Preventing problematic internet use during the COVID-19 pandemic: Consensus guidance.

As a response to the COVID-19 pandemic, many governments have introduced steps such as spatial distancing and "staying at home" to curb its spread and impact. The fear resulting from the disease, the 'lockdown' situation, high levels of uncertainty regarding the future, and financial insecurity raise the level of stress, anxiety, and depression experienced by people all around the world. Psychoactive substances and other reinforcing behaviors (e.g., gambling, video gaming, watching pornography) are often used to reduce stress and anxiety and/or to alleviate depressed mood. The tendency to use such substances and engage in such behaviors in an excessive manner as putative coping strategies in crises like the COVID-19 pandemic is considerable. Moreover, the importance of information and communications technology (ICT) is even higher in the present crisis than usual. ICT has been crucial in keeping parts of the economy going, allowing large groups of people to work and study from home, enhancing social connectedness, providing greatly needed entertainment, etc. Although for the vast majority ICT use is adaptive and should not be pathologized, a subgroup of vulnerable individuals are at risk of developing problematic usage patterns. The present consensus guidance discusses these risks and makes some practical recommendations that may help diminish them.

Self-directed interventions for gambling disorder.

PURPOSE OF REVIEW: To assess recent developments in self-directed interventions for gambling disorder and at-risk gambling. RECENT FINDINGS: Relevant reviews and meta-analyses were published during 2017 and 2018. These reviews assess the nature and efficacy of self-directed and largely self-directed interventions including self-change, assisted self-change and mutual aid support groups. Additional reviews cover government and industry strategies to reduce harm including gambling venue and site self-exclusion and a variety of responsible gambling and consumer protection measures. Further studies were published that advanced understanding of self-directed and related interventions and identified priorities for development and research. SUMMARY: There is variable support for the effectiveness of the foregoing interventions. Some appear to achieve outcomes comparable with professionally delivered therapies. Research is required using more robust designs, larger and more diverse samples and longer follow-up to demonstrate effectiveness and provide a basis for matching at-risk and problem gamblers to interventions of different types and intensity.

Professionally delivered interventions for gambling disorder.

PURPOSE OF REVIEW: To assess recent developments in professionally delivered interventions for gambling disorder. RECENT FINDINGS: During the past 24 months a number of reviews and individual studies have been published. Collectively they assess the efficacy and effectiveness of a range of interventions and identify methodological and other shortcomings. These studies advance knowledge with respect to pharmacological and psychological treatments including brief interventions delivered face-to-face and in other ways. Increased attention has been given to patient diversity, comorbidity, relapse, and nongambling outcomes. A variety of novel interventions have been developed and assessed. SUMMARY: CBT and brief interventions remain well supported and appear to be similarly effective across varied patient groups. A range of promising new and combination treatments have been developed that require further evaluation. Larger, more robust pragmatic trials are required with diverse populations. Increased attention needs to be given to mechanisms of change, therapy mediators, patient retention, comorbidities, long-term treatment outcome, and relapse prevention.

Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale.

Traditionally, gambling and problem gambling research relies on cross-sectional and retrospective designs. This has compromised identification of temporal relationships and causal inference. To overcome these problems a new questionnaire, the Jonsson-Abbott Scale (JAS), was developed and used in a large, prospective, general population study, The Swedish Longitudinal Gambling Study (Swelogs). The JAS has 11 items and seeks to identify early indicators, examine relationships between indicators and assess their capacity to predict future problem progression. The aims of the study were to examine psychometric properties of the JAS (internal consistency and dimensionality) and predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3818 participants. The response rate from the initial baseline wave was 74%. The original sample consisted of a random, stratified selection from the Swedish population register aged between 16 and 84. The results indicate an acceptable fit of a three-factor solution in a confirmatory factor analysis with 'Over consumption,' 'Gambling fallacies,' and 'Reinforcers' as factors. Reinforcers, Over consumption and Gambling fallacies were significant predictors of gambling risk potential and Gambling fallacies and Over consumption were significant predictors of problem gambling onset (incident cases) at 12 month follow up. When controlled for risk potential measured at baseline, the predictor Over consumption was not significant for gambling risk potential at follow up. For incident cases, Gambling fallacies and Over consumption remained significant when controlled for risk potential. Implications of the results for the development of problem gambling, early detection, prevention, and future research are discussed.

