Problem Gambling Research Articles

Voluntary Self-Exclusion and Contingency Management for the Treatment of Problematic and Harmful Gambling in the UK: An Exploratory Study.

Research into self-directed methods for reducing problematic and harmful gambling is still in its infancy. One strategy that individuals use to prevent gambling involves voluntary self-exclusion (VSE) programs. For example, VSE programs can make it challenging to access betting sites or enable banks to block gambling-related transactions. Although individual VSEs can be helpful when used alone, it is unclear whether their efficacy is enhanced when combined. Furthermore, it is unknown how VSE compliance can be improved. We propose that contingency management (CM), an evidence-based strategy to incentivise abstinence, could encourage continued VSE use, promoting long-lasting recovery from problematic or harmful gambling. Here, we conducted exploratory analyses on VSE use and CM for gambling in two populations (members of the UK general population recruited and students). Participants responded favourably regarding combined VSE use. They felt that providing vouchers exchangeable for goods/services could incentivise gambling abstinence during VSE. However, some were concerned about people potentially "gaming" the system. Participants believed supplementing VSE and CM with social support could encourage abstinence. These attitudes, and recent research on treatment providers' opinions on CM for gambling, suggest that experimental evidence should be sought to determine the efficacy of combined VSE use and CM for gambling.

Developing the ACEIG-scale: An adverse childhood experience scale for Inuit youth in Greenland

BackgroundAdverse Childhood Experiences (ACEs) have been identified as a major public health challenge in Greenland. No previous studies have created a multi-item ACE- scale among an Arctic Indigenous population. ObjectiveTo develop a multi-item ACE-scale among Inuit youth in Greenland (the ACEIG scale). MethodsThe ACEIG scale was created with data from the ‘Wellbeing among Inuit youth in Greenland’-survey. Scale items were based on a recognised ACE-scale and further adapted to the context of Inuit youth in Greenland by adding items relevant for the population. The scale was validated through item response theory (IRT) and reliability was assessed by Cronbach's alpha. ResultsFour items relevant for Inuit youth in Greenland were added to the recognised ACE scale (bullying, death of parent, gambling problems in close family, and suicide in close relations). The scale was reduced by IRT, as three items (bullying, divorce of parents and parents passing away) exceeded the difficulty index threshold. The ACEIG scale therefore consists of 10 items: alcohol problems in close family, marijuana use in close family, domestic violence, being victim of physical violence, being victim of psychological violence, any type of sexual abuse, sexual abuse (intercourse), sexual abuse (more than once), suicide in close relations, and gambling problems in close family. Cronbach's alpha was 0.7. ConclusionThe ACEIG scale includes 10 items with acceptable reliability. The scale can inform future screening tools to identify vulnerable youth and target interventions. Future studies should investigate the association between the ACEIG scale and health outcomes.

Health-Related, Social and Cognitive Factors Explaining Gambling Addiction.

Gambling addiction was the first addictive behavior not related to substance use that was recognized by the DSM-5. It shares diagnostics and comorbidity with other addictions. Extensive studies have investigated the clinical variables involved, but there have been fewer studies of related cognitive and social variables. In this research, an integrative model was developed to advance the understanding of gambling addiction, and an explanatory model was created based on the concept of cognitive distortions. The sample comprised 258 university students (59.5% women) with a mean age of 20.95 years (SD = 2.19). A series of questionnaires were administered to measure gambling addiction, depression, coping with stress, prosocial behavior, susceptibility to priming and cognitive distortions about gambling. In addition, correlations, multiple linear regressions and a simple mediation model of these variables were analyzed. The results indicated that gambling addiction was correlated with a variety of clinical, social and cognitive factors. These factors contributed to a model that predicted 16.8% of the variance in gambling addiction and another model using cognitive distortions as a predictor and the maximum bet as a mediator that predicted 34.5% of the variance. The study represents an advance by developing a theoretical model from an integrative perspective and providing a new explanatory model. The findings of this research are of great importance in the development of prevention and intervention programs for gambling addiction.

