Problem Gambling Screening Research Articles

Development and Validation of an ICD-11-Based Adolescent Problem Gambling Screening Scale

Development and Validation of an ICD-11-Based Adolescent Problem Gambling Screening Scale

Development of the Online Problem Gaming Behavior Index: A New Scale Based on Actual Problem Gambling Behavior Rather Than the Consequences of it.

Many items in current problem gambling screens focus on negative consequences of gambling and gambling-related harms. However, few problem gambling screens comprise items that are totally based on actual gambling behavior such as gambling duration, gambling frequency, or gambling late at night. The aim of the present study was to develop and validate the 12-item Online Problem Gambling Behavior Index (OPGBI). A total of 10,000 online Croatian gamblers were administered the OPGBI alongside the nine-item Problem Gambling Severity Index (PGSI), as well as questions regarding types of gambling engaged in and socio-demographic factors. The 12 OPGBI items mainly concern actual gambling behavior. The correlation between OPGBI and PGSI was highly significant (r = 0.68). Three latent factors in the OPGBI were identified (gambling behavior, limit setting, communication with operator). The three factors all significantly correlated with the PGSI score (R2- = 51.8%). The fact that pure gambling behavior related items explained over 50% of the PGSI score strengthens the idea that player tracking could be an important approach in identifying problem gambling.

Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

BackgroundThe limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches.MethodsThis is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients’ medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population.DiscussionA better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians’ and researchers’ awareness and serve as the basis to adapted treatments that will better support recovery.Trial registrationClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

Spanish validation of the Brief Problem Gambling Screen in patients with substance use disorders.

Problematic Gambling or Gambling Disorder (GD) can act by initiating and maintaining the problem of substance addiction. Despite this, there are no rapid screening tools validated in Spanish. The Brief Problem Gambling Screen (BPGS) has proven to be one of the most sensitive tools for detecting GD and populations at risk. This study aims to validate the Spanish version of the original five-item BPGS. A sample of 100 Spanish-speaking adults with substance use disorder were recruited from an addiction treatment center. The participants were administered the Spanish version of BPGS. It showed strong item reliability properties (Ω = 0.93). Sensitivity and specificity values were excellent (0.93 each), also positive (0.7) and negative (0.99) predictive values suggest high discriminant power when compared to non-GD subjects. Statistically significant strong correlation with a gold-standard measure (Problem Gambling Severity Index) was found (r = 0.8, p < 0.01). Similar psychometric properties were found in at-risk gambler patients. In conclusion, the BPGS seems to be an adequate screening instrument in Spanish-speaking clinical population, and also identifies at-risk of GD subjects.

Using artificial intelligence algorithms to predict self-reported problem gambling with account-based player data in an online casino setting

In recent years researchers have emphasized the importance of artificial intelligence (AI) algorithms as a tool to detect problem gambling online. AI algorithms require a training dataset to learn the patterns of a prespecified group. Problem gambling screens are one method for the collection of the necessary input data to train AI algorithms. The present study’s main aim was to identify the most significant behavioral patterns which predict self-reported problem gambling. In order to fulfil the aim, the study analyzed data from a sample of real-world online casino players and matched their self-report (subjective) responses concerning problem gambling with the participants’ actual (objective) gambling behavior. More specifically, the authors were given access to the raw data of 1,287 players from a European online gambling casino who answered questions on the Problem Gambling Severity Index (PGSI) between September 2021 and February 2022. Random forest and gradient boost machine algorithms were trained to predict self-reported problem gambling based on the independent variables (e.g., wagering, depositing, gambling frequency). The random forest model predicted self-reported problem gambling better than gradient boost. Moreover, problem gamblers showed a distinct pattern with respect to their gambling based on the player tracking data. More specifically, problem gamblers lost more money per gambling day, lost more money per gambling session, and deposited money more frequently per gambling session. Problem gamblers also tended to deplete their gambling accounts more frequently compared to non-problem gamblers. A subgroup of problem gamblers identified as being at greater harm (based on their response to PGSI items) showed even higher values with respect to the aforementioned gambling behaviors. The study showed that self-reported problem gambling can be predicted by AI algorithms with high accuracy based on player tracking data.

