1
|
Diaz-Sanahuja L, Suso-Ribera C, Lucas I, Jiménez-Murcia S, Tur C, Gual-Montolio P, Paredes-Mealla M, García-Palacios A, Bretón-López JM. A Self-Applied Psychological Treatment for Gambling-Related Problems via The Internet: A Pilot, Feasibility Study. J Gambl Stud 2024:10.1007/s10899-024-10318-2. [PMID: 38795233 DOI: 10.1007/s10899-024-10318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 05/27/2024]
Abstract
The main purpose of this study was to evaluate the feasibility of an online psychological intervention for individuals with gambling-related problems, supported by ecological momentary assessments and interventions (EMAs and EMIs), along with weekly phone-calls, before conducting a randomized controlled trial. Participants were required to complete 3 of the 8 modules of the program based on cognitive-behavioral therapy (CBT) and extensions and innovations of CBT. The study measured the outcomes of feasibility (i.e., reach, appropriateness, technology literacy and technology usability, fidelity, and adherence). In terms of reach, 19.8% (n = 11) of the initial population met the inclusion criteria and completed the three modules (mean age = 41; 90.9% men). The perceived appropriateness and the technology usability after the first use were both excellent, fidelity and adherence to the online treatment (73.3%) were adequate. Adherence to the EMAs and the weekly phone calls were more modest (54.51% and 66.67%, respectively). The results of the present study show that an online treatment for gambling problems enhanced by EMA and EMI might be feasible but challenges were noted in terms of reach and adherence to these assessments and calls. These challenges are important to consider for future trials and the scalability of treatments for individuals with gambling disorders.
Collapse
Affiliation(s)
- Laura Diaz-Sanahuja
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain.
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Ignacio Lucas
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Psychology and Psychobiology, Universidad de Barcelona, Barcelona, Spain
| | - Cintia Tur
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Macarena Paredes-Mealla
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juana María Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
2
|
Seel CJ, Jones M, Christensen DR, May R, Hoon AE, Dymond S. Treatment of harmful gambling: a scoping review of United Kingdom-based intervention research. BMC Psychiatry 2024; 24:392. [PMID: 38783231 PMCID: PMC11112764 DOI: 10.1186/s12888-024-05843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Understanding and treating the harm caused by gambling is a growing international psychiatric and public health challenge. Treatment of gambling harm may involve psychological and pharmacological intervention, in conjunction with peer support. This scoping review was conducted to identify, for the first time, the characteristics and extent of United Kingdom (UK) based gambling treatment research. We reviewed studies conducted among people seeking treatment for disordered or harmful gambling in the UK, the settings, research designs, and outcome measures used, and to identify any treatment research gaps. METHODS Systematic searches of PsycInfo, PsycArticles, Scopus, PubMed, and Web of Science databases were carried out for gambling treatment research or evaluation studies conducted in the UK. Studies were included if they evaluated the effectiveness of an intervention or treatment designed to improve symptoms of harmful or problematic gambling, reported outcomes of interventions on treatment adherence, gambling symptoms, or behaviours using standardised measures, were conducted in the UK, and were published since 2000. RESULTS Eight studies met the inclusion criteria. Four were retrospective chart reviews, two were single-participant case reports, one described a retrospective case series, and one employed a cross-sectional design. None used an experimental design. CONCLUSION The limited number of studies included in this review highlights a relative paucity of gambling treatment research conducted in UK settings. Further work should seek to identify potential barriers and obstacles to conducting gambling treatment research in the UK.
Collapse
Affiliation(s)
- Christopher J Seel
- School of Psychology, Swansea University, Singleton Campus, Swansea, SA2 8PP, UK
| | - Matthew Jones
- School of Psychology, Swansea University, Singleton Campus, Swansea, SA2 8PP, UK
| | | | - Richard May
- School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, CF371DL, UK
| | - Alice E Hoon
- Swansea University Medical School, Singleton Campus, Swansea, SA2 8PP, UK
| | - Simon Dymond
- School of Psychology, Swansea University, Singleton Campus, Swansea, SA2 8PP, UK.
- Department of Psychology, Reykjavík University, Menntavegur 1, Nauthólsvík, 101 Reykjavík, Reykjavik, Iceland.
| |
Collapse
|
3
|
Koompah D, Teye-Kwadjo E, Kretchy IA. Problem Gambling and Suicidal Behaviours in Young Adult men in Ghana: A Moderated Mediation Model of Psychological Distress and Social Support : Journal of Gambling Studies. J Gambl Stud 2024:10.1007/s10899-024-10305-7. [PMID: 38652387 DOI: 10.1007/s10899-024-10305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours.
Collapse
Affiliation(s)
- Dorothy Koompah
- Department of Psychology, University of Ghana, P. O. Box LG84, Legon, Accra, Ghana
| | - Enoch Teye-Kwadjo
- Department of Psychology, University of Ghana, P. O. Box LG84, Legon, Accra, Ghana.
