Article

Screening for problem gambling within mental health services: A comparison of the classification accuracy of brief instruments

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Abstract

Background and aims: Despite the over-representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was therefore to compare the classification accuracy of nine brief problem gambling screening instruments (2-5 items) with a reference standard among patients accessing mental health services. Design: The classification accuracy of nine brief screening instruments was compared with multiple cut-off scores on a reference standard. Setting: Eight mental health services in Victoria, Australia. Participants: 837 patients were consecutively recruited between June 2015 and January 2016. Measurements: The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen [BPGS] [2-5-item versions], NODS-CLiP, NODS-CLiP2, Brief Biosocial Gambling Screen [BBGS], and NODS-PERC. The Problem Gambling Severity Index (PGSI) was the reference standard. Findings: The 5-item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low-risk, moderate-risk, or problem gambling) [sensitivity=0.803, specificity=0.982, diagnostic efficiency=0.943]. Several shorter instruments adequately detected both problem and moderate-risk, but not low-risk, gambling: two 3-item instruments (NODS-CLiP, 3-item BPGS) and two 4-item instruments (NODS-PERC, 4-item BPGS) [sensitivity=0.854-0.966, specificity=0.901-0.954, diagnostic efficiency=0.908-0.941]. The 4-item instruments, however, did not provide any considerable advantage over the 3-item instruments. The very brief (2-item) instruments (Lie/Bet and 2-item BPGS) similarly adequately detected problem gambling [sensitivity=0.811-0.868, specificity=0.938-0.943, diagnostic efficiency=0.933-0.934], but not moderate-risk or low-risk gambling. Conclusions: The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the 5-item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate-risk/problem gambling) can employ the NODS-CLiP or the 3-item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the 2-item BPGS.

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... La prevalencia de esta asociación muestra gran variación según la jurisdicción, el tiempo de vida, el tipo de muestra y el instrumento utilizado. Revisiones sistemáticas, predominantemente de Estados Unidos, informan una comorbilidad de JP y trastorno por uso de sustancias (TUS) del 57,5% en la población general y hasta del 22,2% en pacientes en tratamiento en unidades clínicas (Dowling et al., 2018). Varias revisiones sistemáticas y metaanálisis indican que los problemas de juego en pacientes con TUS están sobrerrepresentados (10,0%-43,4%) (Cowlishaw, Merkouris, Chapman y Radermacher, 2014;Himelhoch et al., 2015;Lorains, Stout, Bradshaw, Dowling y Enticott, 2014;Manning et al., 2017). ...
... Una de las escalas que ha mostrado resultados más interesantes es la Brief Problem Gambling Screen (BPGS) que se puede utilizar en 4 versiones diferentes de entre 2 y 5 ítems. En un estudio relacional con 837 participantes, se compararon nueve herramientas de cribado breves con el PGSI como estándar de referencia (Calado y Griffiths, 2016), y se concluyó que la única que mostró una sensibilidad adecuada al detectar cualquier nivel de juego problemático, en comparación con las otras ocho herramientas de cribado, fue la versión de 5 ítems de la BPGS (Dowling et al., 2018), lo que también indica que podría ser una herramienta óptima para usar en una población clínica (Lorains et al., 2014). En ese estudio, la BPGS de 5 ítems mostró una sensibilidad del 100% y una especificidad del 86% para pacientes con JP. ...
... En pacientes con riesgo de JP, tanto la sensibilidad como la especificidad fueron del 94%. Los valores predictivos positivos (VPP) y negativos (VPN) también mostraron resultados excelentes (VPP = 70%; VPN = 99%), lo que mostró un fuerte poder discriminante al diferenciar con sujetos sin JP (Dowling et al., 2018). También se confirmó su adecuada capacidad para detectar población de riesgo, lo que consolida la idea de que es una herramienta útil para la detección precoz del JP. ...
Article
Problematic Gambling or Gambling Disorder (GD) can act by initiating and maintaining the problem of substance addiction. Despite this, there are no rapid screening tools validated in Spanish. The Brief Problem Gambling Screen (BPGS) has proven to be one of the most sensitive tools for detecting GD and populations at risk. This study aims to validate the Spanish version of the original five-item BPGS. A sample of 100 Spanish-speaking adults with substance use disorder were recruited from an addiction treatment center. The participants were administered the Spanish version of BPGS. It showed strong item reliability properties (Ω = 0.93). Sensitivity and specificity values were excellent (0.93 each), also positive (0.7) and negative (0.99) predictive values suggest high discriminant power when compared to non-GD subjects. Statistically significant strong correlation with a gold-standard measure (Problem Gambling Severity Index) was found (r = 0.8, p < 0.01). Similar psychometric properties were found in at-risk gambler patients. In conclusion, the BPGS seems to be an adequate screening instrument in Spanish-speaking clinical population, and also identifies at-risk of GD subjects.
... The NODS-CLiP has been reported to have high sensitivity (0.94-0.99) and specificity (0.88-0.95) in the detection of problem gambling (Toce-Gerstein et al., 2009). However, elsewhere it has been recognized that it identifies a high number of false positive cases for problem gambling (Dowling et al., 2018). In order to avoid estimating inflated levels of problem gambling in the present study, we applied the NODS-CLiP criteria to identify the broader category of gambling-related harm. ...
... It is reported to demonstrate excellent sensitivity and specificity for NODS constructs and has been recognized as useful in a range of clinical settings (Toce-Gerstein et al., 2009;Volberg et al., 2011). Although it has been found to adequately detect problem and moderate-risk gambling, it does not reliably detect low-risk gambling (Dowling et al., 2018). Use of this generally accepted screening tool in the present study will enable comparisons with research from other jurisdictions. ...
Article
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Gambling behaviours represent a significant social and economic cost and an important public health problem. A putative index for monitoring gambling-related harm is a concentration of spending indicator that reports the proportion of gambling revenue derived from problem gambling. Using this indicator, we aimed to provide a first estimate of the proportion of gambling revenue associated with gambling-related harm in Switzerland according to the Swiss Health Survey. Data were obtained from the Swiss Health Survey 2017. The National Opinion Research Centre Diagnostic and Statistical Manual of Mental Disorders – Loss of Control, Lying and Preoccupation (NODS-CLiP) screening tool was used as part of the questionnaire, and the study findings were evaluated to determine the prevalence of gambling-related harm. Self-reported spending on terrestrial and online gambling (including gaming tables, electronic gaming machines, lotteries, sports betting) during the past 12 months was then used to calculate the portion of gambling revenue derived from players experiencing harm. A total of 12,191 respondents were included. Gambling-related harm was reported by 3.10% of our sample, according to NODS-CLiP criteria. The findings showed that although 52% of people experiencing harm spend less than 100 francs per month on gambling, 31.3% of total spending is attributable to gambling-related harm. In addition to pre-existing national prevalence studies, data on spending should be made readily available by gambling operators and regulators, in keeping with their regulatory obligations. The revenue structure, according to gambling type, should also be provided, including data from third-party gambling operators. In an interdisciplinary effort to improve public health and consumer protection, organized national structural prevention measures should be developed and evaluated.
... These having often been adapted from interventions developed for use in substance abuse settings by practitioners, despite the absence of a specific evidence base to support their effectiveness in gambling addiction. The three intervention studies identified were delivered in general practice [33], a mental health support service [14], and substance abuse treatment service [1]. Feasibility and discursive reports focusing on general practice [44,45], mental health services [50], consumer credit counselling [48] and social work [46] supported these intervention papers. ...
... The final intervention study was conducted in a mental health service in Australia with clinic patients (n = 837) [14]. The study compared several screening instruments used for problem gambling, of which an optimum five item tool was identified. ...
Article
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Background: Gambling-related harm is an increasing recognised problem internationally. Recent years have seen an explosion in opportunities to gamble, both in person and online. Health and other care settings have the potential to act as screening sites to identify and support gamblers who may be at high risk of experiencing gambling-related harm. This study aimed to identify interventions to screen for risk of gambling-related harm in the general population which may be delivered in health, care and support settings. Methods: Systematic review. Searches of key databases and grey sources since 2012 were undertaken in October 2019. Electronic database searches generated a total of 5826 unique hits. Nine studies published 2013-2019, along with thirteen grey literature documents met our eligibility criteria. The criteria were setting (health, care and support settings), participants (any attendee in help, care and support settings), interventions (screening to identify risk of harm from gambling behaviours) and outcome measures (gambling behaviours, service use). Results: Three papers evaluating screening interventions delivered in general practice (repeat visits and written advice), mental health service (the use of screening tools to identify risk of harm), and substance abuse treatment (intensive outpatient treatment for substance use disorders or methadone maintenance) indicated evidence of potential effectiveness. Six papers supported the feasibility and acceptability of delivering interventions in various settings. Grey literature reports described the implementation of interventions such as training materials, and transfer of interventions developed for substance abuse populations by practitioners. Conclusions: Health, care and support services offer potentially important contexts in which to identify and offer support to people who are at risk of gambling related harm. Screening interventions appear feasible and acceptable in a range of community and healthcare settings for those at risk of gambling harm. Evaluation of effectiveness and cost-effectiveness of screening in these populations should therefore be prioritised.
... The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has classified gambling disorder as an addiction and related disorder, along with substance use disorders (American Psychiatric Association, 2013). In contrast, consistent with public health frameworks that conceptualise gambling problems across a continuum of risk (Shaffer & Korn, 2002), the term problem gambling is employed in many jurisdictions to refer to all forms of gambling that lead to adverse consequences for the gambler, others, or the community services are logistically well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral (Brett et al., 2014;Dowling et al., 2018;Goodyear-Smith, Arroll, & Coupe, 2009;Manning et al., 2017;Rockloff, Ehrich, Themessl-Huber, & Evans, 2011;Sullivan, McCormick, Lamont, & Penfold, 2007). Although health providers in these services acknowledge that they have a role in helping clients with gambling problems (Corney, 2011;Rodda et al., 2018;Sanju & Gerada, 2011;Sullivan et al., 2007;Sullivan, Arroll, Coster, Abbott, & Adams, 2000;Temcheff, Derevensky, St-Pierre, Gupta, & Martin, 2014), they hold generally negative attitudes towards screening (Sullivan et al., 2000) and report low rates of screening behaviour (Achab et al., 2014;Manning et al., 2017). ...
