The impact of the COVID-19 pandemic on gambling participation and levels of gambling harm across populations during the pandemic is now addressed in a well-established body of empirical literature. This study aimed to measure the longer-term implications of COVID-19 on gambling participation and levels of gambling harm. Population-based cohort study using group-based trajectory modelling. Australia, using gambling participation, problem gambling risk, sociodemographic and psychosocial data from 2019 (pre COVID-19), 2020, 2021 (during COVID-19) and 2023 (post COVID-19). A population representative survey of Australian adults, including four waves collected in April 2019 (n = 2054), November 2020 (n = 3029), October 2021 (n = 3474) and January 2023 (n = 3370), with a subset (n = 3160) of the sample having longitudinal data available. Participants were asked which gambling activities they participated in over the past 12 months for money. Problem gambling risk was measured by the nine-item Problem Gambling Severity Index (PGSI). There was an overall reduction in gambling participation during COVID-19 and return to pre-pandemic levels for most gambling activities by 2023. The longitudinal analysis yielded four trajectories of gambling participation from 2019 to 2023, including individuals who (1) never gambled (25.0% of the longitudinal sample; n= 789); (2) engaged in non-problematic gambling (59.8%; n= 1888); (3) ceased gambling during COVID-19 and started again post pandemic (10.7%; n= 337); and (4) engaged in high risk gambling (4.6%; n= 146), with particular demographic and psychosocial profiles and patterns of participation in specific gambling activities related to these trajectories. Although overall gambling participation rates decreased at the population level in Australia during COVID-19, by 2023 participation in gambling appeared to have nearly returned to pre-pandemic levels. Patterns of gambling behavior before, during and after the pandemic appear to be heterogeneous.
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