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Table 3 Included published studies

From: Should screening for risk of gambling-related harm be undertaken in health, care and support settings? A systematic review of the international evidence

Author /year [ref] location Setting approach Funding source Study design/population Findings Results/message Quality appraisal/limitations
Achab 2014
[1]
Switzerland
Problem gambling (PrG) screening in GP settings
Attitudes and beliefs of GPs.
Le Programme Intercantonal de Lutte contre la Dependance au Jeu (PILD). 24 item online questionnaire administered to GPs. March-May 2011.
N = 71 Swiss/French speaking. Age 34-71(median 53). 63.2% male.
66% response rate. 24 GPs had experience of PrG referral.
62% categorised PrG as a (very) important issue of concern. Only 7% screened for PrG in their daily practice (compared to 35% for debt screening). No relationship between screening frequency and GP interest (P = 1).
Of those who had managed PrG, 52% referred to a specialist, 7% treated themselves and 32% stated they did not know what to do, and 3% did not address the issue. They reported their knowledge of PrG and specialist care networks as null (14% and 25%) or unsatisfactory ~965% and 45%). This was independent of their screening behaviour (P=0.2 and P=0.1). Most respondents reported a need for information (86%) and training (77.5%) on PrG.
GPs aware of extent and potential impact of problem gambling on their patients. However, screening isn’t systematic.
Knowledge of adequate treatment or referral methods is scarce; training and information are both needed to facilitate referral.
High rates of missing data for some questions on attitudes/beliefs.
Small sample size.
Dowling 2018
[14]
Australia
Gambling screening in mental health services Victorian Responsible Gambling Foundation Comparison of brief screening instruments for problem gambling. Online survey completed in waiting rooms of mental health services
June 2015-January 2016. Sample 51% M, age 38.7 (13.2).
N = 837 mental health service clinic patients
Of the five screening instruments only the Brief Biosocial Gambling Screen accurately detected any level of gambling problem (low risk, moderate risk, or problem gambling). Adequate identification of problem and moderate risk gambling was achieved by NODS-CLiP and the Brief Problem Gambling Screen.
Optimum five item screening tool identified. BUT Acknowledges it is unclear what to do with patients who screen positive for gambling problems.  
Himelhoch 2015
[23]
USA
Brief screening for gambling disorder in the Substance Use Treatment setting. Not reported Comparison of brief screens for gambling disorder
Age 46.4 (10.2), African American (71%). Half met DSM-5 criteria for gambling disorder.
n=300 intensive outpatients treatment for substance use disorders or methadone maintenance programmes.
Various results for gambling screening tools but suggests that commonly used brief screening tools for gambling disorder are associated with good diagnostic accuracy when used in substance use treatment settings.
Client discontent in filling out screening forms (which has been a problem in previous studies) was not found to be an issue. However, 15% of those found to have a gambling disorder felt uncomfortable answering the questions. Questions were administered by researchers not linked to the patient’s treatment programme, which would not be the case in a normal context. Patients may also be concerned about their responses being shared with their clinical team.
Substance use treatment settings are suitable for screening for gambling problems. Some patient concerns over answering questions and sharing responses may need to be addressed. Funding source not reported.
Nehlin 2016
[33]
Sweden
SBIRT for gambling in primary care
Staff training and interviews; patient questionnaire and support.
Public Health Agency of Sweden Pilot study: primary care personnel trained on brief intervention (2 days); and patients who screened positive were offered a repeat visit to discuss their gambling. Those at greatest risk were also provided with written advice on seeking support. GP received financial support for participating. N=537 screened
34 (6.3) screened positive for problem gambling. Of these, 19 of 24 at risk gamblers agreed to participate. Six completed 1 month follow up
Only five of those who screened positive were female (21%). Mean age of participants was 43.7 (16.2).
5 were identified as having more serious gambling problems (more than 3 items on NODS-12 months) and were advised to seek specialist advice (written support was provided to do this).
Practitioners reported that the training had been valuable. They did not find the process of administering the screening tool to be too time consuming. There was some feeling that patient had not been entirely truthful in answering the screening questions. They felt participants were more willing if asked to participate by their normal care giver (rather than being approached in the waiting room).
Staff training and support was essential. Take up from patients was low. 
The rate of at-risk gambling was elevated in this population suggesting that primary care is a suitable arena for gambling intervention.
Pilot study – small numbers
Roberts 2019
[44]
UK
Feasibility of screening in general practice
GP survey
Not reported GP survey of views. Online survey. N = 85 GPs. Average time as a GP = 14.67 yrs (SD 9.58, range 1–40).