... item screening instruments BPGS-2 (1+)Dowling et al., 2018/ Lubman et al. ...
Article
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Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.
... [Insert Figure 1 about here] Gambling "consumtion" Gambling "consumtion" Type of game (3) Type of game (3) Type of game (1) Time gambled (21) Time gambled (21) Time gambled/Gambling behavior (4) d Sums (10) Sums (10) Sums (6) Gambling behavior (16) Gambling behavior (16) (7) Preoccupation (7) Preoccupation (3) Tolerance (2) Tolerance (2) Tolerance (1) Lost of Control (30) Lost of Control (30) Lost of Control (2) Abstinence symptoms (29) Abstinence symptoms (29) Abstinence symptoms (1) Escape (8) Escape (8) Escape (1) Chasing losses (6) Chasing losses (6) Chasing losses (1) Lies (6) Lies (6) Lies (1) Social consequences (23) Social consequences (23) Social consequences (2) Relies on other (8) Relies on other (8) Negative consequences Negative consequences Negative consequences General problem (2) General problem (2) Health (physical/mental) (5) Health (physical/mental) (14) Health (physical/mental) (14) Financial (2) Financial (20) Financial (20) Critique from others (6) Critique from others (6) Illegal (5) Illegal (5) Other negative cosequences (11) Other negative cosequences (11) ...
... • All authors of reviews of gambling measures identified in our extended literature search [15][16][17]. ...
Article
Background Research on the identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. However, a single instrument measuring gambling behavior, severity, and specific deleterious effects is lacking. Objective This protocol describes the development of the Gambling Disorder Identification Test (G-DIT), which is a 9- to 12-item multiple-choice scale with three domains: gambling consumption, symptom severity, and negative consequences. The scale is analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Methods The G-DIT is developed in four steps: (1) identification of items eligible for the G-DIT from a pool of existing gambling measures; (2) presentation of items proposed for evaluation by invited expert researchers through an online Delphi process and subsequent consensus meetings; (3) pilot testing of a draft of the 9- to 12-item version in a small group of participants with problem gambling behavior (n=12); and (4) evaluation of the psychometric properties of the final G-DIT measure in relation to the existing instruments and self-reported criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), among individuals with problem gambling and nonproblematic recreational gambling behaviors (n=600). This protocol article summarizes step 1 and describes steps 2 and 3 in detail. Results As of October 2018, steps 1-3 are complete, and step 4 is underway. Conclusions Implementation of this online Delphi study early in the psychometric development process will contribute to the face and construct validity of the G-DIT. We believe the G-DIT will be useful as a standard outcome measure in the field of problem gambling research and serve as a problem-identification tool in clinical settings. International Registered Report Identifier (IRRID) RR1-10.2196/12006
... Also, responding to problem gambling in mental health patients is particularly pertinent given that this group frequently experiences marginalization, stigma, isolation, unemployment, low income, and reduced social support [13]. Whilst routine screening of mental health service users could facilitate the early identification and treatment of problem gambling [14], international research reveals that screening for problem gambling rarely takes place in most treatment settings [15,16]. As such, gambling problems often remain undetected and untreated [8,17]. ...
... Although we aimed for our survey to include all areas which previous studies have identified as being relevant, and some newer areas such as stress induced by use of social media, there were some topics that we could not examine to keep the completion time within a manageable limit. These include risk exposures common in this age group such as road safety, sun protection, and gambling [120,121] and more protective factors or indicators of positive wellbeing [122,123]. We may have missed identifying potential groups at risk by not seeking information about students who were the first in their family (first generation) to attend university [124], their socioeconomic background [125], local students who needed to move away from home to attend university [126], and parental education or occupation [127]. ...
Article
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Background Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university’s new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students. Methods The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent. Results Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online. Conclusions This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic.
... Future research should continue to evaluate how best to screen and support personnel with co-existing gambling problems and mental health challenges. It is notable that at present no such screening or assessment procedure exists within the UK Armed Forces community, despite an established evidence base on the best diagnostic tools that could be used [e.g., (39)]. By contrast, the US military has undertaken annual screening since 2018 of active service personnel and routinely screens for gambling problems prior to deployment. ...
Article
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Introduction In military personnel are vulnerable to gambling problems, yet many are reluctant to seek help. The aim of the current study was to explore the lived experience of problem gambling and help-seeking among serving members of the United Kingdom Armed Forces. Methods Seventeen individuals from a larger, cross-sectional survey of gambling and wellbeing in the Royal Air Force (RAF) completed semi-structured interviews. Interview questions focused on personal experiences, the context of the RAF and its influence, knowledge and experiences of treatment and support services, and the impact of COVID-19. Results Reflexive thematic analysis revealed four themes: (1) harmful and protective occupational factors; (2) socio-cultural and personal influences; (3) organizational attitudes toward mental health and help-seeking, and (4) current support pathways and provision. Discussion Findings also indicated that gambling and alcohol use are common within the RAF, and that personnel are actively coping with mental health challenges.
... The sociodemographic variables collected included: age, gender, educational level, marital status and employment. Clinical variables included screening questions for lifetime substance use (substances ever used); current substance use; problem gambling (questions based on brief problem gambling screen (45,46); questions on exposure to childhood adverse events (physical, sexual or emotional abuse and loss of a parent) and data on current methadone dose and cooccurring medical and psychiatric illness that was extracted from the patients' clinical records. ...
Article
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Background There is limited research on the use of digital interventions among individuals with opioid use disorders (OUD) in low-and-middle income countries. This study aimed to assess mobile phone ownership, digital technology use and acceptability of digital interventions for treatment among individuals on treatment for OUD in Nairobi, Kenya. Methods A cross-sectional study was conducted among individuals with OUD. Structured questionnaires were used to collect data on socio-demographic and clinical characteristics, use of mobile phones and other digital technology and acceptability of digital interventions for treatment. Results One hundred and eighty participants were enrolled comprising 83.3% males with mean age of 31.5 years (SD 8.6). Mobile phone ownership was reported by 77.2% of participants of which 59.7% used smartphones. One hundred and sixty-six (92.2%) used phones to call, 82.8 and 77.2% used phones to send and receive text messages respectively; 30% used the internet; 57.2% had replaced the phone in past year and 51.1% of participants reported use of at least one social media platform, of these 44.4% had searched social media for information on drug use. Acceptability to receive treatment by phone was 95% and computer 49.4% with majority (88.1%) preferring a text message-based intervention. The preferred approach of delivery of a text message-based intervention were: one text message per day once a week, message to be personalized and individuals allowed to choose time and day to receive the message. Factors associated with acceptability of digital interventions were education level, being single, smartphone ownership and employment. Conclusion Majority of individuals on treatment for OUD had access to mobile phones but with high device turnover and limited access to computers and internet. There was high acceptability of digital interventions to provide treatment for OUDs, mostly through phones. These findings highlight factors to consider in the design of a digital intervention for this population.
... We screened participants for exclusion based on any endorsement of slot machine experience, which was re-iterated in an open-ended prompt inquiring about any prior slot machine experience. Participants also completed the 9-item Problem Gambling Severity Index (PGSI) section of the CPGI, which is the gold-standard screening tool for problem gambling (see Dowling et al., 2018). To be eligible, participants were required to score below 8, the cutoff for likely problem gambling. ...
Article
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Habit formation is a key process in contemporary models of addictive behaviors but has received limited attention in the context of gambling and problem gambling. Methods for examining habit formation and expression in relation to gambling are also lacking. In this study, 60 participants with no prior slot machine experience attended three sessions spaced 6–8 days apart, during which they played a short 200-spin session on a realistic simulation of a modern multi-line slot machine. Behavioral data were analyzed to characterize habit formation within and between sessions. Fixed-effects regressions, integrating trial- and session-level effects, assessed predictors of gambling speed (spin initiation latencies) and betting rigidity (the likelihood of switching the bet amount), as two putative markers of habit formation. Participants gambled faster and showed less variability in betting strategy as they accumulated experience in the number of trials and sessions gambled. Simultaneously, as the number of sessions gambled increased, participants showed a more pronounced tendency to slow their betting after larger wins (i.e. the post-reinforcement pause increased from session 1 to session 3). Our methods provide a basis for future research to examine habits in the context of slot machine gambling.
... Die freiwillige Limitierung zur Begrenzung von Einsatz, Dauer und Häufigkeit der Glücksspielteilnahme erfolgte mittels 4-stufiger Likert-Skala (1 = "trifft voll und ganz zu" bis 4 = "trifft überhaupt nicht zu"). Zur Unterscheidung von Normal-und Problemspielenden wurde der insbesondere für Verbraucherbefragungen zeitökonomische "Lie-/Bet-Questionnaire" (LBQ ) (Johnson et al., 1998;Johnson et al., 1997) verwendet, der die Lebenszeitprävalenz einer Glücksspielstörung erfasst und bereits in verschiedenen Bevölkerungs-und Patientenbefragungen eingesetzt wurde (Dowling et al., 2018;Götestam et al., 2004). Der zwei Item-Fragebogen ("Mussten Sie jemals Menschen, die Ihnen wichtig sind oder waren, wegen des Ausmaßes Ihres Spielverhaltens anlügen?"; "Haben Sie jemals das Bedürfnis verspürt, mit immer mehr Geld zu spielen?") beinhaltet das dichotome Antwortformat (Ja/Nein). ...
