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Response time of the survey had a median of seconds inter-quartile range, — Participants were asked about their gambling involvement across ten different gambling activities during the past 30 days. Gambling-related problems may have severe consequences for the individual, including financial debts 6 , suicidal ideation, suicide attempts 7 , and an increased risk of completed suicide 8. Online gambling has increased in recent years, including online casino games and live sports betting which constitute rapid gambling activities with significant potential for gambling-related harm. However, there is evidence that treatment uptake may be lower in online gamblers, theoretically contributing to the assumption of a more problematic pattern in online gambling In Sweden, the setting addressed in the present study, several signs indicate an increase in online gambling in recent years. Likewise, as hypothesized, no gender differences were seen with respect to problem gambling or over-indebtedness in the adjusted analyses. The emphasis on these two gambling activities was based on the fact that they represent the two leading gambling activities among patients seeking gambling disorder treatment in Sweden Gambling losses were reported in categories derived from a previous epidemiological study in Denmark, a country with socio-demographic characteristics comparable to those of Sweden, where gambling losses and beliefs about peer gambling losses were highly associated with problem gambling Thus, the same categories although in Swedish instead of Danish currency were used. Meanwhile, governmental sources in Sweden have reported that foreign-based online gambling operators were gaining larger and larger shares of the gambling market, typically providing online casino gambling and online sports betting.

The datasets generated for this study are available on request to the corresponding author. The variables included were gender, age, tertiary education any dancing drums 2020 beyond high schoolproblem gambling described as PGSI score in model 1 onlypsychological distress, need for help for alcohol problems, need for help for drug problems, total gambling losses during the past 30 days, and recent specific online gambling activities.

Importantly, authors have argued that online gambling may more info particularly addictive 14due to its speed and availability Also, others have indicated that even though the literature is limited, people gambling online may be particularly likely to have comorbid substance use or mental health problems Meanwhile, the opposite finding of lower psychological distress in more info gamblers compared to land-based gamblers, also has been demonstrated.

Problem gambling was markedly more common in women, but was not associated with gender in the adjusted analysis.

Expected future over-indebtedness, in logistic regression, was significantly associated with psychological distress, degree of problem gambling, and negatively associated with tertiary education.

As hypothesized, and contrary to previous literature in problem gambling overall, in the present study of online gamblers, problem gambling, and over-indebtedness were not associated with male gender in the adjusted models.

For all logistic regression models, the Nagelkerke value is reported. In addition to the gambling pattern, over-indebtedness was associated with psychological distress and alcohol problems, and, for expected future over-indebtedness, with a lower level of schooling. In particular, female gender may need to be addressed as a stronger risk factor than previously described.

Also, based on the reporting of a possible increase in female problem gambling in Sweden in a recent public health report 25the study hypothesized that male gender would not be as strong a predictor of problem gambling as in previous studies 18 In addition, given the role of indebtedness in the harm related to gambling, the present study also hypothesized that over-indebtedness would differ by gambling activities reported.

Brief questions assessed monthly income, and history of loans, the latter also including questions about whether an individual had ever borrowed money in order to be able to gamble or in order to cover losses derived from gambling, and whether this had happened during the past 12 months.

In online gamblers, high rates of problem gambling and over-indebtedness were seen, and online casino gambling alone or in combination with live sports bettingwas associated with remarkably increased risk.

Sample characteristics are reported in Table 1and past day gambling activities are listed in Table 2. In these regression models, variables were entered simultaneously, and calculated with respect to the odds ratio of each variables with a percent confidence interval.

Comparisons between respondents with and without expected future over-indebtedness svenska spel poker sm online 2020 reported in Table 6.

In addition to descriptive data, analyses examined variables associated with three outcome measures, respectively; a history of over-indebtedness everexpected over-indebtedness during the next two months, and problem gambling.

Problem gambling, and a history of having borrowed money for gambling, were markedly higher in online casino gamblers, compared to subjects not reporting this gambling activity. Over-indebtedness has been defined in different ways in previous literature, and definitions tend to fall into three categories; an administrative definition, an objective definition, and a subjective definition These items were derived from the wording used in svenska spel poker sm online 2020 previous report on over-indebtedness from the Swedish Enforcement Authority In addition, other variables included in the analyses addressed gender and age group, whether an individual ever had felt a need to seek svenska spel poker sm online 2020 for alcohol problems, or problems related to illicit drugs or pharmaceuticals with addiction potential, and the level of education was addressed, and categorized in the analyses as whether an individuals had any post-high-school education, or not.

