Risk factors for gambling problems. Registry-based studies (REGGAM)

Registry data on gambling behavior and health to identify risk factors for developing gambling problems was used. Data on gambling behavior (from the period 2011-2018) is provided by Norsk Tipping (NT). Data on gambling disorder is taken from the Norwegian Patient Register (NPR) for the period 2008-2018. This data is linked to the Population Registry where information on place of birth/citizenship and divorce is included, to the FD-database where information on income, sick leave, unemployment benefit and disability benefit is extracted, and to the prescription registry where information including prescriptions for Parkinson's and depression and information on substance abuse disorders were taken. We investigated whether these factors are risk factors for developing problems with gambling. So far, 6 articles from the project have been published, 5 have been submitted for publication: 1) Age: Data from NT was used from those who had played on slot machines (Multix). Older people had higher theoretical losses (discrepancy between stake and average payback percentage). Among the most intense players, women had higher losses than men. It is concluded that among slot machine players, the elderly and women constitute vulnerable groups. The article is published in International Gambling Studies (https://doi.org/10.1080/14459795.2023.2199051). 2) Gender: The article investigated if women develop gambling problems faster than men (telescoping effect). Data was obtained from NT. Women were older than men when they made their gaming debut. The median time to a loss limit was reached was faster (46 months) for women than men (55 months). It is concluded that women develop gambling problems (reach loss limit) faster than men. The study provides support for the telescoping effect. The article is published in Psychology of Addictive Behaviors (DOI: 10.1037/adb0000844). 3) Ethnicity: Data stemmed from the Norwegian Patient Registry and examined whether place of birth (proxy for ethnicity) predicted gambling disorder diagnosis. A control group from the general population and from the Norwegian Patient Register without gambling disorder was included. When controlling for gender and age, there was a reduced probability of an ethnic minority being diagnosed with gambling disorder. When also controlling for citizenship and number of years lived in Norway, the findings were largely reversed and people born outside Norway (other Nordic countries, Asia and Africa) were more likely to be diagnosed with gambling disorder than those born in Norway. It is concluded that gambling problems are probably more widespread among ethnic minorities, but that they underuse health services related to gambling problems until they have obtained citizenship and/or have lived in Norway for some time. The article is published in BMC Psychology (https://doi.org/10.1186/s40359-023-01391-0). 4) Income: Data from the Norwegian Patient Register and a control group from the general population and a control group from the Norwegian Patient Register without gambling disorder were used. People with gambling disorder were more likely than both control groups to belong to the lowest income quartile. Expected income for those with gambling disorder was lower than the population average. Group-based developmental modeling was done to identify income groups within those with gambling disorder. In all 7 groups were found. Men typically belonged to the groups with the highest income, while women and young people typically belonged to the groups with the lowest income. The findings are published in SSM Population Health (https://doi.org/10.1016/j.ssmph.2023.101504). 5) Substance abuse disorders: We investigated the temporal relationship between substance abuse disorders and gambling disorder. A significant path from substance abuse disorder to gambling disorder was found, but not the opposite. The findings were shown for 4 abuse conditions and support the assumption that substance abuse disorder is a risk factor for gambling disorder. The article is published in Addictive Behaviors Report (https://doi.org/10.1016/j.abrep.2023.100501). 6) Marital status. Among those who were married those becoming divorced had increased likelihood of getting a gambling disorder diagnosis compared to those who remained married. Among those who were unmarried at baseline, the probability of developing gambling disorder was reduced among those who became married compared to those remaining unmarried. The findings indicate that being single is a risk factor for developing gambling disorder. The findings are published in BMC Psychiatry (DOI: 10.1186/s12888-023-04697-w). Articles on the following risk factors: Disability benefits, unemployment, sickness absence, dopamine agonists and depression have been submitted for publication. When all the articles have been published, a user-friendly overview of identified risk factors for gambling problems will be prepared.

I alt 6 artikler fra prosjektet er publisert og 5 er innsendt for publikasjon. Når alle artiklene er publisert vil det bli laget en enkel brosjyre/folder som oppsummerer funnene og som peker på identifiserte risikofaktorer for pengespillproblemer. Funnene vil være relevant for de som driver med forebygging, behandling, rådgivning, og informasjon om pengespillproblem. Sentrale aktører her er klinikere/behandlere, selvhjelpsgrupper, myndigheter, spillselskap og pårørende. Ved å peke på risikofaktorer kan en bedre forebygge, rådgi og behandle (inklusive å forebygge tilbakefall) pengespillproblemer.

In the present project, the state gambling monopolist in Norway, Norsk Tipping, will provide player-account data that the company has collected from all players since 2009, when such data, linking a player card to the social security number, became mandatory. Gambling behavior in terms of time gambled, number of sessions, money staked and money lost, times met daily and monthly loss limits, and PlayScan status (indicating degree of problems) will be used. Norsk Tipping has in total 2.2 million players, and over 100 000 play on slot machines (Multix). In Norway, there are in addition several well-kept population and health registries, also linked to the social security number. One is the Norwegian Social Insurance Database, containing information about income, sick leave compensation, disability pension and marital status. Other registries are the Norwegian Prescription Database, monitoring all drugs dispensed by prescription in Norway. Further registries are the Norwegian Patient Registry (NPR), covering all inpatient and outpatient hospital care in Norway containing detailed data on diagnoses and the Norwegian Population Registry holding information about, among other things, citizenship of all people living in Norway. We aim to link data from these registries, overall covering a seven-year period. Linking of data will be conducted by Statistics Norway, after approval of the Norwegian Data Protection Authority. Through this we will objectively investigate how potential risk factors such as age, gender, change in marital status, ethnicity, income, sick leave, unemployment, disability pension, dopamine agonists, depression and use of antidepressants, and alcohol use disorder influence gambling intensity and gambling problems, longitudinally. A user group comprising gambling authorities, gambling operators, clinicians and patients/next of kin will be established and will act as consultants throughout the project period.