Article
Zusammenfassung: Zielsetzung: Der Glücksspielstaatsvertrag verpflichtet Anbietende von Glücksspielen Spielerschutzmaßnahmen zu implementieren. Befunde, die Rückschlüsse auf die Erreichbarkeit von Problemspielenden ermöglichen, sind limitiert; ebenso die Anwendung freiwilliger Selbstlimitierungsstrategien. Die Studie untersucht die Nutzung von Spielerschutzmaßnahmen sowie Anwendungen selbstlimitierender Strategien. Methodik: Lottospielende in Rheinland-Pfalz wurden mittels Fragebogen (terrestrisch und online) befragt. Die Gesamtstichprobe umfasste 1.966 Fragebogen. Die Differenzierung von Normal- und Problemspielenden erfolgte mittels „Lie-/Bet-Questionnaire“. Ergebnisse: Der Anteil Problemspielender betrug 7.8 % (Lebenszeit). Die Nutzung der Spielerschutzmaßnahmen war durchschnittlich bis gering (41.2-0.0 %) und erfolgte aufgrund konkreter Problemlagen; mehr Problemspielende nutzten Spielerschutzmaßnahmen. Eine Ansprache durch Mitarbeitende erfolgte kaum: 12.9 % der terrestrischen und 1.5 % der online Problemspielenden wurden auf ihr Spielverhalten angesprochen. Problemspielende zeigten signifikant geringere Zustimmungswerte, Spieldauer, -häufigkeit und Einsätze zu begrenzen; online ergab sich kein signifikanter Unterschied bei der Einsatz-Limitierung. Schlussfolgerungen: Die Mehrheit der Problemspielenden wird durch Spielerschutzmaßnahmen nicht erreicht. Verhaltensdatenbasierte Frühwarnsysteme können dazu beitragen, die Reichweite von Spielerschutzmaßnahmen bei Problemspielenden zu erhöhen.
... Items are scored 0 ('never') to 3 ('almost always'), giving a maximum score of 27. This scale is considered the gold standard self-report instrument for gambling problems (Dowling et al., 2018). Scores are categorized "non-problem gambler" (0), "low-risk" (1-4), "moderate-risk" (5-7), and "problem gambler" (8þ; Currie, Hodgins, & Casey, 2013). ...
Article
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Objective Schizotypal personality (schizotypy) is a cluster of traits in the general population, including alterations in belief formation that may underpin delusional thinking. The psychological processes described by schizotypy could also fuel cognitive distortions in the context of gambling. This study sought to characterize the relationships between schizotypy, gambling-related cognitive distortions, and levels of problem gambling. Methods Analyses were conducted on three groups, a student sample ( n = 104) with minimal self-reported gambling involvement, a crowdsourced sample of regular gamblers (via MTurk; n = 277), and an additional crowdsourced sample with a range of gambling involvement (via MTurk; n = 144). Primary measures included the Schizotypal Personality Questionnaire – Brief (SPQ-B), the Peters et al. Delusions Inventory (PDI-21), the Gambling Related Cognitions Scale (GRCS), and the Problem Gambling Severity Index (PGSI). Luck was measured with either the Belief in Good Luck Scale (BIGLS) or the Beliefs Around Luck Scale (BALS). Results Small-to-moderate associations were detected between the components of schizotypy, including delusion proneness, and the gambling-related variables. Schizotypy was associated with the general belief in luck and bad luck, but not beliefs in good luck. A series of partial correlations demonstrated that when the GRCS was controlled for, the relationship between schizotypy and problem gambling was attenuated. Conclusions This study demonstrates that schizotypy is a small-to-moderate correlate of erroneous gambling beliefs and PG. These data help characterize clinical comorbidities between the schizotypal spectrum and problem gambling, and point to shared biases relating to belief formation and decision-making under chance.
... Internal reliability for the full-scale total was high (α = .917). Ferris and Wynne's (2001) Problem Gambling Severity Index (PGSI) is a 10-item measure to assess problem gambling in the last 12 months and has been considered as the gold standard self-report measure for gambling problems (Brooks & Clark, 2019;Dowling et al., 2018). All items are rated on a Likert scale ranging from never (0) to almost always (3) with a total scale range of 0-30. ...
Article
Increased implementation of loot boxes within computer games has received widespread concern for the wellbeing of gamers, especially given the increased engagement during COVID-19 restrictions. Loot boxes share similarities with traditional gambling mechanisms that influence addiction-like behaviors and the amount of money spent on in-game items. The present study investigated loot box expenditure alongside peer engagement, perceptions of gaming value, self-worth, and problematic gambling of 130 Call of Duty players. Results identified significantly higher Risky Loot Box Index and visual authority scores for high-risk and medium-risk problem gamblers than non-problem gamblers. High-risk problem gamblers were also found to have higher purchase intention and validation seeking scores than non-problem gamblers. Problem gambling risk and all but three self-worth and perceived value subscale behaviors were not associated with loot box expenditure, contrasting previous findings. Concerning peer influence, non-problem gamblers were significantly less likely to play any Call of Duty game with friends whilst having all or most friends purchase loot boxes were also found to be associated with higher RLBI scores. The findings continue to support the associations between loot box engagement and problematic gambling and suggests the need to continue to explore individual in-game motivations for engaging with microtransactions.
... Sullivan et al. (2007) drew upon an inmate population, while Brett et al. (2014) did not include a general population sample. Lastly, one study (Dowling et al. 2018b) did not comment on the representatives of their sample. ...
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Background While it is a generally accepted fact that many gambling screening tools are not fit for purpose when employed as part of a public health framework, the evidence supporting this claim is sporadic. The aim of this review is to identify and evaluate the gambling screening tools currently in use and examine their utility as part of a public health approach to harm reduction, providing a holistic snapshot of the field. Methods A range of index tests measuring aspects of problem gambling were examined, including the South Oaks Gambling Screen (SOGS) and the Problem Gambling Severity Index (PGSI), among others. This review also examined a range of reference standards including the Diagnostic Interview for Gambling Severity (DIGS) and screening tools such as the SOGS. Results The present review supports the belief held by many within the gambling research community that there is a need for a paradigm shift in the way gambling harm is conceptualised and measured, to facilitate early identification and harm prevention. Discussion This review has identified a number of meaningful deficits regarding the overall quality of the psychometric testing employed when validating gambling screening tools. Primary among these was the lack of a consistent and reliable reference standard within many of the studies. Currently there are very few screening tools discussed in the literature that show good utility in the domain of public health, due to the focus on symptoms rather than risk factors. As such, these tools are generally ill-suited for identifying preclinical or low-risk gamblers.
... American adult samples [15]. ...
Article
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In this brief letter, we report a new World Health Organization (WHO)-led project developing gold standard instruments to detect gaming disorder and gambling disorder following their inclusion in the ‘disorders due to addictive behaviours’ section of the eleventh revision of the International Classification of Diseases (ICD-11)
... In the same way, gambling can complicate the clinical picture of patients determining more severe symptoms, interpersonal problems, impulsivity and suicide risk. In particular, poor detection of gambling problems may lead to a more difficult course and outcome of the treatment provided by psychiatric services (Dowling et al., 2018). However, only recently with the new classification among the addictive disorder in DSM-5 (Hasin et al., 2013) gambling has gained the status of a possible cause of a 'dual diagnosis'. ...
Article
In the recent literature the rates of gambling in psychiatric patients have been compared only indirectly with those found in community samples and no study has so far matched a clinical sample with community controls. We selected 875 outpatients attending two community mental health centers and 3.500 community subjects, matched for age and sex. At-risk gambling was defined according to the four categories of the Canadian Problem Gambling Index (CPGI) scores: 0 no-risk, 1-2 low-risk, 3-7 moderate-risk, 8+ high-risk. Data were also collected on substance, alcohol, and tobacco use. Patients were diagnosed with schizophrenia, bipolar disorder, unipolar depression, cluster B personality. At-risk gambling was significantly higher in psychiatric patients compared to community subjects. In the univariate multinomial logistic regression analysis, high-risk gambling was associated with lifetime substance use and being unmarried, moderate-risk with age at onset of alcohol use and lifetime tobacco use, and low-risk with higher education. In the multinomial logistic regression analysis high risk-gambling in psychiatric patients was four times that of community controls, while in substance users high-risk gambling was two times that of non-users. The results suggest that screening for gambling could improve the care of psychiatric patients who suffer from a comorbid behavioral addiction.
... A score of 1 or more indicates potential problem gambling, and a need for further assessment (Stinchfield et al., 2012). The BPGS has been used in previous gambling research (McCarthy et al., 2021), and compares favourably to other brief gambling screening tools, reported as being 'the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem' (Dowling et al., 2018). The BPGS was used to group participants into non-gambler (no gambling in the preceding 12 months), non-problem gambler (gambled in preceding 12 months but scored 0 on BPGS) and potential problem gambler (gambled in previous 12 months and scored ≥1 on BPGS) groups for subsequent analysis. ...
Article
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In response to the COVID-19 pandemic, the UK Government placed society on ‘lockdown’, altering the gambling landscape. This study sought to capture the immediate lockdown-enforced changes in gambling behaviour. UK adults ( n = 1028) were recruited online. Gambling behaviour (frequency and weekly expenditure, perceived increase/decrease) was measured using a survey-specific questionnaire. Analyses compared gambling behaviour as a function of pre-lockdown gambling status, measured by the Brief Problem Gambling Scale. In the whole sample, gambling participation decreased between pre- and during-lockdown. Both gambling frequency and weekly expenditure decreased during the first month of lockdown overall, but, the most engaged gamblers did not show a change in gambling behaviour, despite the decrease in opportunity and availability. Individuals whose financial circumstances were negatively affected by lockdown were more likely to perceive an increase in gambling than those whose financial circumstances were not negatively affected. Findings reflect short-term behaviour change; it will be crucial to examine, at future release of lockdown, if behaviour returns to pre-lockdown patterns, or whether new behavioural patterns persist.
