Difficulties in Emotion Regulation, Coping, and Dysfunctional Psychological Symptoms in Family Members of People with Gambling Disorder

Addressing gambling harm to affected others: A scoping review (Part I: Prevalence, socio-demographic profiles, gambling profiles, and harm)

Awareness is growing that gambling harm can affect social networks, including family members and friends. This scoping review broadly aimed to examine contemporary research on gambling harm to adult affected others, covering prevalence, socio-demographic profiles, gambling profiles, and harm (Part I); and coping strategies, assessment, and treatment (Part II). A systematic search of electronic databases identified 121 studies published from 2000, 88 of which related to prevalence (9.9 %), socio-demographic profiles (6.6 %), gambling profiles (4.1 %), and harm (71.9 %). Prevalence estimates in the general population ranged from 4.5 %-21.2 %, though these may overstate direct harm by focusing on exposure to problem gambling. Socio-demographic profiles are mixed, but women are more often affected family members and men are more often affected close friends. Affected others also have higher gambling participation and problems than non-affected individuals. Gambling problems harm an average of six others, who experience an average of seven harms, many of which persist beyond problem resolution, resulting in reduced quality of life. Studies consistently identified harm across multiple domains of harm, with emotional and relationship harms the most common, followed by financial and health harms. Harms were consistently identified using measures with and without direct reference to gambling, but equivocal findings were most evident in research employing standardised measures that did not directly reference gambling. There was some discordance in harm perceptions between gamblers and affected others, suggesting differing family experiences. These findings highlight the need for targeted action by governments, industry, researchers, and service providers to protect affected others from gambling-related harm.

Addressing Gambling Harm to affected others: A scoping review (part II: Coping, assessment and treatment)

Public health definitions of gambling-related harm include risks to family members and friends. This scoping review broadly aims to identify recent research on addressing gambling harm to adult affected others, focusing on prevalence, socio-demographic profiles, gambling profiles, and harm (Part I); and coping strategies, assessment, and treatment (Part II). A systematic search of electronic databases identified 121 studies published from 2000, with 82 focusing on coping strategies (22.3 %), assessment (21.5 %), and treatment (39.7 %). Findings revealed affected others employ various coping strategies, which can be gambler- or family-focussed, before accessing other forms of support. Common strategies include financial strategies and informal support but few studies have assessed their effectiveness. Few brief fit-for-purpose instruments with adequate psychometric evaluation are available to assess affected other status, harm, coping, social support, and help-seeking. Affected others are under-represented in treatment (8 % in general practices, 15 %-26 % in online gambling services, 30 %-43 % in gambling helplines), largely due to various barriers, including a lack of service awareness and shame. Low-intensity internet-delivered interventions show promise and can reach affected others who would not otherwise receive professional help. Other affected other interventions, which can be gambler- and/or family-focused, demonstrate good acceptability but somewhat limited efficacy, while couple interventions demonstrate some promising outcomes, although more rigorous evaluations are needed. The diverse treatment needs and preferences of affected others, coupled with the relatively limited efficacy of current treatments, highlight the need for the development of tailored interventions. The findings of this review can be used to inform clinical, research, and policy decision-making.

The roles of coping style and social support in the experience of harm and distress among people affected by another person's gambling

BACKGROUND

Gambling-related harms can negatively impact the health and wellbeing of those around the person who gambles (affected others, AOs). The stress-strain-coping-support (SSCS) model proposes that the type of coping strategies AOs use, and the availability of social support, can effectively reduce some of these negative consequences. The current study aimed to explore the assumptions in the SSCS model by examining the role of coping styles and social support on the experience of harm and psychological distress in AOs.

METHOD

A community sample (N = 1,131) of AOs completed the Problem Gambling Severity Index (PGSI), Gambling Harm Scale for Affected Others (GHS-AO-20; harm), Significant Other Closeness Scale, Kessler-6 (K6; psychological distress), Brief Coping Questionnaire (coping styles) and the Multidimensional Scale of Perceived Social Support (social support). Data were analysed using hierarchical multiple regression.

RESULTS

The use of maladaptive coping styles was positively associated with harm and psychological distress. Social support was significantly negatively correlated with harm and distress. When all predictors were included in regression analyses, the only significant predictors of harm and distress were being exposed to a more severe gambling problem, being closer to the person with the gambling problem, greater use of maladaptive coping styles, and lower levels of social support. Some interaction effects were identified.

CONCLUSIONS

Some commonly used coping behaviours may inadvertently exacerbate harm and distress, while social support appears to be protective against negative health impacts. Education, treatment, and support to AOs could provide options that address these findings.