Gambling and problem gambling in Sweden: changes between 1998 and 2009.

Gambling participation and rates of problem gambling change over time in response to a variety of factors including gambling availability, demographic changes and adaptation at individual and societal levels. These relationship are complex and only partially understood. The major aim of the present study was to provide general population estimates of gambling participation and problem gambling for Sweden and compare these estimates with estimates from a previous national study. The study was also designed to identify risk factors for problem gambling including change in these factors over time. Data are from the first phase of the Swedish Longitudinal Gambling Study (Swelogs) in which a representative sample of 8,165 people was assessed using validated problem gambling and other measures to facilitate comparison with findings from the 1997/1998 Swedish Gambling Study (Swegs). Overall, it was found that gambling participation reduced markedly, although in some population sectors increases were evident for some forms including poker and electronic gaming machines. Lifetime prevalence of probable pathological gambling increased; however, past 12 months probable pathological and problem gambling prevalence did not. Males, younger adults and people born outside Sweden were at high risk in both studies. Significant prevalence increases were evident for people aged 18-24 and those with low levels of education. The results indicate that relationships between gambling exposure, participation and problems are dynamic with shifting implications for public health and social policy.

Modeling the geographic distribution of serious mental illness in New Zealand.

PURPOSE: This study aims to estimate, apply, and validate a model of the risk of serious mental illness (SMI) in local service areas throughout New Zealand. METHODS: The study employs a secondary analysis of data from the Te Rau Hinengaro Mental Health Survey of 12,992 adults aged 16 years and over from the household population. It uses small area estimation (SAE) methods involving: (1) estimation of a logistic model of risk of SMI; (2) use of the foregoing model for computing estimates, using census data, for District Board areas; (3) validation of estimates against an alternative indicator of SMI prevalence. RESULTS: The model uses age, ethnicity, marital status, employment, and income to predict 92.2 % of respondents' SMI statuses, with a specificity of 95.9 %, sensitivity of 16.9 %, and an AUC of 0.73. The resulting estimates for the District Board areas ranged between 4.1 and 5.7 %, with confidence intervals from ±0.3 to ±1.1 %. The estimates demonstrated a correlation of 0.51 (p = 0.028) with rates of psychiatric hospitalization. CONCLUSIONS: The use of SAE methods demonstrated the capacity for deriving local prevalence rates of SMI, which can be validated against an available indicator.

Knowledge, views and experiences of gambling and gambling-related harms in different ethnic and socio-economic groups in New Zealand.

OBJECTIVE: To describe survey findings which measure broader gambling harms and provide benchmark data to evaluate an awareness and education program to minimise harm; part of NZ's public health approach to problem gambling. To assess whether previously reported ethnic and socio-economic disparities are evident when researching broader gambling harms. METHODS: An in-home, nationwide survey captured data from a multi-stage, random probability sample of 1,774 adults and 199 15-17-year-olds. Oversampling Maori (NZ's indigenous people), Pacific and Asian peoples, and people in areas of deprivation, allowed analysis by ethnicity and socio-economic status. RESULTS: Data show high participation levels; around 8 out of 10 people took part in at least one gambling activity in the previous 12 months. Type and frequency of activities was used to define four groups: infrequent gamblers (60.9%); frequent, non-continuous gamblers (17.6%); frequent, continuous gamblers (4%); and non-gamblers (17.5%). Self-reported knowledge of the signs of gambling harm was high. Arguments about gambling and people going without/unpaid bills provided two indicators of broader gambling harm. Around one-sixth of New Zealanders experienced each of these harms. Impacts were greatest for low-income groups, Maori, and Pacific peoples. CONCLUSIONS: The proportion of New Zealander's experiencing broader gambling harms is much higher than the prevalence for problem gambling. Consistent with other research, results show the flow-on impacts of problem gambling - on family, friends and communities. IMPLICATIONS: Measures can be developed to benchmark the wider harms of gambling and evaluate public health programs addressing harm at population and sub-population levels.