- Department of Industrial Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P. O. Box LG43, Legon, Ghana
| |
Collapse
|
4
|
Wilson C, Butler N, Quigg Z. Harms from Other People's Gambling: Associations with an Individual's Own Gambling Behaviours, Health Risk Behaviours, Financial Problems, General Health, and Mental Wellbeing. J Gambl Stud 2024:10.1007/s10899-024-10291-w. [PMID: 38489134 DOI: 10.1007/s10899-024-10291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/17/2024]
Abstract
This study aimed to explore relationships between being an 'affected other' (AO) and an individual's own gambling, health risk behaviours, financial problems, poor general health, and low mental wellbeing. A cross-sectional survey using representative and supplementary convenience samples was undertaken with 1234 residents of a British Island aged 16 + years. Being an AO was measured as having a partner or relative who has been gambling regularly in the past 12 months. PGSI was used to assess gambling severity. Health risk behaviours included: poor diet, low physical activity, daily smoking, and binge drinking. Other measures included experiencing financial problems, poor general health, and low mental wellbeing. Analyses were performed using χ2 and binary logistic regressions. 11.0% of participants were AOs. AOs were more likely to gamble at at-risk/problem-gambling levels and experience financial problems compared to those who were not affected others. The significant relationship between being an AO and low mental wellbeing was mediated by experiencing financial problems. The relationship between being an AO and engaging in two or more health risk behaviours was no longer significant after controlling for sociodemographics and an individual's own gambling. The relationship between being an AO and poor general health was no longer significant after controlling for sociodemographics, health risk behaviours and an individual's own gambling. AOs experienced risks to health and wellbeing, with findings not limited to AOs specifically with a relationship to an individual with problem-gambling. Therefore, support for AOs should be more widely available, aiming to address AOs' needs holistically.
Collapse
Affiliation(s)
- Charley Wilson
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Liverpool, L3 2ET, UK.
| | - Nadia Butler
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Liverpool, L3 2ET, UK
| | - Zara Quigg
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Liverpool, L3 2ET, UK
| |
Collapse
|
5
|
Estévez A, Macía L, Ontalvilla A, Aurrekoetxea M. Exploring the psychosocial characteristics of women with gambling disorder through a qualitative study. Front Psychol 2023; 14:1294149. [PMID: 38173857 PMCID: PMC10761503 DOI: 10.3389/fpsyg.2023.1294149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Gambling disorder is a behavioral addiction that has been primarily male, but in the last few years, the age of onset has been equated between the sexes. The profile of female gamblers could be different from that of men. Consequently, this study analyzes the testimonies of women with gambling disorder to determine their specific characteristics (gambling motives, gambling preferences, and associated pathologies). Method The sample comprises 18 women with gambling disorder aged between 30 and 68. Three discussion groups were held, and a "blind" inductive process was carried out to extract categories. The Atlas.Ti 22.0 program was used to recode and analyze the data. Results Results show that women may start gambling due to abuse suffered in childhood, and often family members initiate women into gambling. Likewise, the onset of gambling could be a maladaptive way to manage negative emotions. Also highlighted is the predominance of feelings of social stigmatization, which can be reflected in women's choice of games where they are not visible. Comorbidity with other disorders such as depression, anxiety, bipolar disorder, personality disorders, and the use of other substances are noteworthy. Discussion The factors explaining why female gamblers do not seek treatment compared to male gamblers are analyzed. More studies on women's experience with gambling are needed to address the specific characteristics of gambling disorder in women.
Collapse
Affiliation(s)
- Ana Estévez
- Psychology Department, University of Deusto, Bilbao, Spain
| | - Laura Macía
- Psychology Department, University of Deusto, Bilbao, Spain
| | | | - Maite Aurrekoetxea
- Department of Social and Human Sciences, University of Deusto, Bilbao, Spain
| |
Collapse
|
6
|
Grubbs JB, Chapman H, Milner LA, Floyd CG, Kraus SW. Comorbid psychiatric diagnoses and gaming preferences in US armed forces veterans receiving inpatient treatment for gambling disorder. Addict Behav 2023; 147:107840. [PMID: 37643505 DOI: 10.1016/j.addbeh.2023.107840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
Armed Forces Veterans are uniquely vulnerable to problem gambling and gambling disorder. Even so, research regarding the full clinical profile of veterans with gambling problems lags. Gambling activities vary widely from each other, but most gambling activities can be understood as either strategic (i.e., involving some measure of skill and decision-making as a part of the gambling practice) or non-strategic (i.e., gambling activities that are entirely based on chance). Prior works have found that gamblers that prefer strategic gambling activities and those that prefer nonstrategic gambling activities often differ from each other in key ways, with the two preferences being linked to varying motivations for gambling, varying cognitions about gambling, and the course of gambling disorder. The present work sought to examine how preferences for strategic vs. nonstrategic gambling might be related to psychiatric comorbidities among U.S. Armed Forces Veterans receiving inpatient treatment for Gambling Disorder. Data from U.S. Armed Forces Veterans (N = 401) receiving residential treatment for GD between the years of 2010-2016 were analyzed. Results demonstrated that gamblers that preferred strategic gambling, as opposed to non-strategic gambling, were more likely to be younger, more likely to be men, less likely to have a nicotine use disorder, and less likely to have PTSD. Such findings suggest that gamblers with PTSD are likely to prefer nonstrategic games and may imply a unique vulnerability to gambling problems related to non-strategic gambling among armed forces veterans.