Who holds a shared responsibility view of minimizing gambling harm? Results from a multiwave survey of casino gamblers.

Objective: Academics, gambling regulators, and the gambling industry increasingly espouse a shared responsibility view of preventing gambling harm, considering individual gamblers and external stakeholders (e.g., gambling industry employees, government regulators, and public health workers) to be jointly responsible for this task. This study is the third in a series exploring gamblers' beliefs about responsibility for preventing gambling harm. Method: A sample of 4,336 subscribers to MGM Resorts International (MGM)'s loyalty card program as of January 2020 completed a web-based survey. Results: We observed that 58.1% of participants only held individual gamblers responsible for helping prevent gambling harm. However, two factors increased the likelihood of holding a shared responsibility viewpoint and assigning responsibility to casinos for reducing gambling harm: (a) scoring positive on the Brief Biosocial Gambling Screen (BBGS) or an Expanded Problem Gambling Screen (EPGS) and (b) being aware of GameSense, an onsite responsible gambling education program. Those who screened positive on the BBGS or EPGS also were more likely than their counterparts to deny personal responsibility for minimizing gambling harm to individual gamblers; that is, they were more likely to hold a purely external responsibility viewpoint. A meta-analytic year-over-year comparison revealed that compared to being aware of GameSense, screening positive for problem gambling was more strongly associated with assigning responsibility to casinos for minimizing gambling harm. Conclusions: We discuss these findings in the context of self-determination theory and suggest implications for health promotion and best practices for message design in responsible gambling programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring the association between loot boxes and problem gambling: Are video gamers referring to loot boxes when they complete gambling screening tools?

Concerns regarding the similarities between video game ‘loot boxes’ and gambling have been supported by correlations in survey studies between loot box engagement and problem gambling scores. It is generally noted that this correlation could reflect loot box users migrating to conventional gambling, and/or people with gambling problems being attracted to loot boxes when they play video games. We describe a third possibility, that when gamers complete problem gambling screens they may be referring to harms incurred from their loot box use. Using three secondary datasets from cross-sectional online surveys, we explore this account in two ways. First, in participants who do not endorse any participation in conventional forms of gambling, we compare rates of positive (i.e. non-zero) scores on the Problem Gambling Severity Index (PGSI) in participants with and without loot box use. Second, noting that some PGSI items have less relevance to loot box use versus gambling, we compare endorsement rates of individual PGSI items, in gamers versus gamblers, and loot box users vs non-loot box users (focusing on item 3 “going back another day to win back the money you lost”). In analysis 1, positive PGSI scorers among non-gamblers were significantly elevated in loot box users vs non-loot box users, although absolute numbers were low overall. In analysis 2, there were no reliable differences (gamers vs gamblers, loot box users vs non-loot box users) in PGSI item 3 endorsement rates. We conclude that these results provide partial support for this third option, and highlight a need for future studies to consider this possibility more directly.

Psychiatric Drug Prescription and Temporal Associations with a First Diagnosis of Gambling Disorder—Results from a National Register Study

Psychiatric comorbidity is common in gambling disorder (GD), but there are few studies on larger nationwide samples of treatment-seeking patients. Also, temporal associations between GD and other psychiatric disorders are often difficult to study. To address the prevalence and the temporal associations of prescriptions for psychiatric disorders — both in specialized care and primary care — in patients with a GD diagnosis (ICD-10 F63.0). Data was derived from national health registers in Sweden. All patients who were diagnosed with GD in specialized health care in 2005–2016 were included and run against the nationwide database on prescription of pharmaceuticals aimed for psychiatric disorders (n = 2018). Prevalence of psychiatric drug prescription was used as a proxy for psychiatric comorbidity and studied for two 2-year periods (period 1 and 2) prior to GD and one 2-year period (period 3) after the diagnosis. Controlling for gender, age, and time periods, for eight drug categories (anti- epileptics, anti-psychotics, benzodiazepine derivatives, anxiolytics, hypnotics, anti- depressants and drugs used in addictive disorders), significant increases in drug prescription were seen. For central stimulants, a significant increase was seen upon receiving the GD diagnosis (from period 2 to 3), and for benzodiazepines, an increase was seen prior to the GD diagnosis (from period 1 to 2), but not upon diagnosis (from period 2 to 3). Psychiatric comorbidity in GD is common. Drug prescription for psychiatric problems increased markedly in the years temporarily associated with a first diagnosis of GD. The findings may call for early screening for problem gambling in patients with treatment contacts for increasingly poor mental health.

