A systematic review of psychosocial risks for gambling and problem gambling in the Nordic countries

Figures & data

Figure 1. PRISMA flow diagram illustrating the performed identification and screening process

Table 1. The methods and key findings of the included studies (n = 21)

	Design
Author (year) Country Quality appraisal	Data	Psychosocial measure/dimension	Analyses	Key findings
Castrén et al. (2013) Finland Overall quality score:+ Internal validity score:+ External validity score:++	-Cross-sectional population survey (Finnish Gambling 2011) -Computer-assisted telephone interview survey -Original sample size 16,000 15–74-year olds, random sample -Past-year gamblers (n = 3451) selected from total respondents (n = 4484), 53.2% males, mean age 44.3	Loneliness (single-item question)	Multinomial regression analyses	Loneliness associated with problem gambling (OR 3.47, CI 1.98–6.05, p < 0.001) compared to non-problem gamblers and people experiencing gambling disorder
Castrén et al. (2018) Finland Overall quality score:+ Internal validity score:+ External validity score:++	-Cross-sectional population survey (Finnish Gambling 2015) -Computer-assisted telephone interview survey -Original sample size 7400 15–74-year olds, random sample, response rate 62% (n = 4515) -Past-year gamblers (n = 3251) selected from total respondents: 1418 females (mean age 47.6), 1833 males (mean age 45.1)	Loneliness (single-item question)	Multiple log-linear regression, likelihood ratio test	Loneliness and past-year game types gambled removed from regression models predicting gambling expenditure to avoid multi-collinearity
Edgren et al. (2016) Finland Overall quality score:+ Internal validity score:+ External validity score:+	-Cross-sectional population survey (Finnish Gambling 2011) -Computer-assisted telephone interview survey -Study sample (n = 822) selected from total respondents (n = 4484) -16–28-year olds, 49.3 per cent female	Loneliness (single-item question)	Binary logistic regression models, calculated separately for males/females	Loneliness did not predict at-risk and problem gambling for males or females in the most comprehensive model (n.s).
Fröberg et al. (2013) Sweden Overall quality score:+ Internal validity score:+ External validity score:++	-Cross-sectional population survey (Swedish National Public Health Survey) -Postal questionnaire, national register variables linked to data -Average response rate 60.1 per cent (years 2004–07) -Study sample, n = 19,016 (16–24-year olds, 55.6% female) selected from 2004–07 pooled data (total n = 170,327, age range 16–84)	Social support Defined by two questions that were collapsed	Multinomial logistic regression analyses	Social support did not predict gambling or problem gambling compared to non-gambling among women (not analysed for men) (n.s).
Hanss et al. (2015) Norway Overall quality score:++ Internal validity score:++ External validity score:++	-Cross-sectional population survey of 17-year old Norwegians -Postal questionnaire with online option -3000 recipients, randomly selected, response rate 70.4% -n = 2059 (52.9% female)	Loneliness Robert’s UCLA Loneliness Scale (8-items) (Roberts et al., 1993) Family Relations/Cohesion Six-item Family Relations/Cohesion scale (Oregon Mentors, 2019)	Fisher’s Exact tests, multinomial logistic regression analyses	Loneliness did not predict gambling or risk-problem gambling compared to non-gambling (n.s). Family cohesion did not predict gambling or risk-problem gambling compared to non-gambling (n.s.)