... Although Wardle and McManus focus on a sample of young people, it is likely to also be a problem among other age groups, as has been shown previously. 7 In view of these data, it is crucial to improve screening and support services for people with gambling problems, either within primary care or in addiction treatment settings, 8 and to glean a better understanding of what causes this association, including through the improvement of death-investigation systems to capture gambling-related suicides. ...
... Information was also collected about current and past gambling behaviours, and risk of gambling harm using the 5-item Brief Problem Gambling Screen (BPGS) [Volberg and Williams 2011]. The positive endorsement of one or more items on this screen classified an individual as 'at risk' of gambling harm [Dowling et al., 2018;Volberg and Williams 2011]. The interview then explored participant's experiences with gambling, with a particular focus on EGMs. ...
Article
Older women are vulnerable to the risks associated with some forms of gambling. While research has examined how individuals functionally interact with gambling products, very limited research has investigated how individuals conceptualise and interpret the risks associated with these products. Theorists suggest that risk-taking is not based on a lack of knowledge but on the different ways people make sense of their lives. As such, this study aimed to understand the factors that may influence how older women who gamble on electronic gambling machines (EGMs) perceive the risks associated with gambling on these products. It examined how risk perceptions interacted with a range of complex social factors in women's everyday lives to influence their risk behaviours. Semi-structured interviews were conducted with 20 Australian women aged 55 and over who had been negatively impacted by EGM gambling. This study found that older women's risk perceptions of gambling were shaped by their early recreational experiences with gambling, rather than their current regular and harmful gambling behaviours. Risk perceptions of EGMs were often downplayed or ignored as women sought to maintain valued social identities within the venues. Women went through a process of risk negotiation whereby the benefits of this social interaction outweighed the potential harms associated with the machines. This also led them to deflect or ignore risk minimisation messaging which was completely focused on individual behaviours. This study signals the importance of moving away from individualised responsible gambling messages towards risk information about gambling products. This research also provides evidence of the need for regulation addressing the design features of EGMs that ultimately may make products safer and protect the most vulnerable from gambling harm.
... A major persistent issue has been how to measure PG and GD (Caler, Garcia, & Nower, 2016;Dowling et al., 2017;Pickering, Keen, Entwistle, & Blaszczynski, 2017). In an effort to examine the global prevalence of PG across countries and time, Williams, Volberg, and Stevens (2012) Institute's 3rd Annual Conference (Walker et al., 2006), an annual independent gambling conference in Banff, Canada. ...
Article
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Objectives Diverse instruments are used to measure problem gambling and Gambling Disorder intervention outcomes. The 2004 Banff consensus agreement proposed necessary features for reporting gambling treatment efficacy. To address the challenge of including these features in a single instrument, a process was initiated to develop the Gambling Disorder Identification Test (GDIT), as an instrument analogous to the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Methods Gambling experts from 10 countries participated in an international two‐round Delphi (n = 61; n = 30), rating 30 items proposed for inclusion in the GDIT. Gambling researchers and clinicians from several countries participated in three consensus meetings (n = 10; n = 4; n = 3). User feedback was obtained from individuals with experience of problem gambling (n = 12) and from treatment‐seekers with Gambling Disorder (n = 8). Results Ten items fulfilled Delphi consensus criteria for inclusion in the GDIT (M ≥ 7 on a scale of 1–9 in the second round). Item‐related issues were addressed, and four more items were added to conform to the Banff agreement recommendations, yielding a final draft version of the GDIT with 14 items in three domains: gambling behavior, gambling symptoms and negative consequences. Conclusions This study established preliminary construct and face validity for the GDIT.
... Thus, this further points to the need to address problematic gambling behaviors in the assessment of suicidality in patients with poor mental health, and that even in the presence of another disorder known to increase suicide risk, gambling may be of interest to screen for and to diagnose at an early stage. Screening for gambling problems has been called for in mental health services, where a number of brief screening tools have been suggested, and where the prevalence of problem gambling is likely markedly higher than in the general population (24). Furthermore, active screening in specialized mental health services may be of particular importance given the association with suicidal behavior seen in the present study. ...
Article
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Background: Gambling disorder is known to be associated with increased risk of suicidal behavior. However, relatively little is known about how the risk of suicide attempts in gambling disorder is influenced by comorbid alcohol or drug use disorders, as well as other psychiatric conditions. Methods: The present study is a nationwide, diagnostic register study assessing the risk of suicide attempts (including fatal ones) in gambling disorder in Sweden in 2005–2016. Results: In a total of 2,099 individuals (23 percent women) with gambling disorder, 417 individuals had a suicide attempt (including 10 fatal cases of suicide) during the study period. Suicidal behavior was more common in patients with substance use disorders at any time during the study period (50 percent if both alcohol and drug use disorders were present, and 10 percent if none of these were present). In logistic regression, suicidal behavior was significantly associated with female gender (OR 2.13 [1.63–2.78]), mood disorders (OR 2.65 [2.00–3.50]), anxiety disorders (OR 1.78 [1.34–2.35]), and with alcohol (OR 1.95 [1.51–2.51]) or drug use disorders (OR 3.60 [2.76–4.69]), respectively. Conclusions: Suicidal behavior in clinical gambling disorder patients is common, but markedly more common in the presence of substance use and other comorbid disorders.
... In the field of mental health, many researchers focus on comparing the classification accuracy (ACC) of several different screening scales (e.g., Dowling et al., 2018; van Heyningen, Honikman, Tomlinson, Field, & Myer, 2018) with receiver operating characteristics (ROC). There are also studies comparing the ACC of different classification techniques within a single scale. ...
Article
Deep neural network (DNN) has been widely used in various artificial intelligence applications and is, unsurprisingly, penetrating the field of school psychology. In the school environment, universal screening is used by teachers to identify children’s emotional and behavioral risk (EBR) within a screener. EBR can be used to predict possible emotional and behavioral disorders, which impact children’s educational and social outcomes. Using the BASC-2 Behavioral and Emotional Screening System Teacher Rating Scale (BASC-2 BESS TRS; Reynolds & Kamphaus (2004). Behavior Assessment System for Children (2nd ed.). Circle Pines, MN: American Guidance Service) norm data, we classified children’s EBR status from normal to at-risk using DNN. Data oversampling was used to overcome the imbalanced sample feature (i.e., few cases with emotional and behavioral disorder). Traditional machine learning methods, such as Naïve Bayes and logistic regression, were included for comparison. The results indicated that the DNN with oversampling achieved the highest performance levels with accuracy (ACC) of .957, precision (PPV) of .545, true positive rate (TPR or sensitivity) of 1.000, and true negative rate (TNR or specificity) of .942 compared with the other methods. This novel method is helpful to provide accurate screening results for early identification of children’s EBR. The current study provides a useful guide for researchers to apply the DNN and oversampling to classification in assessment-related research.
... Funding for the management of PG in mental health services can act as a facilitator in terms of addressing competing priorities and raising the importance or profile of PG among mental health patients. For example, in recent years, there has been considerable investment in building mental health clinician capacity in responding to alcohol and drug issues across Australia, as evidenced by the development and aims of the National Comorbidity Guidelines, in addition to state-specific strategies, such as the Victorian Dual Diagnosis Initiative [28] and the Victorian Government's "no wrong-door" investment [36]. Such initiatives have seen an increase in mental health workforce capacity to deal with substance use issues as well as greater utilization of routine mental health screening across the alcohol and other drug sector. ...
Article
Full-text available
Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.
... To identify individuals with at-risk problem gambling (i.e., the beginning stages of the GD), we need to adopt standardized screening for problem gambling across healthcare settings that interact with military populations. The implementation of standardized screening for problem gambling could serve to detect those earlier in the course of the illness, thus reducing full onset of the GD, which in turn would prevent much of the irrevocable psychological, medical, social, and financial problems associated with problem gambling [77]. Results from this systematic review suggest that the implementation of standardized screening for GD among organizations (DOD military bases, Veterans Affairs Medical Centers, universities with veteran student programming) that serve US veterans is strongly needed. ...
Article
Full-text available
Purpose of Review Gambling disorder (GD) is a debilitating mental illness characterized by persistent patterns of dysregulated gambling behaviors. Recent evidence suggests that US military veterans are a high-risk population vulnerable to the development of problem gambling. This systemic review examined the published literature on the rates, correlates, comorbidities, treatment, and genetic contributions to US veterans’ gambling behaviors in 39 studies. Recent Findings Overall, we found thatUSmilitary veterans have higher rates of GD (including subthreshold problemgambling/ at-risk problem gambling) compared with civilian populations. Further, we found that GD often co-occurred with trauma-related conditions, substance use, and suicidality, which may complicate treatment outcomes. We also noted a lack of published interventions tested among US veterans and standardized screening for gambling problems among veterans across US federal agencies (i.e., Department of Defense, Department of Veterans Affairs) is lacking and remains a significant gap for ongoing prevention and treatment efforts. Summary Despite growing evidence that individuals frommilitary backgrounds (active-duty personnel, retiredmilitary veterans) are vulnerable to developing problem gambling, limited research has been centered on developing prevention and treatment interventions for affected individuals and their families. The lack of standardized screening for problem gambling among healthcare providers that work directly with US military populations remains a significant barrier to care for problem gamblers.
... The same instrument was also used in the study of problem gambling prevalence in European athletes cited above [5], allowing for comparison with the prevalence data of that study. The Lie/Bet instrument has been described to have a high sensitivity (0.81) and specificity (0.94) with respect to problem gambling as measured with the well-established Problem Gambling Severity Index in clinical mental health samples [24]. ...