비행청소년의 도박문제에 영향을 미치는 접근 요인에 관한 연구

The purpose of this study is to empirically verify the relationship between various factors of cyber gambling initiation and problem gambling in adolescents under probation. Recently, domestic studies on the relationship between gambling initiation and problem gambling among adolescents are active, but these studies did not specifically verify which route of initiation causes problem gambling, and the subject of these studies does not include whom under probation. This study conducted a survey on 113 adolescents under probation to find out which factors of cyber gambling initiation leading adolescents to problem gambling. As a result, adolescent under probation were more likely to start gambling after running away from home or for earning pocket money. The significance and limitations of this study were discussed in detail in the conclusion.

차별적 접촉요인과 자기통제력이 비행청소년의 도박문제에 미치는 영향

Gambling problem means that various aspects of an individual's life are negatively affected by gambling, and despite recognizing this, they cannot control their behavior or the desire to participate in gambling which also causes difficulties in life. The purpose of this study was to verify the effects of differential association factors and self-control on the gambling problem of juvenile currently under probation.
 A survey was conducted on students under probation who visit probation offices across the country. 113 samples were used for analysis. As a result of hierarchical regression analysis, gender and age, the control variables input into model 1, did not have a statistically significant effect on gambling problems, but the experience of witnessing a friend's gambling act, a differential association factor input into model 2, had a statistically significant effect. It was found to have a positive (+) effect. Also the self-control added in Model 3 was found to have a negative (-) effect on gambling problems, but the effect of the experience of witnessing a friend's gambling act was disappeared. In other words, when controlling for other variables, it could be said that self-control has a negative (-) effect on the gambling problem of juvenile delinquents. Recommendations related to the results and the limitations and significance of this study were dealt in detail.

Problem Gambling, Depression, Anxiety and Associated Demographics: Findings and Ethical Implications

Problem Gambling, Depression, Anxiety and Associated Demographics: Findings and Ethical Implications

Improving Documentation of Impulse Control Disorders at a Movement Disorder Program During the COVID-19 Pandemic.

Impulse control disorders (ICD) are a group of behaviors in Parkinson disease (PD), (compulsive buying, gambling, binge eating, craving sweets, and hypersexuality) that occur in up to 20% of individuals with PD, sometimes with devastating results. We sought to determine the rate of ICD screening based on 2020 quality measures for PD care by the American Academy of Neurology. We conducted a quality improvement project to document and improve physician ICD screening in a tertiary movement disorder program. Serial medical records were reviewed for 5 weeks before and 13 weeks after an educational session and documentation tool deployments in 2020. Inclusion criteria included the following: idiopathic PD, PD dementia (PDD), or dementia with Lewy bodies (DLB). Individual encounters for 109 patients preintervention and 276 patients postintervention were reviewed. There was no difference between the preintervention and postintervention (pre-IG vs post-IG, respectively) in terms of age, male to female ratio, proportion of patients with PD, PDD, or DLB, duration of diagnosis, or levodopa equivalents. There was a shift to increased ICD queries above the median for the study period (28.8%) for 7 consecutive weeks in post-IG. The frequency of ICD diagnosis was not different from pre-IG to post-IG (95% confidence interval, 0-32.6 vs 2.7-13.4%, p = 0.444). ICD queries immediately after ICD education and dissemination of documentation tools increased. Both preintervention and postintervention groups were similar in demographic and clinical characteristics. This program was instituted at the height of wave 2 of the COVID-19 pandemic in Alberta during staff redeployment and 100% shift to telemedicine ambulatory care. Our results demonstrate that amid a crisis, quality improvement can still be effective with education and provision of tools for clinicians.

Nationwide, Multioperator Self-Exclusion and Psychiatric Comorbidity in Patients with Gambling Disorder: A Retrospective Chart Review Study from a Regional Treatment Unit.