Kristiansen et al. (2015) Denmark Overall quality score:+ Internal validity score:+ External validity score:+	-Interview study -Data stemming from wave I of a qualitative longitudinal prospective study of gambling behaviour among Danes aged 12–20 -Recruitment from schools in the Aalborg region, 1034 respondents completed a questionnaire, volunteer interview participants recruited from these respondents. Snowballing technique also applied -People with a range of gambling experiences included -n = 52, ages 12–20	Semi-structured interviews. Interview schedule contained themes: initial gambling experiences, current gambling behaviour, self-perceived gambling abilities, friends, and social networks	-Theory-driven and data-driven coding. Focus on social learning processes involving relationships, family and peer group interactions -Cross-sectional and within-case analysis	Themes Family Feelings of community specifically mentioned Peer groups Maintaining a sense of belonging to a social community specifically mentioned
Lalander (2006) Sweden Overall quality score:+ Internal validity score:+ External validity score:+	-Interview and observational study -18 interviews conducted in 2 Swedish cities (5 locations) -9 informants recruited at gaming locations, 6 via personal contacts, 3 through associations for compulsive gamblers -Selection criterion: experienced regular gamblers (Jack Vegas machines) -130 participatory observations made (the researcher played the game alongside players)	Core questions: What type of sociality does the Jack Vegas environment create? What types of gamblers develop in these environments?	Thematic analysis of social dimensions of gambling machine environments. Description of gambler types in relation to earlier research	Themes The gamblers and the staff/owners of restaurants Loneliness specifically mentioned
Lyk-Jensen (2010) Denmark Overall quality score:+ Internal validity score:+ External validity score:+	-Cross-sectional national survey (two waves) -Interviews conducted by phone and face-to-face - 11,737 Danes aged 18–74 randomly selected, first wave response rate ~70% (n = 8153) -Second wave subsample n = 453, response rate ~63% Current non-gamblers and problem gamblers excluded – first wave subsample n = 4932 current non-problem gamblers (4790 no-risk, 142 at-risk), second wave subsample n = 379 current non-problem gamblers (295 no-risk, 84 at-risk)	The second wave included: Conditions in respondent’s childhood and adolescence Questions on for example, -Solitary and left out feelings -Felt understood (items specified in Bonke, 2007)	Logistic regression analyses	Negative childhood and adolescence experiences did not differentiate at-risk gamblers from no-risk gamblers in t-test, variable not included in regression analyses (n.s.)
Matilainen and Raento (2014) Finland Overall quality score:+ Internal validity score:+ External validity score:+	-Narrative study (elicited written data) -Two sets of narratives: 230 respondents (1061 pages), 28 respondents (250 pages) -40 narratives on hobby gambling by gamblers born between 1922–1982 selected (25% women, average age 57 years)	Narratives in which respondents address their first contacts with gambling selected	Data triangulation. Data complemented with authors’ auto-ethnographic observations. Content and discourse analyses	Themes Rituals of belonging and self-determination The described feelings of togetherness, belonging
Nordmyr et al. (2016) Finland Overall quality score:+ Internal validity score:+ External validity score:+	-Cross-sectional postal questionnaire survey (2011 Western Finland Mental Health Survey) -10,000 recipients randomly selected, age range 15–80, 2011 response rate 46.2% (n = 4624, 57.1% women)	Loneliness (single-item question) Social support Oslo 3-item Social Support Scale, OSS-3 (Brevik & Dalgard, 1996) Trust Trust in people in one’s neighbourhood General trust	Stepwise logistic regression analyses	Loneliness predicted problem gambling: Experiencing loneliness seldom OR1.68 (95% CI 1.00–2.84) Experiencing loneliness often OR 3.02 (95% CI 1.77–5.16) Low trust in neighbourhood predicted problem gambling OR 1.92 (95% CI 1.21–3.05) General trust did not predict problem gambling (n.s.) Social support did not predict problem gambling (n.s.)
Oksanen et al. (2019) Finland Overall quality score:+ Internal validity score:+ External validity score:+	-Cross-sectional survey (YouGamble online survey) -Participants recruited from pool of volunteer respondents provided by Survey Sampling International, sample stratified -n = 1200, age range 15–25 (mean age 21.3), 50% female	Social support (single-item question)	Principal component analysis, ordinary least squares regression	Weak social support associated with competent gambling (B – 0.30, SE 0.13, β –.06, p =.018) High social support associated with entertainment gambling (B 0.17, SE 0.06, β.08, p =.007)
Pöysti and Majamäki (2013) Finland Overall quality score:+ Internal validity score:+ External validity score:+	-Interview study -14 group interviews conducted in Finland, 14 in France -Self-identified recreational gamblers recruited from gambling venues -110 gamblers participated (54 women)	Discourses focusing on processes leading to problem gambling coded	Reception Analytical Group Interview (RAGI) method	Themes Social and situational pathways Problems with relationships or lack thereof mentioned as a potential pathway, loneliness specifically mentioned
Räsänen et al. (2016a) Finland Overall quality score:+ Internal validity score:+ External validity score:++	-Cross-sectional, population survey (School Health Promotion Study) -In 2010, 78% of Finnish 8th and 9th graders surveyed, in 2011 81% of 8th and 9th graders participated -102,545 8th and 9th grade students, 51% girls -Total n = 62,956. Adolescents who had not gambled during the previous year (37.3%) or who did not answer the question concerning gambling (1.3%) excluded	Social support Social support from friends (one item) Social support from school personell (five variables created sum variable) Social support from parents (four variables)	Kruskall – Wallis test, Mann-Whitneys’ u-test, Path analysis	Support in relation to frequent gambling (Boys) School staff 8th grade β – 0.11 (p < 0.001) 9th grade β–0.13 (p < 0.001) Parents 8th grade β – 0.13 (p < 0.001) 9th grade β–0.10 (p < 0.001) Friends 8th grade β 0.09 (p < 0.001) 9th grade β 0.08 (p < 0.001) Support in relation to frequent gambling (Girls) School staff 8th grade β – 0.07 (p < 0.001) 9th grade β–0.09 (p < 0.001) Parents 8th grade β – 0.08 (p < 0.001) 9th grade β–0.07 (p < 0.001) Friends (n.s.) Social support did not act as a mediator between poor health and gambling or between health risk-taking and gambling (n.s.)