Article
Full-text available
The world of sports has a complex association to problem gambling, and the sparse research examining problem gambling in athletes has suggested an increased prevalence and particularly high male predominance. The present study aimed to study frequency and correlates of problem gambling in populations with moderate to high involvement in fitness or physical exercise. This is a self-selective online survey focusing on addictive behaviors in physical exercise distributed by ‘fitness influencers’ on social media and other online fitness forums to their followers. Respondents were included if they reported exercise at least thrice weekly, were above 15 years of age, and provided informed consent (N = 3088). Problem gambling, measured with the Lie/Bet, was studied in association with demographic data, substance use, and mental health variables. The occurrence of lifetime problem gambling was 8 percent (12 percent in men, one percent in women). In logistic regression, problem gambling was associated with male gender, younger age, risky alcohol drinking, obsessive-compulsive disorder, and less frequent exercise habits. In conclusion, in this self-recruited population with moderate to high fitness involvement, problem gambling was moderately elevated. As shown previously in elite athletes, the male predominance was larger than in the general population. The findings strengthen the link between problem gambling and the world of sports.
... Problem gambling has also been found to contribute to or exacerbate social isolation, housing instability, and involvement with criminal justice (Dowling et al., 2017;Faregh & Derevensky, 2013;Matheson, Devotta, Wendaferew, & Pedersen, 2014;Sareen, Afifi, McMillan, & Asmundson, 2011;Welte, Barnes, Wieczorek, Tidwell, & Parker, 2001). In particular, problem gambling disproportionately affects those who are living in poverty and those who are precariously housed (Gattis & Cunningham-Williams, 2011;Matheson et al., 2014;Sanacora et al., 2016), with studies reporting a prevalence of problem gambling ranging from 10% in Canada to 46% in Australia within this population (Matheson et al., 2014;Rota-Bartelink & Lipmann, 2007). ...
Article
Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed‐method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in‐person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: “If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?” Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co‐create visual representations of the data. Thirty participants took part in the in‐person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five‐cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co‐developed actionable suggestions that will assist providers in routinely screening for problem gambling.
... It is measured over a 12-month period on a four-point scale (0 = not at all, 3 = almost always) and yields four distinct levels of risk (0 = no risk, 1-2 low risk, 3-7 moderate risk and 8-27 problem gambler). This screen is the most widely used screen for identifying low, moderate and severe problem gambling and good internal consistency and test-retest reliability are reported (Dowling et al. 2018). Readiness to implement strategies was measured by four readiness rulers (Miller and Rollnick 2002): willingness, readiness and confidence to stick to strategies as well as confidence to start using the strategy again should a barrier arise. ...
Article
Full-text available
The aim of this study was to investigate the feasibility and impact of an action and coping planning intervention deployed in gambling venues to improve adherence to expenditure limits. We conducted a 2-group parallel-block randomised controlled trial comparing one 20-min session of action and coping planning to an assessment alone. Gamblers who were intending to set a monetary limit on EGMs (n = 184) were recruited in venues and administered the intervention prior to gambling. Measures were adherence to self-identified gambling limits and adherence to expenditure intentions at 30-days post-intervention using the Time Line Follow-Back. The intervention was feasible in terms of recruitment and willingness of gamblers to engage in a pre-gambling intervention. Most gamblers enacted strategies to limit their gambling prior to entering the venue, albeit these limits were on average higher than the Australian low risk gambling guidelines. In terms of impact, the intervention did not improve adherence to limits at post or 30-day follow-up assessment. However, Moderate Risk/Problem Gamblers in the Intervention group spent less (a median of $60 less) than intended (median $100) within the venue. All intervention participants intended to spend significantly less in the 30 days after the intervention compared to the amount spent in the 30 days prior to the intervention. This reduction was not found for participants in the control group. A simple brief intervention appears feasible in gambling venues and have an impact on gambling intentions over the short term.
... Scores range from 0-27 (0 = no problem, 1-2 low risk, 3-7 moderate risk and 8-27 problem gambling). This scale has demonstrated good psychometric properties with Australian gamblers (Dowling et al., 2018b). ...
Article
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Government and regulator campaigns typically focus on educating gamblers to minimise harms from gambling, but we know little of the full range of strategies gamblers use to stick to limits. This mixed-methods study sought to understand the strategies utilised, recommended or avoided by gamblers. This study recruited 104 participants from 11 EGM venues in Australia, encompassing both no problem/low risk (65%) and moderate risk/problem gamblers (35%). Participants were administered the 30-item Gambling In-venue Strategies Checklist (GISC) and used an average of 14 different strategies over a 30-day period. Two strategies were frequently used by 90% of gamblers: use only the money brought into the venue and only play low denomination machines. Compared to PGs, low risk/no PGs more frequently avoided chasing losses, set cues to keep track of time, used only the money brought into the venue, planned in advance their spending, and also viewed gambling as entertainment. Qualitative analysis revealed the top strategies for limiting gambling were bring in the exact amount of cash and not taking cards and setting a money limit. The measure developed for this study appears to capture a broad range of strategies used by gamblers when engaging with EGM gambling.
... Shorter, more practical screening tools have been assessed for use in mental health services, although none in a UK population. 11 Furthermore, upon establishing the occurrence and severity of a gambling problem, GPs need to know the options available for treatment. Our pilot data suggest that, currently, this is not the case. ...
Article
Despite the increasing number of gamblers in the UK and the overuse of NHS services for associated physical and mental health harms, external agency problem identification for problem gamblers is still very limited. As with alcohol and drug misuse, GPs can have a critical role in early detection of disordered gambling, and referral to enable early intervention before crisis point. However, in the absence of suitable identification and accessible intervention strategies for gambling, there are legitimate reasons for debate regarding the appropriate role of GPs.
... Information was also collected about current and past gambling behaviours, and risk of gambling harm using the 5-item Brief Problem Gambling Screen (BPGS) [Volberg and Williams 2011]. The positive endorsement of one or more items on this screen classified an individual as 'at risk' of gambling harm [Dowling et al., 2018;Volberg and Williams 2011]. The interview then explored participant's experiences with gambling, with a particular focus on EGMs. ...
Article
Full-text available
Background While the prevalence of women’s participation in gambling is steadily increasing, there is a well-recognised male bias in gambling research and policy. Few papers have sought to synthesise the literature relating to women and gambling-related harm and provide practical suggestions to guide future research, policy, and practice which take into account the specific nuances associated with women’s gambling. Methods A narrative literature review was conducted to review the evidence base on women’s gambling behaviours and experiences of harm. Drawing from strategies used effectively in other areas of public health, key elements for a gendered approach to harm prevention were identified and adapted into practical public health research, policy and practice strategies. Results Results indicated a lack of research that explores women’s gambling. Few studies have examined the impact of gambling on the lives of women, with limited understanding of the factors that influence women’s engagement with gambling products, and the impact of industry tactics. A gendered approach was identified as a strategy used successfully in other areas of public health to shift the focus onto women and to ensure they are considered in research. In tobacco control, increasing trends in women’s smoking behaviour were combatted with targeted research, policy and practical initiatives. These key elements were adapted to create a conceptual framework for reducing and preventing gambling harm in women. The framework provides regulatory direction and a research agenda to minimise gambling-related harm for women both in Australia and internationally. Evidence-based policies should be implemented to focus on the influence of gender and associated factors to address gambling-related harm. Practical interventions must take into account how women conceptualise and respond to gambling risk in order to develop specific harm prevention programs which respond to their needs. Conclusion A gendered approach to gambling harm prevention shifts the focus onto the unique factors associated with women’s gambling and specific ways to prevent harm. As seen in other areas of public health, such a framework enables harm measures, policies, and interventions to be developed that are salient to girls and women’s lives, experiences and circumstances. Electronic supplementary material The online version of this article (10.1186/s12954-019-0284-8) contains supplementary material, which is available to authorized users.
... Notwithstanding such limitations, research has treated the PGSI as the best available measure of low severity problems; for example, when evaluating brief tools for screening in health service environments. Such studies support assertions that these tools are appropriate for identifying severe gambling problems, and have limited utility for identification of low severity issues in mental health services (Dowling et al., 2017) and primary care (Cowlishaw, McCambridge, & Kessler, 2018). ...
Article
Full-text available
Addressing gambling problems across a continuum requires understanding of low severity problems, as well as severe levels of problem gambling or disorder. The aims of this study were thus to derive a map of how problematic gambling behaviours and harms are situated across a continuum, and identify the best available indicators of low severity problems to inform assessment and secondary prevention. This involved the Rasch analyses of baseline data from the Quinte Longitudinal Study (QLS); a community-based survey involving random-digit dialling of numbers around Belleville, Canada. Participants were n = 1305 adults with non-zero scores across 26-items from: the Problem Gambling Severity Index (PGSI); the NORC DSM Screen for Gambling Problems (NODS); and the Problem and Pathological Gambling Measure (PPGM). Results indicated that item-level measures except chasing losses provided fit to the Rasch model, and most were clustered within a narrow region of the continuum which resembled addictive disorders. At the most severe end were mainly items about harms, while there were few items representing low severity levels (feeling guilty, betting more than one can afford, attempts to reduce gambling, gambling more than intended). There was Differential Item Functioning (DIF) for several indicators of low severity problems. The findings suggest that measures remain closely aligned with psychiatric models and are suited for discriminating across severe levels of problem gambling or addictive disorder. Although cognitive-affective and behavioural indicators comprise the best available indicators of low severity symptoms, there is an urgent need for improvements in conceptualisation and measurement.
... The problem gambling cut-off has also been further classified as low (8-18) and high gambling severity (19-27) (Dowling et al. 2017). Multiple studies report good internal consistency, test-retest reliability and criterion validity with other measures of gambling (Dowling et al. 2018;Holtgraves 2009). ...