Gambling disorder is an addictive disorder that has been shown to have a detrimental effect on an individual's health, social, and financial situations. Voluntary self-exclusion is one way for patients to reduce harm in gambling disorder, but breaching one's self-exclusion appears to be common. In January 2019, Sweden launched a nationwide, multioperator self-exclusion instrument called Spelpaus (literally "game break"). Spelpaus is unique to Sweden, and there is limited research on the use of this type of nationwide, multioperator self-exclusion services, also in relation to gambling disorder and mental health. There is a reason to follow the clinical picture of treatment seeking for gambling disorder over time, and this study aims to explore clinical characteristics of patients seeking clinical gambling disorder treatment, including sex distribution and mental health comorbidity, as well as the use of Spelpaus amongst patients with gambling disorder and how frequently users gambled despite ongoing self-exclusion, in relation to sex and psychiatric comorbidities. A retrospective chart study was carried out on patients presenting to a regional gambling disorder treatment unit. Information regarding self-exclusions using Spelpaus, gambling despite self-exclusion, and the method of gambling despite self-exclusion as well as psychiatric comorbidities were extracted from medical records. Females were markedly more likely to report overall psychiatric comorbidities (48% vs. 25% among males, p < 0.001), affective, neurotic/anxiety-related (p < 0.001), and behavioral/emotional (p = 0.028) diagnoses and more likely to have two or more diagnoses excluding gambling disorder (p = 0.001). From 120 patients from whom information regarding self-exclusion was present, 114 (95%) had chosen to self-exclude. From the 114 self-excluders, 67 reported to have gambled despite self-exclusion, with unregistered websites being the most common method. Self-exclusion was not significantly related to sex (p = 0.146) or to psychiatric comorbidities (p = 0.178). In conclusion, psychiatric comorbidity was particularly common in female gambling disorder patients and gambling despite self-exclusion was common. Gambling regulations should be improved to help self-excluders avoid being able to gamble on unlicensed gambling operators. Further research should focus on sex differences and the association with psychiatric comorbidities.

Bipolar Disorder and Gaming Disorder-Compatible or Incompatible Diagnoses?

Gaming Disorder (GD) is one of the latest additions in the psychiatric taxonomy, following its official inclusion in the latest revision of the International Classification of Diseases (ICD-11). This narrative review examines the rationale of an exclusion criterion for the diagnosis of GD, that of disordered gaming being limited exclusively during an episode of elevated mood in bipolar disorder. The history of the formulation of diagnostic criteria for the disorder and all relevant published studies are examined critically, and conclusions are drawn as to the potential validity and usability of the exclusion criterion. Suggestions are offered for future research to elucidate not only the relevance of the exclusion criterion but also the differential diagnosis of GD with pathological gambling (PG).

Gambling Motives and Offshore Gambling: A Finnish Population Study

The rise of online gambling has drawn attention towards offshore gambling. Currently there is lack of evidence on reasons and motivations to gamble on offshore gambling sites. This study investigated the general gambling motives of onshore and offshore gamblers, and the reasons to gamble on offshore gambling sites. The study used binary logistic regression model to analyze the data from Finnish Gambling 2019 population survey including adult past-year online gamblers (n = 1,422). The validated measure for problem gambling severity (PGSI, Problem Gambling Severity Index) was used. Furthermore, data-driven qualitative analysis was used to form categories for the reasons to gamble on offshore gambling sites. Offshore gambling was more common among men and younger age groups than among women or older age groups. Offshore gamblers gambled less often for money or worthy causes than onshore gamblers. Furthermore, offshore gamblers had more different types of motives to gamble, they gambled more frequently and had higher problem gambling severity scores (PGSI) than onshore gamblers. Finally, the most common reasons to gamble offshore were: (1) larger game supply and game features, (2) benefits, bonuses, and the usability of the website, and (3) inner motivation. Offshore gambling is characterized with intensity and diversity of gambling behavior and motives, and it poses a risk especially for young men.

Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling Among Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Study.

This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures of mental illness and substance use, functionality, homelessness, in a nationally representative sample of U.S. military veterans. Data were analyzed from 781 veterans who participated National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study conducted in 2021. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions analyses were conducted to examine unadjusted and adjusted associations between gambling group status and sociodemographic, psychiatric, substance use, functioning, and homelessness measures. A significant minority of low-income U.S. veterans reported gambling, with 24.9% (95% confidence interval [CI] 95% CI 21.12-28.76%) exhibiting RG and 6.7% (95% CI 3.88-9.42%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White veterans. ARPG was associated with greater symptoms of substance use and anxiety; poorer physical functioning; history of any mental illness; lifetime history of homelessness; and having any student or car loans relative to NG. Veterans who had RG were more likely to screen positive for drug use disorders relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among low-income U.S. veterans and underscore the importance of routine screening, monitoring, and development of interventions for problematic gambling severity, as well as interventions for ARPG in this population. These findings may inform targeted intervention strategies for this vulnerable subpopulation.