In logistic regression analyses, problem gambling was associated with psychological distress, recent online casino gambling, and recent combined online casino click to see more and live sports betting.

In Sweden, a crazywinners reviews majority of gambling advertisements in television have been reported to represent online gambling, where the gambling advertisements promoting online casino by far outnumber those representing other gambling activities At the same time, changing gender patterns have been described in the most recent general population survey of the national Institute of Public Health, and based on this survey, media reported that the proportion with the highest degree of problem gambling in the survey were more likely to be women than men As this gender distribution is in contrast with previous literature, more research addressing gender differences in novel gambling patterns is warranted 18 In relation to the increase in online gambling, and the theoretically enhanced risk of debts developing rapidly in the online gambling modality, there is need for more research examining how different online gambling activities are related to problem gambling and over-indebtedness.

In logistic regression, lifetime history of over-indebtedness was significantly associated with psychological distress, higher degree of problem gambling, and alcohol problems.

Comparisons between respondents with and without a history of over-indebtedness are reported in Table 4. The main findings demonstrate a very high prevalence of problem gambling in individuals gambling in these gambling activities, and very high rates of over-indebtedness, with large differences depending on the recent gambling activities reported.

Characteristics of the included sample are displayed in Table 1. History of over-indebtedness was associated with recent combined online casino gambling and live sports betting, and expected over-indebtedness was associated with online casino gambling.

Hierarchical logistic regression, with or without problem gambling score PGSI. In order to minimize missing data, respondents who fulfilled criteria of at least a moderate-risk gambling, i.

Altogether, hypotheses were confirmed; problem gambling and learn more here, as hypothesized, differed markedly across types of gambling svenska spel poker sm online 2020, with associations partly remaining when controlling for co-variates.

Eight percent of respondents reported expected over-indebtedness for the next two months. Comparison of respondents with problem gambling and no problem gambling.

Problem gambling was measured using the Problem Gambling Severity Index PGSI, 26and for this nine-item variable, answers were missing on any of the items for a total of 20 individuals. Based on the reporting of online gambling in patients seeking treatment, the study hypothesized that problem gambling would differ by past-month gambling activities reported.

Financial debts contribute to psychological distress and suicidal behavior independent of gambling disorder 10 Over-indebtedness, which refers to an incapacity to fulfil payback requirements, is associated with depressive symptoms, suicidal ideation 12and sleeping problems The past few years have seen an increase in the proportion of online gambling in populations seeking treatment for a gambling disorder.

There is a paucity of research examining whether specific gambling patterns are related to problem gambling and over-indebtedness, when controlling for psychological distress, gender, and other risk factors.

In the second model, when excluding the variable describing problem gambling PGSIfuture over-indebtedness was significantly associated with psychological distress, alcohol problems, negatively associated with tertiary education, and positively associated with online casino gambling Table 7.

In the logistic regression where problem gambling defined by cut-offs in the PGSI was used as the dependent variable, the same independent variables as above were entered.

Chi-squared analysis and Mann-Whitney comparison. The gambling activities listed, for land-based and online gambling modalities, were based on those included in the Swedish updated version of the Addiction Severity Index-gambling ASI-gamblingupdated by the authors and available online from the National Board of Health and Welfare The ASI-gambling is a Swedish adaptation of previously known versions of the ASI for the purpose of measuring gambling patterns and problem gambling Here, the Swedish ASI gambling version served as a template for gambling activities to be included in the study.

Thus, the very high prevalence of PGSI-measured problem gambling and moderate-risk gambling confirm previous hypotheses of a particularly problematic picture in online gamblers 14 — 17 Specifically, problem gambling has been described to be more common in online gamblers than in offline gamblers 37and inherent characteristics of the online gambling modality may inhibit self-control during gambling The fact that gambling is carried out online may not in itself cause gambling problems, but the online modality may increase the risk in some individuals

