addicted? Weekly use of social media platforms is associated with hazardous alcohol use and problem gambling among adults.

AIMS: A wide variety of social media platforms exist, each offering tailored solutions to attract specific target audiences based on their social media needs and interests. This diversity may pose a risk factor for the development or perpetuation of harmful behaviors. Research has established a connection between social media use and increased health risk behaviors. This six-wave exploratory longitudinal study investigated the associations between active social media use, hazardous alcohol use, and problem gambling among adult social media users. METHODS: Data were collected via surveys in 6-month intervals, starting in March-April 2021 (T1: N = 1530; Mage = 46.67; SD = 16.42; 50.33% male). Of the T1 respondents, 58.10% participated in T6 (n = 889). Measures included the frequency of use of different social media platforms, the 3-item Alcohol Use Disorders Identification Test (AUDIT-C), and the Problem Gambling Severity Index (PGSI). Hybrid multilevel regression models were used for analyses. RESULTS: We found positive within-person effects of weekly Facebook use and between-person effects of weekly use of Facebook, TikTok, and gambling-related online communities on drinking. These results suggest an increase in hazardous alcohol consumption over time among the platforms' active users. Weekly Instagram use had a negative between-person effect on hazardous alcohol use. Individuals using TikTok or gambling communities weekly were more prone to problem gambling compared to non-weekly users. CONCLUSIONS: There are risks involved in the active use of some social media services among adult users. Prevention work, including digital health interventions, should be targeted according to the appropriate user group.

Severity of gambling behaviors: exploring associations with venues, legality, and substance use.

INTRODUCTION: The COVID-19 pandemic has been linked to an increase in gambling behaviors, potentially leading to Gambling Disorder (GD) and adverse health and social consequences. Problematic gambling has received little research attention over the years in Israeli society and the issue of gambling is not high on the list of priorities of Israeli policymakers. The present study examined gambling behavior in Israel on a continuum of severity and its association with venues where the gambling occurs, legality, attitude toward the legalization of casinos and poker, and substance use. METHODS: The study questionnaires were distributed to approximately 15,000 Jewish-Israeli adults via internet panel. From 3,088 Israeli adults who answered the questionnaire, 1,251 (40.5%) reported gambling in the last year and were included in the analyses. RESULTS: Based on the Problem Gambling Severity Index, 60% of participants were classified as non-problem gamblers, 25% as at low-risk for a gambling problem, 11% as at moderate risk, and 4% as having a gambling problem. Most online gambling was practiced by non-problem gamblers (40%) and most illegal gambling was by low-risk gamblers (34%). The more severe the gambling behavior was on the continuum, the more it was associated with illegal substance use and positive attitudes toward legalized casinos in Israel. Logistic regression showed the odds of developing moderate and problem gambling were 3.8 times higher for online gamblers (OR = 3.8; CI 2.6-5.4; p < 0.000) and 3.3 times higher for illegal gamblers (OR = 3.3; CI 2.2-4.9; p < 0.000). CONCLUSION: Though more research attention should be paid to gambling behaviors, harm reduction gambling interventions should be made available to all categories on the continuum of severity of gambling behaviors. The present study provides evidence-based information to promote health policies that aim to prevent and reduce harm for Israeli gamblers.

An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders.

Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.