Gambling problems seldom come alone: prevalence and temporal relationships of mental health problems in casino excluders

ABSTRACT

To estimate the effectiveness of gambling exclusion programmes, previous research focused on changes in gambling behaviour post-exclusion. Although other mental health problems, especially co-morbid mental disorders, may be crucial for relapse and recovery of gambling-related problems, these factors have rarely been studied in excluders. Therefore, this study aimed to assess a comprehensive mental health status of excluders using well-validated diagnostic instruments. Fifty-eight casino excluders participated in face-to-face diagnostic interviews and completed several validated questionnaires (e.g. Stinchfield Questionnaire, Brief Symptom Inventory). Retrospective temporal sequences of diagnosed mental disorders, help-seeking behaviour and exclusion were examined. The majority of excluders reported impairments in mental health aspects. About three-quarters met criteria of lifetime gambling disorder, more than half in the last 12 months whereby screening and diagnostic measures correlated moderately. Other mental disorders were frequent, especially affective and substance-related disorders and typically preceded the onset of gambling disorder. Six years passed between self-awareness of gambling problems and help-seeking. Two more years passed until exclusion. Frequent mental health problems suggest the need for individually tailored support beyond exclusion programmes (e.g. psychotherapy, pharmacotherapy, counselling services). Late help-seeking and exclusion entry claim for improved early detection and intervention concepts that consider underlying mental disorders.

KEYWORDS:

• Casino
• self-exclusion
• pathological gambling
• co-morbidity
• mental health

Acknowledgements

The authors extend special thanks to Maria Prkno for her conscientious help with the data acquisition and Caroline Beyer for editing the revised manuscript.

Conflicts of interestFunding sources

This work was supported by the Bundesverband deutscher Spielbanken gegr. 2008 als BupriS e. V.with an unrestricted research grant.

Competing interests

Roxana Kotter, Anja Kräplin and Andre Pittig declare that they have no further competing interests. Gerhard Bühringer has received unrestricted research grants from the Bavarian State Ministry of Finance (regulatory authority for and operator of the state gambling monopoly) via the Bavarian State Ministry of the Environment and Public Health, the German Federal Ministry of Economics and Technology (regulatory authority for the commercial gaming industry and from public and private gambling providers.

Constraints on publishing

The authors declare that there were no constraints on publishing.

Additional information

Notes on contributors

R. Kotter

R. Kotter (PhD) currently works as a postdoctoral researcher and psychotherapist at the University of Würzburg. She is associated with the Institute of Clinical Psychology and Psychotherapy at the Technische Universität Dresden. Her PhD thesis focused on the impact of casino exclusion. Her research interests concern the prevention and treatment of gambling disorder as well as social cognitive neuroscience (in particular, the psychological and psychopathological processes of social gaze). To see her articles: https://orcid.org/0000-0001-8545-8632

A. Kräplin

A. Kräplin (PhD) is a postdoctoral researcher at the Collaborative Research Centre (CRC) ‘Volition and Cognitive Control’ of the Technische Universität Dresden (SFB940). Her field of research focuses cognitive processes and vulnerability factors of addictions (in particular, gambling disorder). To see her articles: https://orcid.org/0000-0002-1612-3932

A. Pittig

A. Pittig (PhD) currently works as the head of the early career research group ‘Cognitive Control in the Context of Stress and Health’ (Department of Psychology) at the University of Würzburg. His main research interests focus on cognitive control processes (e.g. emotional approach-avoidance conflicts) and their relevance for mental disorders, mental health, and behavioural treatment. To see his articles: https://orcid.org/0000-0003-3787-9576

G. Bühringer

G. Bühringer (PhD) is senior professor at the Technische Universität Dresden and leader of the Work Group Addictive Behaviours, Risk Analysis, and Risk Management (Institute of Clinical Psychology and Psychotherapy). His research interests are focused on the epidemiology, aetiology, and treatment of drug and behavioural addictions. He has written more than 150 peer-reviewed articles and several books and book chapters in the field of addiction. To see his work: https://orcid.org/0000-0002-5568-1435 as well as https://www.psychauthors.de/psychauthors/index.php?wahl=forschung&uwahl=psychauthors&uuwahl=p00017GB_pub