Collapse
Affiliation(s)
- Joshua B Grubbs
- Department of Psychology, Center on Alcohol, Substance use, And Addictions, University of New Mexico, United States.
| | | | | | | | | |
Collapse
|
7
|
Markham F, Gobaud AN, Mehranbod CA, Morrison CN. Casino accessibility and suicide: A county-level study of 50 US states, 2000 to 2016. Addiction 2023. [PMID: 36739526 DOI: 10.1111/add.16153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Suicide is the tenth leading cause of death in the United States (US). Research over many decades identifies that its etiology is complex, with risk factors operating in multiple domains. One such risk factor is gambling. Over the past three decades, exposure to gambling has increased dramatically in the United States. The aim of this study was to measure the magnitude of the association between casino density and absolute risk of suicide in US counties. DESIGN, SETTING, CASES This spatial panel analysis used data for 3131 counties from 50 US states from 2000 to 2016, for an overall sample of 53 227 county-year units. Using Bayesian conditional autoregressive Poisson models, we measured incidence rate ratios and credible intervals for the association between the density per population of casinos and other gambling outlets and the incidence of suicide. MEASUREMENTS The outcome of interest was counts of suicides. The main exposures of interest were casinos and other gambling outlets. FINDINGS A total of 527 401 suicides occurred during the study period. On average, there was a mean of 1.3 casinos (SD = 9.1) and 1.4 other gambling venues (SD = 5.9) in each county-year. After controlling for confounding, the incidence rate ratio for casinos was 1.016, and the credible interval was between 1.010 and 1.023. CONCLUSIONS The density of casinos and other gambling venues is positively associated with suicide mortality in the United States.
Collapse
Affiliation(s)
- Francis Markham
- Centre for Aboriginal Economic Policy Research, Australian National University, Australia
| | - Ariana N Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Christina A Mehranbod
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Christopher N Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| |
Collapse
|
8
|
Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. Suicidal Behaviors and Associated Factors Among Individuals with Gambling Disorders: A Meta-Analysis. J Gambl Stud 2023; 39:751-777. [PMID: 36693983 DOI: 10.1007/s10899-023-10188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
The risk for suicidal behaviors including suicide ideations and attempts among individuals with gambling disorder (IWGDs) is high compared to the general population. Little is known about the interplay of mood disorders, alcohol use disorders, and suicidal behaviors among IWGDs. The study aimed to determine the prevalence, sociodemographic characteristics, risky behaviors, mental health disorders, and alcohol use disorders associated with suicide behaviors among IWGDs. Studies published between January 1 1995 and September 1 2022 were obtained from following databases: PubMed, Scopus, Web of Science and Cochrane Library databases. PECOS (population, exposures, comparison, outcome, and study design) criteria were used for selecting studies. The Newcastle-Ottawa Scale (NOS) was used for assessing risk of bias and rated each study in terms of exposure, outcome, and comparability. After initial assessment of 10,243 papers, a total of 39 studies met the eligibility criteria. Among IWGDs, the findings indicated a life-time pooled prevalence rate of 31% for suicide ideations (95% CI, 23-39%), 17% for suicide plans (95% CI, 0-34%), and 16% for suicide attempts (95% CI, 12-20%). Generally, suicide ideations among IWGDs were associated with having any financial debt and having chronic physical illnesses, as well as experiencing depression, mood disorders, and alcohol use disorders. Suicide attempts among IWGDs were associated with being older and having a childhood history of sexual abuse, as well as experiencing depression, mood disorders and alcohol use disorders. Interventions can help to facilitate seeking support among IWGDs by de-stigmatizing mental health disorders as well as improving the quality of care presented to individuals with psychiatric conditions.
Collapse
Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran. .,Department of Public Health, Saveh University of Medical Sciences, Saveh, Iran.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| |
Collapse
|
9
|
Wilson C, Butler N, Quigg Z. Associations between playing free-to-play sports gambling predictor games and online sports betting frequency for men in the United Kingdom. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aim
This study aimed to describe associations between playing predictor games and online sports betting behaviours, and problem gambling.
Methods
An online survey using a convenience sample was completed by males aged 18 + years, living in the United Kingdom, and having participated in any gambling activity in the past year (n = 384). The survey asked questions about sociodemographics, gambling behaviours and predictor game playing behaviours. The Problem Gambling Severity Index (PGSI) tool was used to determine existence of at-risk and problem gambling. Bivariate analyses using X2, and multivariate analyses using binary logistic regressions were carried out.
Results
Predictor games were played by 45.8% of all participants. In bivariate analyses, there was an association between predictor game playing and age (p = 0.019), with predictor game playing most prevalent in the age group 18–24 years 51.8%. In bivariate analysis, there was a significant graded relationship between playing predictor games and PGSI group (p < 0.001), with predictor game playing most prevalent among those with problem gambling 76.9%. In multivariate analysis, after controlling for sociodemographics and PGSI group, those who played predictor games were 2.80 (1.65–4.74 p < 0.001) times more likely to engage in high frequency online sports gambling than those who did not play predictor games.
Conclusions
This study suggests there may be links between playing predictor games and gambling harms through increased frequency of online sports gambling, particularly amongst already vulnerable groups. Policy options placing restrictions on the most harmful inducements – one of which being predictor games – must be considered to protect against gambling harms.