Gambling in COVID-19 Lockdown in the UK: Depression, Stress, and Anxiety.

To combat the spread of COVID-19, the UK Government implemented a range of “lockdown” measures. Lockdown has necessarily changed the gambling habits of gamblers in the UK, and the impact of these measures on the mental health of gamblers is unknown. To understand the impact of lockdown on gamblers, in April 2020, after ~6 weeks of lockdown, participants (N = 1,028, 72% female) completed an online questionnaire. Gambling engagement data was collected for pre-lockdown via the Brief Problem Gambling Screen (BPGS) allowing participants to be classified as Non-Gamblers (NG), Non-Problem Gamblers (NPG) or Potential Problem Gamblers (PPG). The Depression, Stress, and Anxiety Scale (DASS21) was used to measure depression, stress, and anxiety scores both pre- and during-lockdown. Results indicate that depression, stress and anxiety has increased across the whole sample. Participants classified in the PPG group reported higher scores on each sub scale at both baseline and during lockdown. Increases were observed on each DASS21 subscale, for each gambler group, however despite variable significance and effect sizes, the magnitude of increases did not differ between groups. Lockdown has had a significant impact on mental health of participants; whilst depression stress and anxiety remain highest in potential problem gamblers, pre-lockdown gambler status did not affect changes in DASS21 scores.

Transmission of Problem Gambling Between Adjacent Generations

We investigate the extent to which gambling problems at age 20 are linked to parental gambling behaviour during childhood, employing data from a longitudinal study (ALSPAC) which has followed parents and children from Avon, England since pregnancy. 1058 children completed a problem gambling screen at age 20. When those children had been age 6, each of their parents was asked about their own gambling. We used regression to estimate the effect of parental gambling behaviour at child age 6 on the child’s problem gambling risk at age 20. Parental gambling participation at child age 6 was not a predictor of offspring problem gambling; but problem gambling by parents was a predictor of offspring problem gambling. However, this latter result was found only cross-gender (fathers’ behaviour influencing daughters and mothers’ behaviour influencing sons). This pattern was robust to models including measures of parental education and variables capturing family attitudes to health choices and the degree of domestic harmony. The sample illustrates high problem gambling prevalence amongst young adults. Although there is transmission of ‘problem gambling’ between generations, it appears to happen only cross-gender. This limits the importance of parental problem gambling as a source of the high prevalence because relatively few mothers exhibit problem gambling and risks to daughters from fathers are in the context of initially low baseline risks. Preventative policies might therefore be more appropriately targeted at young adults rather than rely on influencing parental gambling behaviour earlier in the child’s life.

Gamblers’ beliefs about responsibility for minimizing gambling harm: Associations with problem gambling screening and gambling involvement

Increasingly, gambling stakeholders communicate that minimizing gambling harm is a shared societal responsibility. Individual gamblers’ beliefs about responsibility for minimizing gambling harm are worthy of study because these beliefs might influence gambling behavior. In this study, using a sample of casino loyalty program subscribers (N = 4,795), we observed that respondents who had a positive result on a brief gambling disorder screen were more likely than those who screened negative to hold seven stakeholder groups (i.e., scientists, clinicians, casino employees, government regulators, public health officials, casino industry lobbyists, public safety officials) responsible for helping to minimize gambling harm. The sum of stakeholder groups held responsible for minimizing gambling harm, along with beliefs that casinos share responsibility for encouraging responsible gambling behavior, predicted gambling disorder screening status after controlling for established problem gambling risk factors. These results replicated our previous study using a mostly independent sample. Contrary to our expectations, beliefs about responsibility for mitigating gambling harm were mostly unrelated to measures of gambling involvement. These results provided additional support for the notion that those who are at risk for gambling harm are especially likely to hold others responsible for minimizing such harm. However, they call into question the role of gambling involvement in this relationship.

An Examination of Clinician Responses to Problem Gambling in Community Mental Health Services.

Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.