Online Assessment of Social Cognition in a Population of Gamers and Gamblers: Results of the eSMILE Study

The purpose of the eSMILE study was to explore social cognition (SC) in the two behavioural addictions (BAs) included in international classifications: gaming disorder and gambling disorder. In these disorders, cognitive functioning is involved in the development and maintenance of addiction. Nevertheless, SC have received less attention than other cognitive functions. The eSMILE study was conducted online and included 105 participants (gamers and gamblers). This study included: the Penn emotion recognition task, the Condensed and Revised Multifaced Empathy Test, the Interpersonal Reactivity Index, the Chicken Game, social metacognition questions, and the Toronto Alexithymia Scale. We analysed the relationships among SC measures, addiction levels, and behaviour frequency. For gamers, we showed that the higher their level of addiction was, the lower their self-confidence following the identification of basic emotions, although the more frequently they played, the better their performance on this task. Additionally, we found lower performance on the identification of more complex emotions by gamblers, which seems to be the result of their levels of addiction rather than the frequency of their gambling behaviour. This study contributes to our understanding of the cognitive processes underlying BAs. Additionally, working on SC abilities may be an additional management mode for BAs that could be added to existing treatments.

THE RELATIONSHIP OF ONLINE GAMBLING ADDICTION AND LONELINESS: A UNIVERSITY CASE FROM TURKIYE

Objective The aim of this study was to determine the relationship and mutual effects between online gambling addiction and loneliness in young adults studying at a public university in Türkiye. Material and Method This study was designed in a cross-sectional style and prepared with the information collected by the survey application method. The study population was made up of young adults studying at a public university in Türkiye. The data were obtained in December 2021 using an in-person data collection method with two questionnaire forms containing demographic data, Online Gambling Addiction Scale (OGAS) and Social and Emotional Loneliness Scale for Adults (SELSA-S). Results There were a total of 449 university students participated in the study. Of them, 52.8% were females. Those who were addicted to online gambling constituted 35.0% of the group, and those who were addicted to young adults gambling had significantly higher loneliness than those who were not (p=0.005). Conclusion In young adults, loneliness has been shown to have a predictive effect on online gambling addiction.

The Dynamics of Psychological Distress in the Trajectory of At-Risk and Problem Gambling: Results from a Prospective Population-Based Longitudinal Study in Australia

AbstractThis study employed parallel growth curve modelling to examine the changes in both psychological distress and at-risk and problem gambling as a development process. We used a prospective longitudinal population-based study to provide further insights beyond treatment samples and cross-sectional studies. A secondary data analysis was conducted by extracting a sample of 3460 Victorian adults from the Victorian Gambling Study 2008–2011. Findings suggested that psychological distress was a consistent risk factor for at-risk and problem gambling, as measured by the problem gambling severity index (PGSI), after controlling for other risk factors such as sex, age, histories of at-risk and problem gambling, and the experience of trauma. A more rapid increase in psychological distress over time was related to a more rapid increase in the PGSI trajectory. It is concluded that this study supports a positive association in the development trends of problem gambling severity and psychological distress in individuals who engaged in gambling. The association persists after adjusting for histories of gambling problem risk and the experience of trauma in life. The implications of the study suggest addressing the comorbidity of problem gambling risk and psychological distress in treatment and prevention, and the development of dual-diagnosis treatment programs.

Looking at Sex Differences in Gambling Disorder: The Predictive Role of the Early Abandonment Schema, Gambling Motives and Alexithymia in Depression

A growing body of research indicates differences between men and women with gambling disorder. However, although alexithymia, gambling motives or abandonment have been associated with GD, women’s clinical profile remains unexplored. This study aims, firstly, to explore mean differences in gambling motives (i.e. enhancement, coping and social [SOC]), the early maladaptive abandonment schema, alexithymia and depression in women and men with GD. Secondly, to analyse the correlation between the aforementioned variables as a function of sex. Thirdly, to examine the predictive role of gambling motives, early abandonment schema and alexithymia in depression as a function of sex. Lastly, to analyse the mediating role of COP between the early maladaptive abandonment schema and depression in women with GD, and the mediating role of ENH and the early maladaptive abandonment schema between alexithymia and depression in men with GD. The sample comprised 108 adults with GD diagnosis, of whom 60 were women and 48 were men. Regression and mediation analyses were carried out to explore possible sex differences in GD, through the SPSS programme. Results showed that depressive symptoms are predicted by alexithymia in men with GD and by the early maladaptive abandonment schema in women with GD. Regarding mediation analyses, the results suggest that COP mediated the relationship between early abandonment schema and depressive symptoms in females; and ENH and abandonment schema mediated the relationship between alexithymia and depressive symptoms in males. These results provide evidence of the relevance of considering sex differences when establishing therapeutic strategies in GD rehabilitation.