Collapse
|
10
|
Augner C, Vlasak T, Aichhorn W, Barth A. Psychological online interventions for problem gambling and gambling disorder - A meta-analytic approach. J Psychiatr Res 2022; 151:86-94. [PMID: 35472684 DOI: 10.1016/j.jpsychires.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Covid-19 pandemic has reignited discussions about the prevalence of and treatment options for problem gambling and gambling disorder (PGGD). Since affected persons seldom seek professional help, online interventions can improve accessibility. Thus, this study aimed to investigate the effectiveness of psychological online interventions on PGGD. METHODS We conducted a systematic review and meta-analysis and searched in PubMed, PsycINFO, and Google Scholar for peer-reviewed experimental and quasi-experimental research published between 2010 and 2021. We calculated two meta-anlyses, one for treatment control comparisons (TCC), and one for pre-post-comparisons (PCC). RESULTS We included six studies (ten TCC and n = 2076) in meta-analysis 1 and five studies (six PCC and n = 781) in meta-analysis 2. Online interventions turned out to be effective in both analyses with Hedges g = 0.41, 95% confidence interval = [0.22 to 0.60], p < .001, for meta-anaylsis 1 and Hegdes g = 1.28, 95% confidence interval = [0.85 to 1.71], p < .001, for meta-analysis 2. CONCLUSIONS We identified significant effects of online interventions on PGGD in both analyses, indicating the potential of online applications. We discuss methodological aspects and further research directions.
Collapse
Affiliation(s)
- Christoph Augner
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, University Clinics of the Paracelsus Medical University, Salzburg, Austria; Institute for Human Resources Research in Health Care, University Clinics of the Paracelsus Medical University, Salzburg, Austria.
| | - Thomas Vlasak
- Institute for Psychology, Sigmund Freud University Linz, Austria
| | - Wolfgang Aichhorn
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, University Clinics of the Paracelsus Medical University, Salzburg, Austria
| | - Alfred Barth
- Institute for Psychology, Sigmund Freud University Linz, Austria
| |
Collapse
|
11
|
Marko S, Thomas SL, Robinson K, Daube M. Gamblers' perceptions of responsibility for gambling harm: a critical qualitative inquiry. BMC Public Health 2022; 22:725. [PMID: 35413823 PMCID: PMC9004097 DOI: 10.1186/s12889-022-13109-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/29/2022] [Indexed: 12/31/2022] Open
Abstract
Background Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm. Methods A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted. Results Six common tropes were constructed from gamblers’ responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action – but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices. Conclusions This study demonstrates that gamblers’ perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from ‘responsible gambling’ messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.
Collapse
Affiliation(s)
- Sarah Marko
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia.
| | - Samantha L Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia
| | - Kim Robinson
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
| |
Collapse
|
12
|
Bowden-Jones H, Hook RW, Grant JE, Ioannidis K, Corazza O, Fineberg NA, Singer BF, Roberts A, Bethlehem R, Dymond S, Romero-Garcia R, Robbins TW, Cortese S, Thomas SA, Sahakian BJ, Dowling NA, Chamberlain SR. Gambling disorder in the UK: key research priorities and the urgent need for independent research funding. Lancet Psychiatry 2022; 9:321-329. [PMID: 35180386 PMCID: PMC7612512 DOI: 10.1016/s2215-0366(21)00356-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/31/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.
Collapse
Affiliation(s)
- Henrietta Bowden-Jones
- National Problem Gambling Clinic & National Centre for Gaming Disorders, London, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK; Faculty of Brain Sciences, University of Sussex, Brighton, UK
| | - Roxanne W Hook
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, IL, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ornella Corazza
- Department of Clinical, Pharmacological and Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Naomi A Fineberg
- Department of Psychiatry, University of Cambridge, Cambridge, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertforshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Bryan F Singer
- School of Psychology, University of Sussex, Brighton, UK; Sussex Addiction Research and Intervention Centre, University of Sussex, Brighton, UK; Sussex Neuroscience, University of Sussex, Brighton, UK
| | - Amanda Roberts
- School of Psychology, College of Social Science, University of Lincoln, Lincoln, UK
| | | | - Simon Dymond
- Department of Psychology, Swansea University, Swansea, UK; Department of Psychology, Reykjavík University, Reykjavík, Iceland
| | - Rafa Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Departamento de Fisiología Médica y Biofísica, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shane A Thomas
- School of Health, Federation University, Ballarat, VIC Australia
| | | | - Nicki A Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia; Melbourne Graduate School of Education, University of Melbourne, VIC, Australia
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK.
| |
Collapse
|
13
|
Sharman S, Murphy R, Turner J, Roberts A. Predictors of suicide attempts in male UK gamblers seeking residential treatment. Addict Behav 2022; 126:107171. [PMID: 34772503 DOI: 10.1016/j.addbeh.2021.107171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Disordered gambling can have serious negative consequences for the individual and those around them. Previous research has indicated that disordered gamblers are at an increased risk of suicidal thoughts, ideation and attempts. The current study sought to utilise data from a clinical sample to identify factors that are associated with prior suicide attempts. METHODS The sample included 621 patients entering a gambling-specific residential facility in the UK. A series of Chi-Square analyses and binary logistic regressions were run to identify clinical and sociodemographic variables associated with suicide attempts. RESULTS Of the 20 variables analysed using Chi-square statistics, five were significantly associated with the outcome variable (lifetime attempted suicide): loss of family relationships, loss of home, prior depression, prior suicidal thoughts, and medication use. Regression analysis showed that individuals were more likely to have reported suicide attempts if they had experienced loss of family relationships (1.65 times), loss of a home (1.87 times), prior depression (3.2 times), prior suicidal thoughts (6.14 times), or were taking medication (1.95 times) compared to those not reporting such individual events. CONCLUSIONS Disordered gamblers are vulnerable to suicide; a number of factors have been identified in the current study that predict an increased likelihood of attempted suicide. The factors mainly revolve around loss: not financial loss, but rather disintegration of an individual's support network and deterioration in the individual's mental health. Findings indicate that isolation and negative affect associated with gambling are most influential in attempted suicide and should therefore be more strongly considered when creating and providing the legislative, educational and treatment environments for those experiencing gambling related harm.