Article
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Problem gambling is often accompanied by co-morbid psychiatric disorders and maladaptive personality traits. Subtyping gamblers based on these pervasive comorbidities has been attempted so as to aid understanding of the aetiology of problem gambling and inform treatment options. However, there has been less focus on subtyping gamblers with (past or current) or without a history of problem gambling, or on providing more specific treatment or self-help recommendations. The current study sought to subtype current-, past-, and non-problem gamblers using three common comorbidities; psychological distress, risky alcohol use, and impulsivity. Participants’ endorsement of helpful behaviour change strategies was also examined by subtype membership. A total of 385 participants were recruited who had a current gambling problem (n = 128; 33%), a past gambling problem (n = 131, 34%) or never had a gambling problem (n = 126, 33%). Hierarchical cluster analysis identified distinct subtypes of current (i.e., low comorbidity, high psychological distress, risky alcohol use and high comorbidity), past (i.e., low comorbidity, high psychological distress and high comorbidity) and non-problem gamblers (i.e., low comorbidity, high psychological distress, risky alcohol use and moderate impulsivity). The most helpful change strategies for current and past gamblers were similar across subtypes (i.e., accept that gambling needs to change, remind yourself of the negative consequences). Non-problem gamblers reported the most helpful strategy as setting financial limits. This study indicated that treatment of psychological distress, risky alcohol use or impulsivity may be important for all gamblers regardless of their level of risk.
... In step 1, we aimed to identify as many existing gambling measures as possible. We conducted an extensive literature search consisting of review articles of gambling measures [15][16][17] and a prior, unpublished compilation of measures by local colleagues (personal communications A. Nilsson & K. Magnusson). The result was a list of 48 gambling measures. ...
Preprint
UNSTRUCTURED Research on identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. These circumstances are problematic when, for example, comparing the effectiveness of different treatments. This protocol describes the development of the Gambling Disorders Identification Test (G-DIT) as a 9-12 item multiple-choice scale with three domains: (1) Gambling consumption behaviors, (2) symptom severity, and (3) negative consequences. The scale is developed to be analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT). The G-DIT will be developed in four steps: (1) Identify items eligible for the G-DIT from a pool of existing gambling measures; (2) present proposed items for evaluation by invited expert researchers in an online Delphi process and subsequent consensus meetings; (3) pilot test a draft 9-12 item version in a small group of problem gambling participants (n=10-20); and (4) evaluate the psychometric properties of the final G-DIT measure in relation to existing instruments and self-reported DSM-5 criteria, among individuals with problem gambling as well as non-problematic recreational gambling (N=600). This protocol article briefly summarizes step 1 and describes steps 2 and 3 in detail. Implementation of this online Delphi study early on in the psychometric development process should contribute to the G-DIT’s face and construct validity. We hope the new instrument will complement existing screening scales in coming intervention trials among community and treatment-seeking samples, and prove useful as a standard outcome measure in the problem gambling research field.
... Problem gambling was measured using the NODS-CLiP [17], a three-item instrument which has demonstrated acceptable psychometric properties in the screening of problem gambling [18] [19]. Items included address the following criteria likely to indicate problematic gambling; the patient has ever experienced an episode with increased tolerance for gambling, a reported need to cut back on gambling, or a need to lie to concerned significant others about the extent of her/his gambling. ...
Article
Cross-sectional studies have established a robust correlational link between loot box engagement and problem gambling, but the causal connections are unknown. This longitudinal study tested for ‘migration’ from loot box use to gambling initiation 6-months later. A sample of gamers (aged 18–26) was stratified into two subgroups at baseline: 415 non-gamblers and 221 gamblers. Self-reported engagement with video game microtransactions distinguished loot boxes and ‘direct purchase’ microtransactions (DPMs). Loot box expenditure and the Risky Loot Box Index (RLI) were tested as predictors of self-identified gambling initiation and spend at follow-up. At baseline, gamblers spent significantly more than non-gamblers on microtransactions. Among baseline non-gamblers, loot box expenditure and RLI predicted gambling initiation (logistic regressions) and later gambling spending (linear regressions). DPM expenditure did not predict gambling initiation or spend after correcting for multiple comparisons, underscoring the key role of randomized rewards. Exploratory analyses tested whether baseline gambling predicted loot box consumption (the ‘reverse pathway’): among loot box non-users, gambling-related cognitive distortions predicted subsequent loot box expenditure. These data provide empirical evidence for a migration from loot boxes to gambling. Preliminary evidence is also provided for a reverse pathway, of loot box initiation by gamblers. These findings support regulatory steps directed toward young gamers and those who gamble.
Article
Purpose To explore the personal gambling behavior and problem symptoms of social workers and other mental health providers to gauge their level of self-awareness, an important prerequisite to identifying and assisting clients who gamble. Method A survey was conducted with a convenience sample of 2,317 social workers and other mental health providers. Results Bivariate and regression analyses found that than 76% of participants reported gambling in the past year, and nearly 30% gambled at moderate or high frequency. About 5% reported one or more problem gambling symptom. Nearly 78% of participants, endorsing between two and ten gambling activities, denied they gambled, and 23% gambled at moderate to high frequency. Overall, 55% of all participants with at least one problem gambling symptom denied gambling. Discussion/Conclusion It is critical for providers to receive training and education to understand their own gambling behaviors and problem symptoms, which could adversely impact the therapeutic relationship.
Article
Gambling‐related harms are increasingly recognised as public health concerns internationally. One response is to improve identification of and support for those affected by gambling‐related harms, including individuals who gamble and those close to them, ‘affected others’. Adult social care services have been identified as a setting in which screening for gambling‐related harms is suitable and desirable. To achieve this, a tool is required which can identify gambling‐related harms experienced by individuals and affected others. This scoping review aimed to identify whether any brief (i.e. three questions or less) screening tools are being used and, if so, how brief screening for gambling‐related harm is being implemented in health and social care‐related contexts. An international English language scoping review of research and grey literature was undertaken between April and July 2021. The search included single‐item and brief screening tools which have been developed to identify gambling‐related harms for individuals and affected others across a range of health and social care‐related contexts. Findings show that screening tools for gambling‐related harms have been developed for use in health settings rather than in social care contexts. For example within gambling, mental health or substance misuse support services. We found no evidence of a brief or single‐item screening tool for identifying harms to individuals and affected others which is of adequate quality to strongly recommend for use in an adult social care setting. Development of a validated brief or single‐item screening tool is recommended to assist adult social care practitioners to effectively screen, identify, support and signpost people affected by gambling‐related harms.
Article
Gambling disorder (GD) is estimated to be experienced by about 0.5% of the adult population in the United States. The etiology of GD is complex and includes genetic and environmental factors. Specific populations appear particularly vulnerable to GD. GD often goes unrecognized and untreated. GD often co-occurs with other conditions, particularly psychiatric disorders. Behavioral interventions are supported in the treatment of GD. No medications have a formal indication for the GD, although clinical trials suggest some may be helpful. Noninvasive neuromodulation is being explored as a possible treatment. Improved identification, prevention, and treatment of GD are warranted.
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Despite the rapid expansion of legalized gambling, few social workers are trained to identify problem gambling symptoms. This study explored gambling knowledge, behavior, and problem symptoms in a sample of 1,777 clinical social workers through an online survey. Findings indicate about 77% of social workers gambled and more than 4% of those who gambled reported at least one problem gambling symptom. Participants answered less than half of the knowledge questions correctly, and a majority were unaware of the current diagnostic classification for gambling disorder or the legal age for gambling. Results of a multivariate regression analysis found that social workers in practice 8 to 15 years, employed in substance treatment facilities or universities, and/or with training in gambling treatment had higher levels of knowledge about gambling and gambling treatment. Findings underscore the need for social work schools and organizations to prioritize education and training for problem gambling identification and treatment.
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Aims During the COVID-19 pandemic, many treatment or help services for gambling were closed or moved online. At the same time, closures of gambling opportunities impacted gambling availability and practices. This study investigates gamblers’ and their concerned significant others’ (CSOs) experiences and views on treatment and help services during this exceptional time and perceptions on how to develop services further after the pandemic. Design Three online questionnaires to elicit gambler and CSO experiences were conducted during the spring 2020 in Finland. In total, 847 respondents answered and shared experiences on how the situation had impacted their gambling behaviour and service needs, how service closures or the moving of services online had impacted them, and how they thought the prevention and treatment of gambling harms should be organised during and after COVID-19. Results Changed gambling practices reduced overall service needs. Service closures had negative impacts, but online services were considered positively, as these provided a low-threshold option. Respondents also shared insights into how the service provision for gamblers should further be developed during and after COVID-19.
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Background Gambling Disorder (GD) has been associated with considerable mental and physical health risks in clinical samples. The paper determines risk factors, mental and physical health burden of probable GD for both men and women in the general population. Methods In the Gutenberg Health Study, a population-based sample of N = 11,875 aged 40–80 years was analyzed regarding lifetime probable GD prevalence (measured with the Lie/ Bet Questionnaire) and a wide array of health variables including standardized measures of depression, anxiety, and somatic symptoms. Results Probable GD lifetime prevalence was 2.1%, with higher rates among 1st generation migrants (5.5%; vs. non-migrants 1.6%), men (3.0%; vs. women 1.2%), and the sample’s youngest age decade (40–49 y., 3.1%). Lifetime probable GD was associated with current work-related, family and financial stressors as well as unhealthy behavior (smoking, extended screen time), and lifetime legal offenses. In men, but not in women, increased rates of imprisonment, mental and somatic symptoms were found. Conclusions GD is a major public health problem with serious social, mental and physical health burden. Epidemiological findings underscore the preponderance of GD among 1st generation migrants and men. Findings are consistent with a vicious cycle of family, work related and financial stress factors, and mental and physical burden, particularly in men. Demographic risk factors may help to target specific prevention and treatment efforts.
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Although most people gamble safely, national prevalence rates indicate that approximately 0.2 to 1% of the Australian population experience problems with gambling. An issue that has not been extensively researched in Australia is whether the nature of gambling, and the associated harms is consistently observed across the nation. In particular, are there are differences between metropolitan and rural areas in people’s experiences with gambling and the associated impacts? A qualitative study involving interviews with 10 help-seekers affected by problem gambling examined the nature of gambling in rural and remote areas and the potential barriers and challenges associated with help-seeking. Particular issues relevant to rural gamblers that set them apart from metropolitan gamblers were: limitations in leisure choices in rural areas; the problem of social familiarity in relation to anonymous help-seeking; and the dearth of specialized services. This study highlights the need to consider the role of rural-specific barriers, motivating and protective factors in developing service delivery models and specialized interventions for problem gambling in rural and remote communities.