Two years on: gambling amongst Pacific mothers living in New Zealand.

Research investigating the prevalence and correlates of Pacific peoples gambling within a New Zealand context is limited. This paper provides data about gambling activity from the two-year data collection point for a cohort of mothers within the longitudinal Pacific Islands Families study. The results indicate a number of consistencies and discrepancies between data collected at this time point and two years previously (six-week baseline data collection point). For example, at baseline, Samoans were the least likely to gamble and spent less money on gambling activities. Two years later, Samoans remained the least likely to gamble, but those who did gamble, were more likely to spend more money than other ethnicities. This article highlights the importance of this type of prospective study in examining the development of the risk and protective factors in relation to the development of problem gambling.

Postnatal depressive symptoms among Pacific mothers in Auckland: prevalence and risk factors.

OBJECTIVE: To assess the prevalence of and risk factors for postnatal depressive symptoms in a cohort of mothers of Pacific Island infants in Auckland, New Zealand. METHOD: The data were gathered as part of the Pacific Island Families Study, in which 1376 mothers were interviewed when their babies were 6 weeks old. The interview included the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 16.4% of mothers were assessed as probably experiencing depression. Prevalence rates varied from 7.6% for Samoans to 30.9% for Tongans. In addition to ethnicity, risk factors identified by stepwise multiple logistic regression included low Pacific Island acculturation, first birth, stress due to insufficient food, household income less than dollar 40,000, difficulty with transport, dissatisfaction with pregnancy, birth experience, baby's sleep patterns, partner relationship and home. A large prevalence difference between Tongans and other groups remained when the effects of other risk factors were controlled statistically. CONCLUSIONS: The prevalence of depressive symptoms among Pacific mothers is at the upper end of the range typically reported. Focus on the overall rate, however, obscures substantial variation between groups. Risk factors are generally similar to those identified in previous research. IMPLICATIONS: The findings have implications for prevention and treatment and caution against assuming homogeneity within ethnic categories. Further research is required to explain differences in prevalence between Tongan and other Pacific Island groups.

Gambling and problem gambling among recently sentenced male prisoners in four New Zealand prisons.

Recently sentenced inmates in four New Zealand male prisons (N = 357) were interviewed to assess their gambling involvement, problem gambling and criminal offending. Frequent participation in and high expenditure on continuous forms of gambling prior to imprisonment were reported. Nineteen percent said they had been in prison for a gambling-related offence and most of this offending was property-related and non-violent. On the basis of their SOGS-R scores, 21% were lifetime probable pathological gamblers and 16% were probable pathological gamblers during the six months prior to imprisonment. Of the "current" problem gamblers, 51% reported gambling-related offending and 35% had been imprisoned for a crime of this type. Gambling-related offending increased with problem gambling severity. However, only five percent of problem gamblers said their early offending was gambling-related. The large majority reported other types of offending at this time. Few men had sought or received help for gambling problems prior to imprisonment or during their present incarceration. This highlights the potential for assessment and treatment programs in prison to reduce recidivism and adverse effects of problem gambling and gambling-related offending.

Gambling and problem gambling among recently sentenced women in new zealand prisons.