Collapse
|
14
|
Abbasi NUH, Iqbal M, Yan Y, Mubarik S, Nadeem M, Turan MB, Younas R. Shame and guilt activations: Associations and sociodemographic differences among ploysubstance abusers. Front Psychiatry 2022; 13:1021876. [PMID: 36339879 PMCID: PMC9633675 DOI: 10.3389/fpsyt.2022.1021876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/06/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Shame and guilt in polysubstance abusers are still understudied despite their significance in substance use disorders (SUD). The goal of the current study is to develop a better understanding of how shame and guilt interact among polysubstance abusers who are receiving residential treatment. METHODS The sample of two hundred four males with SUD admitted to five rehabilitation centers from two cities in Pakistan participated in this study. For comparison, 215 age-matched healthy individuals were recruited (control). All participants reported their scores on the state shame and guilt scale (SSGS) and demographic form. A cross-sectional study design was adopted. RESULTS The group with SUD reported greater activations on SGSS (r = 0.79, p < 0.001) as compared to healthy (control) individuals (r = 0.48, p < 0.001). Further, multivariate analysis indicated that people with SUD who were of older age, unemployed, living in a nuclear family system, with a higher level of education, and low income, experienced higher levels of shame and guilt. Multinomial logistic regression analysis revealed that people with SUD in the age group 41-60 years (OR 5.2, 95%CI 2.4-6.8), unemployed (OR 4.4, 95%CI 3.2-4.7), nuclear family system (OR 5.9, 95%CI 4.5-6.4) and low monthly income group (OR 5.4, 95%CI 3.5-5.8) had a significantly high risk of shame and guilt than the control group. CONCLUSION Findings of the current study indicate an association between shame and guilt activation and SUD. These results suggest that polysubstance users may benefit from therapeutic interventions to avoid a generalization of shame and guilt toward their substance use. Reducing shame and guilt should be considered a priority in treating adults with multiple SUD.
Collapse
Affiliation(s)
| | - Mujahid Iqbal
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, China
| | - Yu Yan
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Muhammad Nadeem
- Department of Psychology, University of Lahore, Lahore, Punjab, Pakistan
| | | | - Romana Younas
- School of Psychology, University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
15
|
Gambling Disorder in an Italian Population: Risk of Suicide Attempts and Associated Demographic-Clinical Factors using Electronic Health Records. J Gambl Stud 2021; 38:1143-1156. [PMID: 34800239 DOI: 10.1007/s10899-021-10088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
To identify the demographic and clinical characteristics associated with access to Emergency Departments for Suicide Attempt in a cohort of patients with Gambling disorders. We used electronic health records of inpatient and outpatient services to identify individuals who received a diagnosis of gambling disorder (ICD-9 or ICD-10 codes) in the Metropolitan area of Bologna from 2009 to 2019. In this cohort we identified accesses to Emergency Departments for suicide attempt through cross-matching with electronic records. We calculated Crude Suicide Attempt Rates; we also included the demographic-clinical variables in a multivariate Poisson regression. We identified 692 patients with a diagnosis of gambling disorder and a total of 2733 Person Years. The Crude Suicide Attempt Rate per 1000 Person Years was 9.17 (95% CI 6.20-13.58), higher for females and much higher than the general population (incidence rate ratio = 93.72). The multivariate analysis showed a higher risk of suicide attempt in the year following the first contact with a clinical service, in patients younger than 45 years, with alcohol use disorders and personality disorders. This study evidenced a high risk of access to Emergency Departments for suicide attempt in individuals with a diagnosis of gambling disorder and highlighted important demographic and clinical factors that should be considered when evaluating suicide risk in this population.
Collapse
|
16
|
Sichali JM, Dube A, Kachiwanda L, Wardle H, Crampin AC, Bunn C. Case Report: A gambling-related suicide in rural Malawi. Wellcome Open Res 2021; 6:308. [PMID: 34869913 PMCID: PMC8609396 DOI: 10.12688/wellcomeopenres.17333.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 01/31/2023] Open
Abstract
Background As in many other countries across sub-Saharan Africa, Malawi's commercial gambling sector has grown considerably in recent years. Driven by the widespread availability of internet through mobile devices, the industry has penetrated both urban and rural settings. In Malawi the model commonly implemented by gambling companies is similar to that used by mobile phone operators. Agents equipped with cellular devices connect to providers' servers to place wagers for customers and print receipts using simple printers attached to their devices. This has produced lucrative returns for providers. While increasing attention is being paid to this trend, most research focusses on sports betting and there is a deficit of papers that document gambling-related harms. Methods Here we present a narrative case report of a 16-year-old boy, 'Wati' (pseudonym), who lived in rural Malawi and took his own life after gambling and losing money that did not belong to him. As his community is part of a demographic surveillance site, a verbal autopsy was conducted, later supplemented with interviews with Wati's close friend and uncle, to whom his mother referred us. We triangulated data from these three sources to create a narrative case report of Wati's suicide and its relationship to his gambling practices. Results We found that the gambling harms leading up to Wati's suicide were recurrent, that his gambling practices were diverse (lottery, football betting, digital games and cards) and that signs of distress were apparent before his suicide. Conclusions From this case report, we learn that underage individuals participate in gambling in Malawi, can develop harmful habits and that their gambling is not confined to sports betting. We also learn that there is a lack of accessible services for people who develop harmful gambling practices. Wati could have benefited from such services and they may have saved his life.