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Loot boxes are virtual goods in video games that produce randomly-generated in-game rewards, and have attracted scrutiny because of a resemblance to gambling. This study tests relationships between gaming involvement, engagement with loot boxes, and their associations with disordered gambling and gambling-related cognitions. Online questionnaires were completed by 144 adults via MTurk (Study 1) and 113 undergraduates (Study 2). Gaming and loot box-related variables included estimated time spent gaming and monthly expenditure, the Internet Gaming Disorder Scale (IGDS), and questions that assessed perceptions and behaviours related to loot boxes. Most participants thought loot boxes were a form of gambling (68.1% & 86.2%). A subset of items were condensed into a unidimensional “Risky Loot-box Index” (RLI) via exploratory factor analysis. In Study 1, the RLI showed significant associations with the Problem Gambling Severity Index (r =.491, p <.001) and the Gambling Related Cognitions Scale (r =.518, p <.001). Overall, gambling-related variables predicted 37.1% (p <.001) of the variance in RLI scores. Findings were replicated, though attenuated, in Study 2. These results demonstrate that besides the surface similarity of loot boxes to gambling, loot box engagement is correlated with gambling beliefs and problematic gambling behaviour in adult gamers.
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Although most gamblers set limits on their gambling and stick to them most of the time, there are times when limits are breached (a ‘bust’). Little is known about the prevalence, reasons for and strategies to address busts despite associated harms with a single bust. This mixed methods study used an online survey with a sample of electronic gaming machine gamblers. A total of 104 gamblers were recruited from 11 Australian gambling venues and almost half (45%) reported a bust in the past 12 months. The amount of money spent on the bust ranged from $20 to $1500 AUD (M = $446, SD = $402). The presence of a bust was positively associated with the amount of money spent in the past 30 days, and self-reported greater gambling related harms and greater gambling severity. Reasons for busts included both distal (pre-venue) factors (i.e., negative affect, lapse in intentions to set a limit, needing to win money) and proximal (inside venue) factors (i.e., chasing losses, wins or spins, social facilitation and losing money too quickly). Bust-prevention strategies identified by participants were both distal (e.g., avoid gambling altogether, leave cards or cash at home, set a time or money limit) and proximal (e.g., walk away when losing and change the manner of gambling). As busts are relative to a priori limits, gamblers at any level of gambling severity can experience a bust. Repeated busts may be an indicator of loss of control and a progression towards problem gambling. Interventions need to focus on factors that mitigate the risk of a bust (e.g., pre-commitment) and that assist gamblers to stick to their limits all of the time.
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Background and aims Relatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia. Methods A total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling. Results The gambling participation rate was 41.6% [95% CI = 38.2–44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0–22.4] as “non-problem gamblers,” 7.2% [CI = 5.4–8.9] as “low-risk” gamblers, 8.4% [CI = 6.5–10.2] as “moderate-risk” gamblers, and 6.3% [CI = 4.7–8.0] as “problem gamblers.” One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98–9.37]), borderline personality (OR = 2.59 [CI = 1.13–5.94]), bipolar affective (OR = 2.01 [CI = 1.07–3.80]), and psychotic (OR = 1.83 [CI = 1.03–3.25]) disorders were significant predictors of problem gambling. Discussion and conclusions Patients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria’s adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling.
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Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.
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Standard approaches to sample size specify power, significance, treatment effect, one-or two-sided test and allocation ratio, to yield the number of patients. Typical reactions are “I can only get 60”. Statisticians often respond by seeing what effect the available number can “buy” for reasonable significance/power. This approach can extend to other constraints. Time is the most important because “How quickly we need the answer” defines the overall duration, partitioned into setup & closedown, minimum follow-up (enough to see response), and accrual time (related to number of sites, rate of site opening and recruitment per site). The last site opened must also contribute patients before accrual ends. From these quantities the number of patients follows, but will this be enough to detect a signal? A signal is strong evidence favouring H1 rather than H0, encapsulated in the likelihood ratio (LR). This combines power, significance and effect size. Constraints are what defines strong evidence, the chance of finding this if H1 is true, plus the risk of misleading strong evidence favouring H1 when H0 is true. Other constraints are the need for Maturity (follow-up enough to observe late outcomes) and Generalizability (reduced by restrictive eligibility criteria that give more power, but also take longer to recruit). Lastly Money: the budget must be consistent with what the proposed funder is prepared to pay. In reality sample size for a trial is a compromise chosen from many possible alternatives. It should never be taught as if unthinking application of a mathematical formula will suffice.
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The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5–DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.
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Background, aims and design: The increase in mobile telephone-only households may be a source of bias for traditional landline gambling prevalence surveys. Aims were to: (1) identify Australian gambling participation and problem gambling prevalence using a dual-frame (50% landline and 50% mobile telephone) computer-assisted telephone interviewing methodology; (2) explore the predictors of sample frame and telephone status; and (3) explore the degree to which sample frame and telephone status moderate the relationships between respondent characteristics and problem gambling. Setting and participants: A total of 2000 adult respondents residing in Australia were interviewed from March to April 2013. Measurements: Participation in multiple gambling activities and Problem Gambling Severity Index (PGSI). Findings: Estimates were: gambling participation [63.9%, 95% confidence interval (CI) = 61.4-66.3], problem gambling (0.4%, 95% CI = 0.2-0.8), moderate-risk gambling (1.9%, 95% CI = 1.3-2.6) and low-risk gambling (3.0%, 95% CI = 2.2-4.0). Relative to the landline frame, the mobile frame was more likely to gamble on horse/greyhound races [odds ratio (OR) = 1.4], casino table games (OR = 5.0), sporting events (OR = 2.2), private games (OR = 1.9) and the internet (OR = 6.5); less likely to gamble on lotteries (OR = 0.6); and more likely to gamble on five or more activities (OR = 2.4), display problem gambling (OR = 6.4) and endorse PGSI items (OR = 2.4-6.1). Only casino table gambling (OR = 2.9) and internet gambling (OR = 3.5) independently predicted mobile frame membership. Telephone status (landline frame versus mobile dual users and mobile-only users) displayed similar findings. Finally, sample frame and/or telephone status moderated the relationship between gender, relationship status, health and problem gambling (OR = 2.9-7.6). Conclusion: Given expected future increases in the mobile telephone-only population, best practice in population gambling research should use dual frame sampling methodologies (at least 50% landline and 50% mobile telephone) for telephone interviewing.
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Background North American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.Method The Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).Conclusions Approximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems. © The Royal College of Psychiatrists 2015.
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To describe the services provided to young people aged 12-25 years who attend headspace centres across Australia, and how these services are being delivered. A census of headspace clients commencing an episode of care between 1 April 2013 and 31 March 2014. All young people first attending one of the 55 fully established headspace centres during the data collection period (33 038 young people). Main reason for presentation, wait time, service type, service provider type, funding stream. Most young people presented for mental health problems and situational problems (such as bullying or relationship problems); most of those who presented for other problems also received mental health care services as needed. Wait time for the first appointment was 2 weeks or less for 80.1% of clients; only 5.3% waited for more than 4 weeks. The main services provided were a mixture of intake and assessment and mental health care, provided mainly by psychologists, intake workers and allied mental health workers. These were generally funded by the headspace grant and the Medicare Benefits Schedule. headspace centres are providing direct and indirect access to mental health care for young people.
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The goal of this study was to determine the diagnostic accuracy of brief screens for Gambling Disorder within a sample of people receiving outpatient treatment for substance use disorders. Individuals (n = 300) recruited from intensive outpatient substance use treatment (23.67%) or methadone maintenance programs (76.34%) participated in the study. Four brief screens for Gambling Disorder were administered and compared to DSM-5 criteria. Receiver operator curves were created and an Area Under the Curve (AUC) analysis (an overall summary of the utility of the scale to correctly identify Gambling Disorder) was assessed for each. On average participants were aged 46.4 years (SD = 10.2), African American/Black (70.7%), with an income less than $20,000/year (89.5%). Half the participants were female. Approximately 40% of participants (40.5%; n = 121) met DSM-5 criteria for Gambling Disorder. Accuracy of the brief screens as measured by hit rate were .88 for the BBGS, .77 for the Lie/Bet, .75 for NODS-PERC, and .73 for the NODS-CLiP. AUC analysis revealed that the NODS-PERC (AUC: .93 (95% CI: .91-.96)) and NODS-CLiP (AUC: .90 (95% CI: .86-.93)) had excellent accuracy. The NODS-PERC and NODS-CLiP had excellent accuracy at all cut-off points. However, the BBGS appeared to have the best accuracy at its specified cut-off point. Commonly used brief screens for Gambling Disorder appear to be associated with good diagnostic accuracy when used in substance use treatment settings. The choice of which brief screen to use may best be decided by the needs of the clinical setting. (Am J Addict 2015;XX:XX -XX). © American Academy of Addiction Psychiatry.