Gambling Problems in US Military Veterans

Gambling disorder (GD) is a debilitating mental illness characterized by persistent patterns of dysregulated gambling behaviors. Recent evidence suggests that US military veterans are a high-risk population vulnerable to the development of problem gambling. This systemic review examined the published literature on the rates, correlates, comorbidities, treatment, and genetic contributions to US veterans’ gambling behaviors in 39 studies. Overall, we found that US military veterans have higher rates of GD (including subthreshold problem gambling/at-risk problem gambling) compared with civilian populations. Further, we found that GD often co-occurred with trauma-related conditions, substance use, and suicidality, which may complicate treatment outcomes. We also noted a lack of published interventions tested among US veterans and standardized screening for gambling problems among veterans across US federal agencies (i.e., Department of Defense, Department of Veterans Affairs) is lacking and remains a significant gap for ongoing prevention and treatment efforts. Despite growing evidence that individuals from military backgrounds (active-duty personnel, retired military veterans) are vulnerable to developing problem gambling, limited research has been centered on developing prevention and treatment interventions for affected individuals and their families. The lack of standardized screening for problem gambling among healthcare providers that work directly with US military populations remains a significant barrier to care for problem gamblers.

Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment.

BackgroundProblem gambling is a public health issue and its comorbidity with other health conditions may provide an opportunity for screening in healthcare settings; however, a high level of uncertainty and a lack of research in the field remains. The objective of this study is to investigate potential associations between problem gambling and numerous other health conditions, including substance use, mental health problems, and behavioural addictions.MethodsA cross-sectional web-survey was distributed by a market research company to an online panel of respondents in Sweden, which aimed to be representative of the general population. Chi-squared and Mann-Whitney U tests, followed by logistic regression analysis, were performed to determine associations between screening positive for lifetime problem gambling and potential comorbid conditions and behaviours.ResultsAmong 2038 participants, 5.7 percent screened positive for lifetime problem gambling. Significant associations were found between problem gambling and male gender, education level, daily tobacco use, moderate psychological distress, problematic shopping, and problem gaming.ConclusionThe association between screening for problem gambling and other health conditions, including psychological distress and behavioural addictions such as shopping and gaming, demonstrates the need to screen for problem gambling in the context of other health hazards, such as in different healthcare settings. Further research is required to identify the temporal relationship between these conditions and to investigate underlying etiological mechanisms.

Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study.

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.

Problem gambling and support preferences among Finnish prisoners: a pilot study in an adult correctional population.

The purpose of this paper is to explore the prevalence of potential problem gambling among Finnish prisoners; the associations between problem gambling and demographics, substance use and crime-related factors; and problem gamblers' support preferences. Prisoners (n=96) from two Finnish prisons were recruited between December 2017 and January 2018. The estimated response rate was 31 percent. Gambling problems were measured using the Brief Biosocial Gambling Screen. The participants were asked to report their gambling both for one year prior to their incarceration and for the past year. The independent variables were demographics (age, gender and marital status), substance use (alcohol, smoking and narcotics) and crime-related factors (crime type, prison type and previous sentence). Statistical significance (p) was determined using Fischer's exact test. Past-year pre-conviction problem gambling prevalence was 16.3 percent and past-year prevalence 15 percent. Age, gender, smoking, alcohol or illicit drug use were not associated with past-year problem gambling before sentencing. One-third of the prisoners (33.3 percent) who were sentenced for a property crime, financial crime or robbery were problem gamblers. One-quarter (24 percent) of all participants showed an interest in receiving support by identifying one or more support preferences. The most preferred type of support was group support in its all forms. It is recommended that correctional institutions undertake systematic screening for potential problem gambling, and implement tailored intervention programs for inmates with gambling problems. This study provides a deeper understanding of problem gambling in prisons. Problem gambling is associated with crime and also seems to be linked with serving a previous sentence. Early detection and tailored interventions for problem gambling may help to reduce reoffending rates.

Designing and Evaluating the Validity and Reliability of the Persian Gambling Disorder Screening Questionnaire.