Finally, a total number of 1, individuals answered the survey. A recent study demonstrated that problem gambling may lead to psychological distress both through a direct pathway, and through a pathway mediated via financial debts 9 , demonstrating the important role of debts in the problem pattern described in patients with a gambling disorder. In logistic regression Table 3 , problem gambling was significantly associated with younger age, psychological distress, a higher level of education, level of recent gambling losses, and with recent online casino gambling and recent combined online casino gambling and live sports betting. When excluding the problem gambling PGSI in the second model, lifetime history of over-indebtedness was significantly associated with psychological distress, alcohol problems, and past day combined online casino and live betting Table 5. Also, in an unadjusted analysis, problem gambling was more than twice as common in women than in men. The K-6 internationally has been shown to perform well as a measure of psychological distress [see for example 31 — 33 ]. The aim of the study was to address roughly 1, adult individuals from the general population, stratified for age, who had gambled for money on either an online casino site or an online betting site on at least 10 occasions during the past 12 months. Therefore, the present study aimed to examine financial debts and problem gambling symptoms in online gamblers, and how debts and problem gambling are related to psychological distress, specific online gambling activities, gender, and socio-demographic data. A higher number of individuals are believed to suffer from problem gambling, a problematic gambling pattern which may or may not fulfil diagnostic criteria. This scale includes nine symptoms related to gambling problems, and constitutes a well- established measure for epidemiological studies of problem gambling in the general population 4 , Here, respondents were categorized as in previous use of the total score of the instrument, with a sum of eight or more describing problem gambling, 3—7 indicating moderate-risk gambling, 1—2 indicating low-risk gambling, and a sum of 0 representing no risk 4. Based on the way this wording is typically used in gambling advertising in Sweden 24 , online casino games are likely to be understood by the general public as slot games, although other casino games appearing online also could be understood by this term. The present study is a cross-sectional survey study conducted in a sample derived from the adult general population, and recruited from a pre-existing web panel of a national market research company. The latter was expressed as a four-level categorical variable describing the occurrence of online casino gambling and online sports betting, respectively. Psychological distress was measured using the Kessler Scale-6, K-6 This scale includes six core symptoms, and the respondent endorsed criteria based on six Likert scales describing how often the respondent has perceived each particular symptom. Also, in helpline callers in Sweden, the share of problem gamblers reporting online gambling has increased in recent years, with online casino being by far the most common among these Along with concerns raised about online casino gambling, authors have also highlighted the addictive potential of live sports betting, i. Gambling disorder is a psychiatric condition listed among addictive disorders along with alcohol and drug use disorders 1 , affecting around 0. Also, the respondents were asked whether they had had debts which during the past 12 months had been passed on to a collection service or to the Swedish Enforcement Authority. The variables related to online casino gambling and live sports betting were categorized into the following; clients gambling on 1 both these two gambling activities, 2 online casino but not live sports betting, 3 live sports betting but not online casino gambling, or 4 none of these two gambling activities. The present study examined over-indebtedness and problem gambling in online gamblers, in a sample defined by the reporting of having gambled on either online casino or sports betting, the two gambling activities reported to be the most common in the gambling disorder treatment setting, on at least ten occasions during the past year. The options provided were the following; casino games online, land-based casino, online horse race betting, land-based horse race betting, sports and odds live betting , sports and odds non-live betting , online poker, land-based poker, land-based electronic gambling machines, and online bingo. For descriptive purposes, unadjusted comparisons were carried out using chi-square method for categorical variables and the Mann-Whitney test for the continuous variable psychological distress, the summed Kessler-6 value, as this was assumed not to be equally distributed. The participants were recruited from the web panel of the market survey company Ipsos, which typically addresses individuals in their web panel for commercial markets surveys and political opinion polls. Thus, increasing concerns about online gambling are raised due to increasing proportions of online gamblers among treatment-seeking patients. Six percent of respondents reported a history of feeling a need to seek treatment for problem gambling. In the examination of factors associated with each outcome measure, logistic regression was used. The present study demonstrated a high prevalence of past-year problem gambling in web panel participants who endorsed the criteria of being online gamblers during the past year. Clients were moved further to the survey only if they gave online written informed consent to the study. Rates of problem gambling and over-indebtedness were markedly higher in individuals reporting recent online casino gambling, alone or in combination with online sports betting. Gender distribution of problem gamblers was clearly in contrast to that found in previous problem gambling literature. The unadjusted comparison between problem gamblers and non-problem gamblers is displayed in Table 3. A general population-based web panel of 1, online gamblers were examined in an online survey addressing problem gambling symptoms the PGSI , psychological distress Kessler- 6 , past day gambling activities, past day gambling losses, history of subjective over-indebtedness and expected over-indebtedness in the near future, as well as socio-demographic data. These findingsa suggest regulations in the market of online casino gambling, and prevention of over-indebtedness in gambling-related borrowing, in consumer credit counselling and in mental health care.