Problem gambling severity in a nationally representative sample of the Israeli population: the moderating role of ethnonational affiliation.

Gambling is a public health concern. Problem gambling is related to a range of psycho-social risk factors including ethnonational affiliation. Israel is an insightful case to probe problem gambling, given the socio-economic marginalization of Israeli Arabs, the continued exposure of Israelis to stress and the conservative Israeli gambling market. This study aimed to estimate problem gambling severity in Israeli society, characterize the sociodemographic, environmental, mental health, and gambling-related risk factors associated with problem gambling severity, and examine the role of ethnonational affiliation (Israeli Jewish/Arab) as a moderating factor in the associations between these risk factors and problem gambling severity. A cross-sectional study based on a representative sample of 3,244 Israelis was conducted in 2022, of whom 1,626 had gambled in the previous year. Measurements included Problem Gambling Severity Index, Gambling Behaviors, Perceived Neighborhood Cohesion, Stress, the Patient Health Questionnaire-4, and sociodemographic variables. Low-risk, moderate-risk and problem gambling were reported by 16.7% of the total sample. The main risk factors for problem gambling were being an Israeli Arab, traditional, residing in a low socio-economic cluster, reporting anxiety symptoms, and higher gambling behaviors, specifically in legal/illegal online gambling. Ethnonational affiliation (Israeli Jewish/Arab) moderated the associations between gambling, illegal online gambling, and problem gambling severity. Higher neighborhood cohesion emerged as a risk factor for problem gambling solely for Israeli Arabs. As an excluded minority, Israeli Arabs may turn to gambling as a method to access the core republican community, thus, exposing themselves to a higher risk of developing problem gambling.

Relationship Between Social Isolation, Cultural Adaptation, and Sports Gambling Addiction Among Korean Chinese Sports club Participants.

This study aims to verify the relationship between social isolation, cultural adaptation, and gambling addiction tendency among Korean Chinese sports club participants living in Korea. This will be helpful in identifying the sports gambling tendencies of Korean Chinese sports club participants living in Korea and provide basic data for the development and implementation of preventive measures and treatments. This study recruited 340 sports club participants in Seoul and Incheon, Gyeonggi province in South Korea, using a convenience sampling method. A survey was conducted by visiting the places where the subjects were taking part in sports activities and explaining the contents and purpose of the survey. The survey was a self-administered questionnaire that the participants were to complete themselves. Of the original 340 participants, 314 questionnaires were included in the data analysis, with 26 questionnaires excluded for insincere responses or omissions. analysis result, First, considering the effect of social isolation of Korean Chinese sports club participants on cultural adaptation, the results show that emotional isolation had a negative effect on all subfactors of cultural adaptation, and social alienation had a negative effect on work adaptation, among the subfactors of cultural adaptation. Second, examining the effect of social isolation of Korean Chinese sports club participants on sports gambling addiction tendency, among the subfactors of social isolation, we find that emotional isolation had the most positive effect on sports gambling addiction tendency, followed by social alienation. Third, we examined the effect of the cultural adaptation of Korean Chinese sports club participants on sports gambling addiction tendency; among the subfactors of cultural adaptation, work adaptation had a negative effect on sports gambling addiction tendency.

Gambling Behavior of Excluded Gamblers in a Multi-venue Exclusion System: Results from a Three-Wave Survey Conducted in Switzerland

Gamblers enrolled in the Swiss Multi-Venue Exclusion Program completed a written questionnaire three times, at six-month intervals. In addition to sociodemographic information, they provided details of their gambling behavior, and completed the South Oaks Gambling Screen-Revised (SOGS-R). The excluded gamblers were compared to a control group of non-excluded gamblers who also completed the questionnaire. The baseline survey demonstrated that there was a significant association between gamblers status (excluded n = 87 and non-excluded n = 259) and income (p = .039), as well as debt situation (p < .001) and SOGS-R score classification (p < .001). Over the course of three surveys, 242 gamblers participated. Of these, 133 respondents were not excluded from casinos at any time, 33 were excluded at the time of the first survey wave and remained so, while the exclusion status of 76 respondents changed over time, thus they were excluded for a minimum of one wave. Overall, 12.1% of excluded individuals stopped gambling altogether. Although exclusion is circumvented by some gamblers, it is associated with significant reductions in frequency, duration, and expenditure, as well as severity of problem gambling. The effects were more significant among gamblers who were excluded from casinos during the entire survey period. The results suggest that the duration of an exclusion should be at least six months instead of the current three months. 62.6% of the excluded gamblers had at least one exclusion lifted during the survey period. Further research is needed to investigate the implications of repeated exclusions for gambling-specific problems.