Affected Other Prevalence and Profiles: Findings from a Cross-Sectional Australian Population-Representative Gambling Study

Gambling-related harm can extend to family members and friends but few population-representative studies have investigated affected other (AO) prevalence estimates and profiles in the general population. Using data from the 5000 adult respondents in the Fourth Social and Economic Impact Study of Gambling in Tasmania, this study aimed to: (1) identify prevalence estimates of AO status and professional help-seeking; (2) establish the socio-demographic and gambling profiles of AOs; (3) extend the growing literature examining negative mental health characteristics experienced by AOs, after accounting for socio-demographic characteristics and other potential sources of harm; and (4) explore the degree to which gender moderates these relationships. Results found that 1 in 20 adults (5.11%, 95% CI: 4.33, 6.01) reported past-year AO status but only 1 in 7 AOs (14.15%, 95% CI: 9.01, 21.52) had ever sought help in relation to another person's gambling (i.e., < 1% of all adults). AOs were significantly more likely than non-AOs to be younger, Australian-born, employed, and living in households with children. They were significantly more likely than non-AOs to report depression symptoms, anxiety symptoms, binge drinking, tobacco use, and drug use, even after controlling for socio-demographics and other potential sources of harm. Finally, they were more likely to report their own gambling participation, problems, and harm but only 2.20% (95% CI: 0.69, 6.78) had ever sought help for their own gambling. These findings suggest that a considerable proportion of AOs in the general population may benefit from support to improve their own mental health and address their own gambling harm.

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

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

Mediating Role of Rumination Between Anger and Anxious-Depressive Symptomatology in Family Members of People with Gambling Disorder

Gambling disorder is characterized by a behavioural pattern of dysfunctional gambling that persists despite its negative implications in different areas of people's daily life. One of the most negatively affected areas is the one related to family members. This study aimed, firstly, to study the differences between family members of people with gambling disorder and a general population sample in anger (state, trait, expression-out, expression-in. control-out and control-in), rumination (brooding, reflection and total), and anxiety and depression. The second aim was to analyse the correlation between these variables in the family members of people with gambling disorder, and thirdly, to analyse the mediating role of rumination between anger, anxiety and depression. This study consisted of 170 people, of whom 87 were family members of people with a gambling disorder, and 83 were from the general population. Instruments measuring anger, anxiety, depression, and ruminative responses were administered. Results showed that family members had significantly higher scores in anger (state), depression, anxiety, rumination (total and brooding). Also, results showed that anger correlated positively and significantly with rumination, depression and anxiety, which also correlated positively and significantly with each other. Third, rumination mediated the relationship between the following variables: anger (state) and depression; anger (trait) and anxiety and depression; anger (external expression) and anxiety and depression. A complete mediating effect was found in the latter case and a partial mediating effect in the first two cases. In conclusion, it is found that having a family member with a gambling disorder may increase levels of anger, anxiety, depression and rumination. Furthermore, it is shown that working on rumination may reduce depression and anxiety in family members of gamblers.

The Persian Version of the COVID-19 Phobia Scale (Persian-C19P-S) and the Differences in COVID-19-Related Phobic Reactions in Patients with Anxiety Disorders

Coronavirus disease 2019 (COVID-19) is a pandemic outbreak increasing several psychological distress, such as anxiety and phobia, and may affect patients with anxiety disorders. A scale has been recently designed to assess COVID-19-related phobic reactions named the COVID-19 Phobia Scale (C19P-S). The present study aimed to evaluate factor structure, reliability, and validity of the Persian version of the C19P-S (Persian-C19P-S) in patients with anxiety disorders and to compare COVID-19-related phobia among these patients. Three hundred patients with anxiety disorders completed the Persian-C19P-S and other scales assessing anxiety traits (e.g., the Short Health Anxiety Inventory (SHAI), the Health Concerns Questionnaire-54 (HCQ-54), and the Patient Health Questionnaire-4 (PHQ-4)) and COVID-19-related distress (e.g., the COVID Stress Scales (CSS) and the Fear of COVID-19 Scale (FCV-19)). The results showed that the Persian-C19P-S replicated the four-factor structure of the original C19P-S. Internal consistency and test-retest reliability coefficients evidenced the reliability of the scale. The validity of the scale (convergent and discriminant validity) was confirmed. Patients who had generalized anxiety and panic disorders showed higher phobic reactions related to COVID-19 than those with social anxiety disorder and specific phobia. This study indicates that the Persian version of the C19P-S is a valid scale to be used in Iranian patients with anxiety disorders to evaluate COVID-19-related phobia. Moreover, COVID-19-related phobic reactions are higher in some specific types of anxiety disorders.