Ninety-four recently sentenced women prisoners were interviewed to assess aspects of their gambling involvement, problem gambling and relationships between gambling and criminal offending. A third of the women, on the basis of their SOGS-R scores, were assessed as lifetime probable pathological gamblers and just under a quarter were assessed as probable pathological gamblers during the 6 months prior to imprisonment. For women prisoners, a preference for non-casino gaming machines and housie were predictive of problem gambling. Relative to non-problem gamblers, problem gamblers experienced higher rates of childhood conduct disorder and current non-psychotic mental disorder. Just over a quarter of prisoners and a half of the problem gamblers had committed a crime to obtain money to gamble. Few women said their early offending or convictions related to gambling. It was concluded that most women were "criminals first and problem gamblers second" rather than people whose offending careers commenced as a consequence of problem gambling. However, the extent of problem gambling-related offending among the women prisoners highlights the potential for comprehensive assessment and treatment programs in prison to reduce recidivism and other adverse impacts of problem gambling and gambling-related offending.

Comparing the New Zealand and Swedish national surveys of gambling and problem gambling.

National surveys of gambling and problem gambling have recently been completed in New Zealand and Sweden. These studies are unique in that data collection was undertaken by official government statistical agencies, involved large, nationally representative samples, and attained high response rates. Comparison of the findings is facilitated by the use of similar procedures and instrumentation and is of interest in that both countries have similar per capita gambling expenditure and welfare states that have recently undergone major economic and social restructuring. Data on gambling participation, problem gambling prevalence and risk factors for problem gambling are presented and discussed. While there are a number of similarities and differences, the Swedish findings are more similar to those of an earlier national survey conducted in New Zealand during 1991. This suggests that risk factors are changing over time in relation to evolving patterns of gambling participation and attitudes towards gambling, a finding that has implications for future patterns of gambling and problem gambling in these and other countries.

A prospective study of problem and regular nonproblem gamblers living in the community.

Little is known about the life course of gambling problems and there have been no prospective studies of problem gambling. This article describes a study of 77 problem gamblers and 66 nonproblem gamblers recruited from a national prevalence survey in New Zealand in 1991 and reassessed in 1998. While most 1991 problem gamblers were nonproblematic at follow-up, a significant minority had developed more serious problems. Multiple logistic regression analysis identified more severe gambling problems, hazardous drinking, and a preference for track betting as the strongest independent predictors of subsequent problem gambling. These findings contradict conventional notions that pathological gambling is invariably a chronic or chronically relapsing disorder. The findings have implications for the interpretation of previous research, conduct of future research, and problem gambling policy and treatment.

Depression in older Chinese migrants to Auckland.

OBJECTIVE: This study was conducted to identify risk factors for depressive symptomatology among older Chinese migrants. METHOD: One hundred and sixty-two Chinese migrants aged 55 years or older, living in the community and recruited via Chinese community organizations and general practitioners, were interviewed using a Chinese version of the Geriatric Depression Scale and measures of stressful life events, morbid conditions, self-rated health, acculturation, social support and service utilization. RESULT: Twenty-six percent of participants met the criteria for depressive symptomatology. No recent migrants showed symptoms of depression. Multiple logistic regression analysis showed that lower emotional support, greater number of visits to a doctor, difficulties in accessing health services and low New Zealand cultural orientation increased the risk of showing symptoms of depression. CONCLUSION: Significant numbers of older Chinese migrants appear to be depressed or at risk for depression and, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. The findings point to the need for further epidemiological study of this growing sector of the population and investigation of the nature of its engagement with health services. Social support and aspects of acculturation may play a significant role in preventing depression. This also requires further investigation.

A Reply to Gambino's "An Epidemiologic Note on Verification Bias: Implications for Estimation of Rates"

While two-stage designs in problem gambling research are expensive and relatively difficult to execute, they have the potential to yield more accurate prevalence estimates as well as valuable additional information about gambling and problem gambling in the community. However, gains in precision are heavily dependent on the accuracy of the screening methods used and the sample sizes involved. Sound practice requires reliable information about the variances and confidence levels associated with different screens. In the spirit of contributing to the ongoing dialog about ways to improve the measurement of problem gambling, we examine several reasons to question whether the revised estimates offered by Gambino are in fact an improvement.