Collapse
Affiliation(s)
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Heather Wardle
- Social and Political Sciences, University of Glasgow, Glasgow, Scotland, G120QQ, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G120QQ, UK
| | - Christopher Bunn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Social and Political Sciences, University of Glasgow, Glasgow, Scotland, G120QQ, UK
| |
Collapse
|
17
|
Valenciano-Mendoza E, Fernández-Aranda F, Granero R, Gómez-Peña M, Moragas L, Pino-Gutierrez AD, Mora-Maltas B, Baenas I, Guillén-Guzmán E, Valero-Solís S, Lara-Huallipe ML, Codina E, Mestre-Bach G, Etxandi M, Menchón JM, Jiménez-Murcia S. Suicidal behavior in patients with gambling disorder and their response to psychological treatment: The roles of gender and gambling preference. J Psychiatr Res 2021; 143:317-326. [PMID: 34536663 DOI: 10.1016/j.jpsychires.2021.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/14/2023]
Abstract
Suicidal ideation and attempts are prevalent among patients with gambling disorder (GD). However, patients with GD and a history of lifetime suicidal events are not a homogeneous group. The main objective of this study was to compare sociodemographic, clinical, personality, and psychopathological features among different profiles of adults with GD with and without a history of suicidal behavior, taking into account two relevant variables: gender and gambling preference. The second aim was to examine how the different profiles of patients with a history of suicidal events responded to cognitive-behavioral therapy (CBT). A total of 1112 treatment-seeking adults who met the criteria for GD were assessed at a hospital specialized unit for the treatment of behavioral addictions. The participants completed self-reported questionnaires to explore GD, personality traits, and psychopathological symptomatology. The lifetime histories of suicidal ideation and attempts, and gambling preferences, were assessed during semi-structured face-to-face clinical interviews. Of the total sample, 229 patients (26.6%) reported suicidal ideation and 74 patients (6.7%), suicide attempts. The likelihood of presenting suicidal ideation was higher for women than men, but no differences were observed based on gambling preference. Regarding suicide attempts, the odds were higher among women with non-strategic forms of gambling. Suicidal ideation and attempts were associated with higher GD severity, a worse psychopathological state and higher self-transcendence levels. In terms of treatment outcomes, neither gambling preference nor past suicidal behavior had an influence on dropouts and relapses. Nevertheless, female gender and a lack of family support constitute two good predictors of a worse treatment outcome.
Collapse
Affiliation(s)
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Amparo Del Pino-Gutierrez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Elías Guillén-Guzmán
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona, Spain
| | - Susana Valero-Solís
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Ester Codina
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Mikel Etxandi
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
18
|
Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111085. [PMID: 34769603 PMCID: PMC8583661 DOI: 10.3390/ijerph182111085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022]
Abstract
Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.
Collapse
|
19
|
Jolly T, Trivedi C, Adnan M, Mansuri Z, Agarwal V. Gambling in patients with major depressive disorder is associated with an elevated risk of Suicide: Insights from 12-years of Nationwide inpatient sample data. Addict Behav 2021; 118:106872. [PMID: 33676161 DOI: 10.1016/j.addbeh.2021.106872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a frequent occurrence of gambling disorder (GD) in patients with major depressive disorder (MDD). Psychiatric comorbidities can present more severely in patients diagnosed with pathological gambling. There is limited information on symptom trends in MDD patients with GD, particularly in association with suicidality. OBJECTIVES Our primary aim was to compare baseline characteristics in MDD patients with and without a GD diagnosis. The secondary aim was to assess the rate of suicidality (suicidal ideation/attempt) between groups and evaluate any predictors that may be associated with an increased risk of suicidal behavior. In addition, we also assessed the variation in gambling trends in MDD patients over several years. METHODS Data for the study were obtained retrospectively from the Nationwide Inpatient Sample (NIS) dataset for the years 2006-2017. Our primary patient cohort was composed of patients age ≥ 18 years; admitted to the hospital with a primary diagnosis of MDD and a secondary diagnosis of GD. For baseline characteristics and suicidality, we compared these patients to MDD patients without a GD diagnosis. In addition, we also assessed the trends of baseline characteristics in MDD patients with GD over the years. RESULTS A total of 6646 patients were included in the MDD with GD group, and compared with 4,021,063 MDD patients without a GD diagnosis. More patients in MDD with GD group were older, white, and male. Alcohol abuse and obesity were seen more commonly in the GD group. In the outcome analysis, suicidal ideation (45.4% vs. 39.5%, p < 0.001), suicide attempt (7.2% v. 4.5%, p < 0.001) and composite of suicidal ideation/attempt (50.7% vs. 43.1%, p < 0.001) were more common in MDD with GD group compared to MDD without GD. In the multivariate analysis, GD was associated with higher odds of suicidality (Odds Ratio: 1.42 (1.35-1.49), p < 0.001). For the in-hospital trend analysis, we observed that, out of all MDD related admissions, comorbid GD related admissions decreased from 0.20% in 2006-2008 to 0.12% in 2015-2017. Among MDD patients with GD, there was an upward trend of inpatient admissions for non-white race, and Southern part of the United States (US) and a downward trend white race, and Western part of the US. CONCLUSIONS There is a higher risk of suicide, with an upward trend over the years in MDD patients with GD when compared to MDD patients without GD. Also, the prevalence of alcohol abuse was high in the GD group. Increased resource allocation and efforts to raise awareness campaigns for suicide prevention are needed to address the morbidity in this vulnerable patient population.