Räsänen et al. (2016b) Finland Overall quality score:+ Internal validity score:+ External validity score:++	-Cross-sectional population survey (School Health Promotion Study) -In 2010, 78% of Finnish 8th and 9th graders surveyed, in 2011 81% of 8th and 9th graders surveyed -In total, 102,545 8^th and 9th grade students participated, 51% girls -Total n = 62,956. Adolescents who had not gambled during the previous year (37.3%) or did not answer gambling-related question (1.3%) excluded.	Social support Social support from friends (one item) Social support from school personnel (five variables created sum variable) Social support from parents (four variables)	Mann-Whitney U test, structural equation modelling	Support in relation to frequent gambling (Boys) School staff 8th grade β – 0.11 (p < 0.001) 9th grade β–0.13 (p < 0.001) Parents 8th grade β – 0.09 (p < 0.001) 9th grade β–0.08 (p < 0.001) Friends 8th grade β 0.07 (p < 0.001) 9th grade β 0.04 (p < 0.001) Support in relation to frequent gambling (Girls) School staff 8th grade β – 0.06 (p < 0.01) 9th grade β–0.11 (p < 0.001) Parents 8th grade β – 0.10 (p < 0.001) 9th grade β–0.06 (p < 0.001) Friends 8th grade β – 0.08 (p < 0.01) 9th grade β–0.09 (p < 0.001) Indirect effects indicated that social support mediated the relationship between problem behaviour and gambling frequency, with the exception of social support from friends
Sagoe et al. (2017) Norway Overall quality score:++ Internal validity score:++ External validity score:++	-Longitudinal survey study of young Norwegians -Self-completion questionnaire -3000 individuals aged 17 randomly selected, final sample n = 2055, females 53.0 per cent. Response rate 70.4% -2012 respondents contacted again in 2013 (aged 18 years). In the second wave, 1 334 individuals responded (females 58.7%, retention rate 64.9%) -First wave respondents contacted again in 2014 (aged 19 years). 1277 individuals responded (females 61.7%, retention rate 62.1%)	Loneliness Robert’s UCLA Loneliness Scale (8-items) (Roberts et al., 1993)	Latent class analysis	Loneliness at age 17 associated with lower odds of belonging to risky-and problem gambling class compared to no gambling (OR 0.30, 95% CI 0.12 to 0.75, p ˂ 0.011) Loneliness not associated with gambling compared to non-gambling (n.s). At age 19 loneliness not associated with gambling or risky-and problem gambling compared to non-gambling (n.s).