BackgroundGambling disorder (GD) and substance use disorder (SUD) have mutual impact and each could aggravate the effects of the other. This is the first study on GD among Iranian substance users to develop and validate a GD Screening Questionnaire-Persian (GDSQ-P).MethodsIranian male adults (n = 503) with SUDs were recruited via clustered sampling. Problem gambling screening instruments and Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5) criteria for GD were used to develop the tool which was sequentially assessed for face validity, content validity index (CVI), content validity ratio (CVR), and reliability (Kuder-Richardson coefficient). To establish construct validity, interviews based on DSM-5 as a gold standard method were used. A receiver operating characteristic (ROC) curve was conducted to determine sensitivity and specificity.FindingsAfter removing items with low CVI values, 27 final items remained in GDSQ-P with impact score greater than 1.5. Card games (33.8%), dice gambling methods (26.6%), betting on sports teams and players (24.1%), and betting on horseback, rooster, pigeon, dog, or other animals (16.7%) were common gambling methods among participants. Overall Kuder-Richardson coefficient was 0.95. Cut-off threshold for GDSQ-P was calculated as 4.5 with 98.9% sensitivity and 98.3% specificity. The interviewers confirmed GD for participants based on DSM-5 as the gold standard. The prevalence of GD among participants was 17.9% based on GDSQ-P and 19.1% based on DSM-5 criteria.ConclusionGDSQ-P is a valid and reliable tool to screen for GD in SUD treatment centers and probably in the general population.

Pilot Study of Problem Gambling in Specialized Substance Use Disorder Treatment—High Lifetime Prevalence of Problem Gambling in Opioid Maintenance Treatment Patients

Problem gambling is over-represented in patients treated for substance use disorders, but substance-specific prevalence of problem gambling is rarely reported. In specialized addiction treatment facilities for opioid maintenance treatment and for alcohol and prescription drug dependence, respectively, 129 patients were screened for problem gambling using the NODS-CLiP. The lifetime prevalence of problem gambling was markedly higher in opioid maintenance treatment (61 percent) than in alcohol and prescription drug dependence treatment (11 percent, p < 0.001). When controlling for gender and age, problem gambling remained significantly associated with opioid maintenance treatment. The present study demonstrated a very high prevalence of lifetime problem gambling in opioid maintenance treatment patients. This calls for active screening for problem gambling in substance use disorder patients, and mainly in treatment for opioid dependence.

Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services.

Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.

A meta-regression analysis of 41 Australian problem gambling prevalence estimates and their relationship to total spending on electronic gaming machines

BackgroundMany jurisdictions regularly conduct surveys to estimate the prevalence of problem gambling in their adult populations. However, the comparison of such estimates is problematic due to methodological variations between studies. Total consumption theory suggests that an association between mean electronic gaming machine (EGM) and casino gambling losses and problem gambling prevalence estimates may exist. If this is the case, then changes in EGM losses may be used as a proxy indicator for changes in problem gambling prevalence. To test for this association this study examines the relationship between aggregated losses on electronic gaming machines (EGMs) and problem gambling prevalence estimates for Australian states and territories between 1994 and 2016.MethodsA Bayesian meta-regression analysis of 41 cross-sectional problem gambling prevalence estimates was undertaken using EGM gambling losses, year of survey and methodological variations as predictor variables. General population studies of adults in Australian states and territory published before 1 July 2016 were considered in scope. 41 studies were identified, with a total of 267,367 participants. Problem gambling prevalence, moderate-risk problem gambling prevalence, problem gambling screen, administration mode and frequency threshold were extracted from surveys. Administrative data on EGM and casino gambling loss data were extracted from government reports and expressed as the proportion of household disposable income lost.ResultsMoney lost on EGMs is correlated with problem gambling prevalence. An increase of 1% of household disposable income lost on EGMs and in casinos was associated with problem gambling prevalence estimates that were 1.33 times higher [95% credible interval 1.04, 1.71]. There was no clear association between EGM losses and moderate-risk problem gambling prevalence estimates. Moderate-risk problem gambling prevalence estimates were not explained by the models (I2 ≥ 0.97; R2 ≤ 0.01).ConclusionsThe present study adds to the weight of evidence that EGM losses are associated with the prevalence of problem gambling. No patterns were evident among moderate-risk problem gambling prevalence estimates, suggesting that this measure is either subject to pronounced measurement error or lacks construct validity. The high degree of residual heterogeneity raises questions about the validity of comparing problem gambling prevalence estimates, even after adjusting for methodological variations between studies.