Collapse
Affiliation(s)
- Taranjeet Jolly
- Dept. of Psychiatry & Behavioral Health, Penn State University College of Medicine, 500 University Dr., Hershey, PA 17033, USA.
| | - Chintan Trivedi
- St. David's Medical Center, 1015 E 32 nd Street, Suite 408, Austin, TX 78705, USA
| | - Mahwish Adnan
- Dept. of Psychiatry, Mercy Hospital and Medical Center, 6501 Lincoln Ave, Lincolnwood, IL 60712, USA
| | - Zeeshan Mansuri
- Dept. of Psychiatry, Boston Children's Hospital/Harvard Medical School, 300, Longwood Avenue, Boston, MA 02115, USA
| | - Vishesh Agarwal
- Dept. of Psychiatry, Christiana Care Hospital, 501 W 14(th) Street, Wilmington, DE 19801, USA
| |
Collapse
|
20
|
Muggleton N, Parpart P, Newall P, Leake D, Gathergood J, Stewart N. The association between gambling and financial, social and health outcomes in big financial data. Nat Hum Behav 2021; 5:319-326. [PMID: 33542528 DOI: 10.1038/s41562-020-01045-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/23/2020] [Indexed: 11/09/2022]
Abstract
Gambling is an ordinary pastime for some people, but is associated with addiction and harmful outcomes for others. Evidence of these harms is limited to small-sample, cross-sectional self-reports, such as prevalence surveys. We examine the association between gambling as a proportion of monthly income and 31 financial, social and health outcomes using anonymous data provided by a UK retail bank, aggregated for up to 6.5 million individuals over up to 7 years. Gambling is associated with higher financial distress and lower financial inclusion and planning, and with negative lifestyle, health, well-being and leisure outcomes. Gambling is associated with higher rates of future unemployment and physical disability and, at the highest levels, with substantially increased mortality. Gambling is persistent over time, growing over the sample period, and has higher negative associations among the heaviest gamblers. Our findings inform the debate over the relationship between gambling and life experiences across the population.
Collapse
Affiliation(s)
- Naomi Muggleton
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK. .,Warwick Business School, University of Warwick, Coventry, UK. .,Applied Science, Lloyds Banking Group, London, UK.
| | - Paula Parpart
- Warwick Business School, University of Warwick, Coventry, UK.,Applied Science, Lloyds Banking Group, London, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip Newall
- Warwick Manufacturing Group, University of Warwick, Coventry, UK.,School of Health, Medical and Applied Sciences, CQ University, Melbourne, Australia
| | - David Leake
- Applied Science, Lloyds Banking Group, London, UK
| | - John Gathergood
- School of Economics, University of Nottingham, Nottingham, UK
| | - Neil Stewart
- Warwick Business School, University of Warwick, Coventry, UK
| |
Collapse
|
21
|
Livingstone C, Rintoul A. Gambling-related suicidality: stigma, shame, and neglect. LANCET PUBLIC HEALTH 2021; 6:e4-e5. [PMID: 33417846 DOI: 10.1016/s2468-2667(20)30257-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Charles Livingstone
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Angela Rintoul
- Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| |
Collapse
|
22
|
Flores-Pajot MC, Atif S, Dufour M, Brunelle N, Currie SR, Hodgins DC, Nadeau L, Young MM. Gambling Self-Control Strategies: A Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020586. [PMID: 33445592 PMCID: PMC7827429 DOI: 10.3390/ijerph18020586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/16/2022]
Abstract
There is limited research exploring the perceptions of people who gamble on the self-control strategies used to limit their gambling. This qualitative study examines self-control strategies used to limit money spent gambling, frequency of gambling, and time spent gambling. A total of 56 people who gamble (27 males and 29 females) participated in nine focus groups and five individual interviews in Montreal, Calgary, and Toronto (Canada). Self-control strategies used to limit their gambling expenditure were more common than frequency or time limiting strategies. Strategies to limit expenditure included: restricting access to money; keeping track of money allocated to gambling activities; and avoiding certain types of gambling activities. Various contextual factors were identified to influence those strategies, including social influences; winning or losing; using substances. Findings from this study emphasize the importance of communicating clear gambling limits to people who gamble, as well as the value of developing individual self-control strategies to limit frequency, time and money spent gambling.
Collapse
Affiliation(s)
| | - Sara Atif
- Canadian Centre on Substance Use and Addiction, Ottawa, ON K1P 5E7, Canada; (M.-C.F.-P.); (S.A.)
| | - Magali Dufour
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada;
| | - Natacha Brunelle
- Département de Psychoéducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada;
| | - Shawn R. Currie
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.R.C.); (D.C.H.)
| | - David C. Hodgins
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.R.C.); (D.C.H.)
| | - Louise Nadeau
- Département de Psychologie, Université de Montréal, Montréal, QC H2V 2S9, Canada;
| | - Matthew M. Young
- Canadian Centre on Substance Use and Addiction, Ottawa, ON K1P 5E7, Canada; (M.-C.F.-P.); (S.A.)