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The Problem Gambling Severity Index, the scored module of the Canadian Problem Gambling Index, is a population-based survey instrument that is becoming the preferred epidemiological tool for estimating the prevalence of disordered gambling. While some validation evidence for the Problem Gambling Severity Index is available, very little is known about its psychometric characteristics in developing countries or in countries the populations of which are not highly Westernised. The aim of this study was to investigate the validity of the Problem Gambling Severity Index with a specific focus on its criterion-related and construct (concurrent) validity in a community sample of gamblers in South Africa (n = 127). To this end, the Problem Gambling Severity Index was administered alongside the Diagnostic Interview for Gambling Severity and measures known to associate with gambling severity (impulsivity, current debt, social problems, financial loss, race, sex). Results showed that the Problem Gambling Severity Index was predictive of Diagnostic Interview for Gambling Severity diagnosis from both a categorical and dimensional point of view and demonstrated high discrimination accuracy for subjects with problem gambling. Analysis of sensitivity and specificity at different cut-points suggests that a slightly lower Problem Gambling Severity Index score may be used as a screening cut-off for problem gambling among South African gamblers. The Problem Gambling Severity Index also showed significant correlations with the Barratt Impulsiveness Scale, a widely known measure of impulsivity, and with some of the predicted behavioural variables of interest (gambling activities, money lost to gambling, current debt, interpersonal conflict). This article therefore demonstrates initial criterion and concurrent validity for the Problem Gambling Severity Index for use in South African samples.
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Objective: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. Methods: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. Results: Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5–93.9) and lifetime (75.5%, 95% CI 46.5–91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9–34.0), alcohol use disorders (21.2%, 95% CI 15.6–28.1), anxiety disorders (17.6%, 95% CI 10.8–27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7–24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7–75.2) and major depressive disorder (29.9%, 95% CI 20.5–41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4–24.2), alcohol dependence (15.2%, 95% CI 10.2–22.0), social phobia (14.9%, 95% CI 2.0–59.8), generalised anxiety disorder (14.4%, 95% CI 3.9–40.8), panic disorder (13.7%, 95% CI 6.7–26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4–35.7), cannabis use disorder (11.5%, 95% CI 4.8–25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1–19.6), adjustment disorder (9.2%, 95% CI 4.8–17.2), bipolar disorder (8.8%, 95% CI 4.4–17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4–18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. Conclusions: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.
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The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem gambling in a family violence victimisation treatment sample and to explore the relationship between problem gambling and family violence in other treatment-seeking samples. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services (n=463), family violence services (n=95), alcohol and drug services (n=47), mental health services (n=51), and financial counselling services (n=48). The prevalence of family violence in the gambling sample was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence sample was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) samples reported significantly higher rates of any family violence than the gambling sample, while the financial counselling sample (10.6%) reported significantly higher rates of problem gambling than the family violence sample. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine screening, assessment and management of problem gambling and family violence in a range of services.
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The purpose of this study is to investigate change in gambling behaviours over the life course, and, correspondingly, the treatment-seeking behaviours of 86 people who met the criteria for at-risk (participants endorsing two to four items on the South Oaks Gambling Screen [SOGS]) and problem gamblers (participants endorsing five or more items on the SOGS) over the last five years. Data were obtained from informants during semi-structured interviews using Structured Clinical Interview for DSM-IV axis I and axis II disorders (SCID I and II), SOGS and treatment-seeking interviews. The results showed three groups of gambling behaviours over the life course. A first group started gambling early on and continued participating in recreational gambling until its participants were between 40 and 50 years of age, during which time they became problem gamblers. A second group transitioned from recreational gambling to problem gambling over a short period of time; its participants were aged between 40 and 50. Lastly, a third group which was exposed to gambling later on in life, mostly after retirement, developed gambling problems quickly. Psychopathology was prevalent in all groups, given that 98% suffered from a mental health problem during their life, and 62% within the last six months. Participants who made use of the services available mostly turned to medical and specialized mental services for brief periods, usually when in crisis. In terms of problem gambling, the results argue in favour of maintaining dedication toward treatment, especially in the presence of co-morbidity.
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Improved methodology was used to re-examine the weak correspondence between problem and pathological gamblers identified in population surveys and subsequent classification of these individuals in clinical interviews. The SOGS-R, the CPGI, the NODS and the Problem and Pathological Gambling Measure (PPGM), as well as questions about gambling participation and expenditures, were administered to a total of 7272 adults. Two clinicians then assessed each person's status, based on comprehensive written profiles derived from these questionnaire responses. Instrument classification was then compared to clinical classification. All four instruments correctly classified most non-problem gamblers (i.e. had good to excellent sensitivity, specificity and negative predictive power). However, the PPGM was the only instrument with good classification of problem gamblers (i.e. excellent sensitivity and positive predictive power). The CPGI and SOGS-R had weak positive predictive power and the NODS had only adequate sensitivity and positive predictive power. Improvement in the classification accuracy of the CPGI occurred when a 5+ cut-off was used and when a 4+ cut-off was used with the SOGS. In general, the classification accuracy of the NODS, SOGS and CPGI is better than prior research suggested but overall accuracy is still modest. With adjusted cut-offs, all three instruments are reasonably congruent with clinical ratings.
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New technology is changing the nature of gambling with interactive modes of gambling becoming putatively associated with higher rates of problem gambling. This paper presents the first nationally representative data on the prevalence and correlates of problem gambling among Australian adults since 1999 and focuses on the impact of interactive gambling. A telephone survey of 15,006 adults was conducted. Of these, 2,010 gamblers (all interactive gamblers and a randomly selected subsample of those reporting land-based gambling in the past 12 months) also completed more detailed measures of problem gambling, substance use, psychological distress, and help-seeking. Problem gambling rates among interactive gamblers were 3 times higher than for noninteractive gamblers. However, problem and moderate risk gamblers were most likely to attribute problems to electronic gaming machines and land-based gambling, suggesting that although interactive forms of gambling are associated with substantial problems, interactive gamblers experience significant harms from land-based gambling. The findings demonstrate that problem gambling remains a significant public health issue that is changing in response to new technologies, and it is important to develop strategies that minimize harms among interactive gamblers. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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To provide the first national profile of the characteristics of young people (aged 12-25 years) accessing headspace centre services - the Australian Government's innovation in youth mental health service delivery - and investigate whether headspace is providing early service access for adolescents and young adults with emerging mental health problems. Census of all young people accessing a headspace centre across the national network of 55 centres comprising a total of 21 274 headspace clients between 1 January and 30 June 2013. Reason for presentation, Kessler Psychological Distress Scale, stage of illness, diagnosis, functioning. Young people were most likely to present with mood and anxiety symptoms and disorders, self-reporting their reason for attendance as problems with how they felt. Client demographic characteristics tended to reflect population-level distributions, although clients from regional areas and of Aboriginal and Torres Strait Islander background were particularly well represented, whereas those who were born outside Australia were underrepresented. headspace centres are providing a point of service access for young Australians with high levels of psychological distress and need for care in the early stages of the development of mental disorder.
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Clinical predictions made by mental health practitioners are compared with those using statistical approaches. Sixty-seven studies were identified from a comprehensive search of 56 years of research; 92 effect sizes were derived from these studies. The overall effect of clinical versus statistical prediction showed a somewhat greater accuracy for statistical methods. The most stringent sample of studies, from which 48 effect sizes were extracted, indicated a 13% increase in accuracy using statistical versus clinical methods. Several variables influenced this overall effect. Clinical and statistical prediction accuracy varied by type of prediction, the setting in which predictor data were gathered, the type of statistical formula used, and the amount of information available to the clinicians and the formulas. Recommendations are provided about when and under what conditions counseling psychologists might use statistical formulas as well as when they can rely on clinical methods. Implications for clinical judgment research and training are discussed.
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The Problem Gambling Severity Index (PGSI) is a widely used nine item scale for measuring the severity of gambling problems in the general population. Of the four gambler types defined by the PGSI, non-problem, low-risk, moderate-risk and problem gamblers, only the latter category underwent any validity testing during the scale's development, despite the fact that over 95% of gamblers fall into one of the remaining three categories. Using Canadian population data on over 25,000 gamblers, we conducted a comprehensive validity and reliability analysis of the four PGSI gambler types. The temporal stability of PGSI subtype over a 14-month interval was modest but adequate (intraclass correlation coefficient = 0.63). There was strong evidence for the validity of the non-problem and problem gambler categories however the low-risk and moderate-risk categories showed poor discriminant validity using the existing scoring rules. The validity of these categories was improved with a simple modification to the scoring system.
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The focus of this report is to examine the process of validation of new screening tests designed to detect the problem gambler in research and practice settings. A hierarchical or phases of evaluation model is presented as a conceptual framework to describe the basic features of the validation process and its implications for application and interpretation of test results. The report describes a number of threats to validity in the form of sources of unintended bias that when unrecognized may lead to incorrect interpretations of study results and the drawing of incorrect conclusions about the usefulness of the new screening tests. Examples drawn from the gambling literature on problem gambling are used to illustrate some of the more important concepts including spectrum bias and clinical variation in test accuracy. The concept of zones of severity and the bias inherent in selecting criterion thresholds are reviewed. A definition of reference or study gold standard is provided. The use of 2-stage designs to establish validity by efficiently using reference standards to determine indices of accuracy and prevalence is recommended.
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The Problem Gambling Research and Treatment Centre (PGRTC) has developed the first evidence-based guideline to address problem gambling in Australia — Guideline for screening, assessment and treatment in problem gambling. The entire guideline and related appendices have been approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) under s. 14A of the National Health and Medical Research Council Act 1992. In approving the guideline, the NHMRC considered that it meets the NHMRC’s standard for clinical practice guidelines. The full guideline addresses screening, assessment and treatment issues relating to problem gambling; in this abridged outline, we focus solely on treatment interventions for problem gamblers.
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Increases in the availability of gambling heighten the need for a short screening measure of problem gambling. The Problem Gambling Severity Index (PGSI) is a brief measure that allows for the assessment of characteristics of gambling behavior and severity and its consequences. The authors evaluate the psychometric properties of the PGSI using item response theory methods in a representative sample of the urban adult population in South Africa (N = 3,000). The PGSI items were evaluated for differential item functioning (DIF) due to language translation. DIF was not detected. The PGSI was found to be unidimensional, and use of the nominal categories model provided additional information at higher values of the underlying construct relative to a simpler binary model. This study contributes to the growing literature supporting the PGSI as the screen of choice for assessing gambling problems in the general population.
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