Samuelsson et al. (2018) Sweden Overall quality score:++ Internal validity score:++ External validity score:++	-Longitudinal study (The Swedish longitudinal gambling study Swelogs) -The study comprised an epidemiological track and an in-depth track, an epidemiological track sub-sample followed -Study inclusion criteria: having gambled at least monthly during the past 12 months, having participated in at least three Swelogs epidemiological track studies, having a minimum of a three-point difference in PGSI scores between two data collections. Among those who met these criteria, 102 individuals sampled, 40 gamblers interviewed (19 women, 21 men, mean age 37)	Semi-structured interview guide, covering current and previous gambling, personal circumstances, negative consequences, reasons for changes in gambling behaviour and problems	-Cases categorised based on extent of harm, gambling intensity over time, stability versus change, pace of change -Using framework matrices, broad themes and categories identified within and across cases, resulting in four configurations of change and harm. Configurations constructed on four dimensions: pattern of change, harm level, gambling motives, factors of importance for change	Themes Factors increasing gambling: Important life events Lack of supportive network and meaningful employment (loneliness specifically mentioned) These two themes only for fluctuating and increasing gambling intensity: periodic gambling with moderate harm and high-frequency gambling with substantial harm Factors decreasing gambling: Important life events This theme for: high-frequency gambling with occasional harm and periodic gambling with moderate harm Criticism, demands and support from significant others This theme for high-frequency gambling with occasional harm; periodic gambling with moderate harm; high-frequency gambling with substantial harm
Savolainen et al. (2019) Finland Overall quality score: - Internal validity score: + External validity score:-	-Cross-sectional survey (YouGamble online survey) -Finnish and U.S. participants recruited from volunteer pool administered by Survey Sampling International -1200 Finnish young people aged 15–25 (mean age 21.3, 50% female)	Social support (single-item question)	Linear regression analysis, moderation and slope difference analysis	High perceived social support not associated with lower problem gambling (n.s) High perceived social support moderated the association between problem gambling and peer group identification with both offline peers (B = −.22, SE =.10, t(1199) = −2.27, p =.024) and online peers (B = −.27, SE =.10, t(1199) = −2.61, p =.009) Slope difference test results not country-specified (not reported on here)
Sirola et al. (2019) Finland Overall quality score:+ Internal validity score:++ External validity score:-	-Cross-sectional survey (YouGamble online survey) -Finnish and US participants -Finnish sample 1 (n = 1 200) recruited from pool of volunteer respondents administrated by Survey Sampling International -Age 15–25 (mean 21.3, 50% female) -Finnish sample 2 (n = 230) recruited from Finnish social networking site (convenience sampling) -Age 15–30 (mean 24.3, 53.5 per cent female)	Loneliness Three-Item Loneliness Scale	Multivariate logistic regression analysis	Excessive gambling higher among those reporting higher level of loneliness in Sample 1 (OR 1.75, p < .001, 95% CI 1.47–2.09.) and Sample 2 (OR 1.81, p =.003 95 per cent CI 1.22–2.69) Loneliness moderated the association between excessive gambling and daily online gambling community participation in Finnish Sample 1 (OR = 1.20, z = 2.74, p =.006), Sample 2 (n.s)
Svensson and Romild (2011) Sweden Overall quality score:++ Internal validity score:++ External validity score:++	-Longitudinal survey (Swelogs population study conducted in 2008/09, waves I and II) -Stratified sample, computer-based telephone interviews -Age range 16–84 -Response rate phase I 63% (n = 8165), weighted response rate phase II 80% (n = 6017)	Social support (instrumental and emotional) (Items detailed in Romild et al., 2014)	Multivariate logistic regression models	Social support not associated with incident Internet gambling (n.s.)
Svensson and Sundqvist (2019) Sweden Overall quality score:+ Internal validity score:+ External validity score:+	-Cross-sectional survey (2014 annual Swedish school survey) -Paper-and-pen questionnaire -Annual samples comprise ~9000 individuals (roughly equal number of boys/girls) -2014 sample: Grade 9 (n = 4763, girls 2272), Grade 11 (n = 3720, girls 1842) -Response rate 85% (Grade 9), 83% (Grade 11)	Family satisfaction (single-item question)	Poisson multivariate regression models	Family satisfaction not associated with past-year gambling or past-year frequent gambling, variable not included in final analyses (n.s.)
Svensson (2011) Sweden Overall quality score:- Internal validity score:- External validity score:-	-Interview study, participants two males and one female aged 17–19	Analyses of young people’s gambling and gambling careers as a part of their internalisation of adult habits	No information available	Themes Gambling – lifestyle and identity Relevant subtheme Electronic and virtual friends Search for belonging and fellowship specifically mentioned Young people’s gambling careers Relevant subthemes: The first phase of the gambling career – gambling within the family The second phase of the gambling career – gambling with one’s peers outside of the family No psychosocial phenomena specifically mentioned under these themes

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