Transformation of internet addiction on the background of social isolation and security crisis

Aim — based on the analysis of the characteristics of Internet addiction, identify its peculiarities on the background of social isolation and security crisis. Materials and methods. The study was conducted on a contingent of 120 respondents (students of higher education) aged 18 to 23, who have experience of permanent stay in conditions of social isolation in Ukraine (2020—2023), with established Internet-addiction according to Internet Addiction Test (K. Young, 1998) and Internet Use Disorders Identification Test (Linskiy I. V., Minko A. I., Artemchuk A. P. et al., 2009). The distribution of the contingent by gender was symmetrical. The research method is a structured psychological interview. Study results. In our analysis, it becomes evident that the excessive utilization of the Internet does not merely align with a series of non-chemical addictions; rather, it operates as a facilitative mechanism for a broad range of behavioral and psychological transgressions, which arise as an interconnected functional entity. Within this multifaceted spectrum, we discern two discrete categories: the formation of compulsive behavior patterns and the justification of pre-existing behavior abnormalities. Compulsive behavior patterns include compulsive gaming and gambling behavior, compulsive social media use, compulsive pornography consumption, news-related compulsive behavior. Formation of compulsive behavior patterns associated with problematic excessive use of Internet have such mechanisms: openness and accessibility of hyper-stimulating content, reinforcement and rewards with feedback loops, social comparison, escapism and avoidance, information overload. Justification of pre-existing behavior abnormalities associated with problematic excessive use of Internet include reinforcement of attention-seeking and provocative behaviors; reinforcement of rude and violent behaviors, reinforcement of self-harm and destructive behaviors, progressive reinforcement of deviant sexuality, reinforcement of cult-like behavior. Noticed underlying mechanisms: echo chambers, disinhibition due to anonymity, group polarization and competitive dynamics. Conclusions. Behavioral and psychological disorders linked to problematic excessive Internet use do not fit neatly into a singular pathological disorder classification within current assessment frameworks that may trivialize Internet addiction as a mere form of non-chemical addiction. Instead, in the contemporary context, it is imperative to examine and thoroughly evaluate the intricate array of behavioral and psychological disorders that manifest through Internet usage. Key words: Internet, addiction, Internet addiction, compulsions, behavior violations

Loot boxes, gambling-related risk factors, and mental health in Mainland China: A large-scale survey

Loot boxes can be bought with real-world money to obtain random content inside video games. Loot boxes are viewed by many as gambling-like and are prevalently implemented globally. Previous Western and international studies have consistently found loot box spending to be positively correlated with problem gambling. Previous Western studies presented mixed results as to the correlations between loot box purchasing and gambling-related risk factors, mental wellbeing, and psychological distress. A large-scale survey of adult video game players from the People’s Republic of China (PRC) (N = 2601) was conducted through Tencent Survey. The positive correlations between loot box spending and problem gambling, and between loot box spending and problem videogaming, were successfully replicated. However, other potential risk factors (i.e., impulsivity/impulsiveness; binary past-year gambling participation status; and sensation-seeking tendencies) either did not positively correlate with loot box spending or only did so weakly. Contrary to expectations, high impulsivity was negatively associated with loot box engagement. The Risky Loot Box Index (RLI) most strongly positively correlated with, and was the best predictor in multiple linear regression models for, loot box spending. The RLI may be effective at measuring loot box harms cross-culturally. A surprising weak positive correlation was found between loot box engagement and PRC players’ mental wellbeing, and high psychological distress unexpectedly negatively predicted loot box purchasing. Although gambling-like, the risk and protective factors of loot boxes are seemingly different, meaning they should rightfully be treated as novel products. Cross-cultural research can contribute to a better understanding of loot box harms.