- Department of Psychology, Carleton University, Ottawa, ON K1S 5B6, Canada
- Correspondence:
| |
Collapse
|
23
|
Wardle H, McManus S. Suicidality and gambling among young adults in Great Britain: results from a cross-sectional online survey. Lancet Public Health 2021; 6:e39-e49. [PMID: 33417845 PMCID: PMC7788474 DOI: 10.1016/s2468-2667(20)30232-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide rates in young people have increased in England and Wales since 2010. There are a range of possible explanations for this increase, and problem gambling has been suggested as a potential risk factor. We aimed to examine the association between suicidality (suicidal thoughts and suicide attempts) and problem gambling specifically for young adults in Great Britain, where gambling has become more widely available and normalised in the past two decades. METHODS We analysed data from the Emerging Adults Gambling Survey: a cross-sectional, online, non-probability sample survey of young adults aged 16-24 years living in Great Britain, who were selected from a YouGov online panel. Participants were eligible if they had not taken part in any other YouGov survey on gambling in the past year. We examined associations between problem gambling (defined as a score of 8 or higher on the Problem Gambling Severity Index [PGSI]) and suicidal thoughts and suicide attempts in the year before survey completion in a series of regression models, with and without adjustment for sociodemographic factors, alcohol use, video gaming, anxiety, loneliness, and impulsivity. FINDINGS 3549 eligible participants completed the survey between June 25 and Aug 16, 2019. 24 (37·0% [95% CI 25·6-50·2]) of 62 men who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 38 (3·6% [2·6-5·0]) of 1077 men who had not attempted suicide or had suicidal thoughts in the past year. 13 (14·5% [8·5-23·6]) of 85 women who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 25 (2·0% [1·4-3·0]) of 1184 women who had not attempted suicide or had suicidal thoughts in the past year. The adjusted odds ratio for attempted suicide was 9·0 (4·1-19·7) in men with scores that indicated problem gambling and 4·9 (2·0-12·0) in women with scores that indicated problem gambling, compared with participants of the same gender with PGSI scores of 0. INTERPRETATION Problem gambling appears to be associated with suicide attempts in both young men and young women. This association persisted after adjusting for anxiety, impulsivity, life satisfaction, and other factors, which suggests that other mechanisms, such as the severity and multiplicity of harms experienced, or gambling to cope with life stressors, might underpin this relationship. Young people with problem-gambling behaviours should be considered at risk for suicidality. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Heather Wardle
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Sally McManus
- School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
24
|
Swanton TB, Gainsbury SM. Debt stress partly explains the relationship between problem gambling and comorbid mental health problems. Soc Sci Med 2020; 265:113476. [PMID: 33143953 DOI: 10.1016/j.socscimed.2020.113476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE Easy access to consumer credit products, such as credit cards, overdrafts, and personal loans, may facilitate gambling beyond affordable levels, which can result in debt problems. Debt and mental health problems are both potential motivators and core consequences of problem gambling. Debt stress (i.e., worry regarding ability to repay debts) is one potential psychological mechanism underlying the relationship between debt and mental health problems. Few previous studies have investigated debt stress among gamblers. OBJECTIVE This cross-sectional study aimed to investigate the mediating effect of debt stress between gambling frequency and mental health and wellbeing. METHODS & RESULTS A sample of 309 Australian past-month gamblers (83.8% male; mean age 41.5 years) completed an online survey. There was no evidence for the preregistered association between gambling frequency and debt stress, ruling out a predicted mediating effect for debt stress between gambling frequency and mental health and wellbeing. However, exploratory path analysis showed debt stress has statistically significant mediating effects between problem gambling and psychological distress, depression, wellbeing, and gambling-related family impacts, after controlling for sociodemographic factors and psychiatric history. CONCLUSIONS & IMPLICATIONS Debt stress is a robust indicator of financial problems and may indicate underlying problem gambling and mental health issues, making debt stress a useful risk indicator. Clinical services should conduct screening for debt stress and address subjective worry about debts as a standard part of treatment plans as this may help to mitigate some of the impact of gambling and/or financial problems on poor mental health. Health practitioners should develop strong referral networks with gambling and financial counselling services. Government investment in making gambling and financial counselling services freely available and easily accessible is recommended to ensure appropriate support is received via effective care pathways.
Collapse
Affiliation(s)
- Thomas B Swanton
- The University of Sydney, Faculty of Science, School of Psychology, Brain & Mind Centre, Gambling Treatment & Research Clinic, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Sally M Gainsbury
- The University of Sydney, Faculty of Science, School of Psychology, Brain & Mind Centre, Gambling Treatment & Research Clinic, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| |
Collapse
|
25
|
Abstract
The Emerging Adults Gambling Survey is a longitudinal survey of young adults aged 16-24 living in Great Britain. It aims to explore a range of gambling behaviours and harms among young adults and examine how this changes over time. It is part of a broader project funded by Wellcome into the gambling behaviours of young people and its relationship with technological change. Funding is currently available for two waves of data collection: the first collected in June/August 2019 (n=3549) and the second to be collected in June/August 2020. The second wave of data collection will also obtain information about the immediate impact of coronavirus on gambling behaviours. With a sample size of 3549 for Wave 1, this is one of the largest study of gambling behaviours among young adults to be conducted in Great Britain and is a resource for other researchers to draw on. Data will be deposited in the UK Data Archive upon completion of Wave 2 data collection and analysis. This protocol is intended to support other researchers to use this resource by setting out the study design and methods.
Collapse
Affiliation(s)
- Heather Wardle
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK
| |
Collapse
|