GPs estimated that less than 1% of patients had disclosed a gambling problem (mean 0.67), compare to 25% who discussed their smoking, and 5% drugs problems. However around 25% of GPs thought that gamblers would disclose a problem unprompted (significantly overestimating the likelihood).
When asked to identify symptoms associate with problem gambling, over 75% identified financial hardship, anxiety, depression, preoccupation with gambling, stress, lying to conceal gambling and previous failed attempts to reduce gambling as indicative of problems.
However, when asked to identify a care pathway for a problem gambler, only 35% of GPs were able to identify, from prior knowledge, a recognised gambling treatment provider. Other responses included “not a GP problem” or “tell them to stop” to referring to other appropriate services.
As spontaneous disclosure of problem gambling is low, GPs should be encouraged to routinely ask about gambling behaviours (as they do for substance misuse). Early detection and treatment could reduce serious mental and physical health issues associated with gambling.
Overall, only 35% of GPs surveyed were able to identify, from prior knowledge, a recognised gambling treatment provider. GP knowledge of specialist referral services, and the sparsity of provision will both need to be tackled to support GPs to refer problem gambles appropriately.
Brief paper, some methodological detail missing.
Rodda 2018
[45]
Australia
Views on screening for problem gambling in mental health services.
Qualitative study.
Victorian Responsible Gambling Foundation Qualitative. Interviews with clinicians and managers. January–October 2015.
N = 30 clinicians and managers from 11 mental health services. 19F, 11M. Mean clinical practice 12 years (1–40). 10% had received training on how to respond to problem gambling.
Barriers to screening included a focus on immediate risk and gambling being considered as a long-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. Current practice was for the most part, ad hoc or at the discretion of individual clinicians.
Barriers to screening were multiple and interconnected including immediate risks taking priority, seen as a rare condition and the view that tools resulted in low identification of problems
Competing priorities with the requirements to screen for a range of physical and mental health conditions.
Needs to be an agreement at clinical level that brief problem gambling screening is included within a minimum dataset and routine screening practices in mental health services. Did not seek view of other specialities.
Rogers 2013
[46]
UK
Social work as a venue for screening and brief intervention of problem gamblers. Not reported Discussion paper Author views: Social workers provide more support to people with problems relating to addictions that those in other helping professions. Despite this, the training of social workers and the evidence base relating to social work and addictions are sparse. As few problem gamblers actively seek treatment, efforts to improve recognition of the problem and facilitate referral to treatment would be well placed. Social workers are well placed to facilitate the management of gambling as a public health problem. Problem gambling should be moved onto the radar of the social work profession through training programmes, research and dissemination of good practice. Discussion paper
Sacco 2019
[48]
USA
Feasibility of SBIRT screening for gambling in consumer credit counselling National Council on Responsible Gambling Mixed methods
Routine screening for gambling in callers to a credit counselling service (Brief Bioscience Gambling Screening),
Two focus groups (credit counsellors) and three key informant interviews
N = 2438. Callers were mostly female (68%), mean age 48. 52% African American, 39% White. 61% employed full time.
20% of callers to the national credit counselling agency reported gambling behaviour.
Older people were most likely to be gamblers (both low and high risk) as were the full time employed and not having post-secondary level education
SBIRT: screening questions were easy to incorporate, some discomfort over offering brief intervention (boundary of traditional roles), additional resources require for referral to treatment.
Credit counsellors see the benefit of screening within the service. Useful route to identify via money problems
SBIRT for problem gambling is feasible in consumer credit counselling.
 
Temcheff 2014
[50]
Canada
Beliefs/attitudes of mental health professional on youth problem gambling Not reported Qualitative
Online survey
Child psychologists, social workers, and psychoeducators (n = 649)
Female 553 (85%).
Differences between male and females as well as years of experience were assessed but no appreciable differences were found.
Most able to identify characteristics of adolescent problem gamblers including preoccupation (86%), excessive time spent (79%), and increased amount of money wagered over time (81%). However, very few professionals reported knowledge of policies relating to gambling (14-18%).
Viewed by most as the least serious adolescent risk behaviour (vs. drugs, alcohol and violence). BUT Strong interest in receiving continuing education in the prevention, identification, and treatment of problem gambling.
Mental health professionals felt they had a significant role to play in the prevention, identification and treatment of problem gambling. Highlighted the need for professional training. Self-reported measures