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Statistics and research release

Problem gambling screens

We regularly collect data on the prevalence of problem gamblers.

Summary

The most widely used measure of problem gambling in the population comes from the combined health surveys of England, Scotland and Wales. The screens used in these surveys are the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Problem Gambling Severity Index (PGSI).

The following table summarises the Commission’s surveys and the problem gambling screens used in each of them.

Survey Screen used
Health Survey for England DSM-IV and PGSI
Scottish Health Survey DSM-IV and PGSI
Welsh Problem Gambling Survey DSM-IV and PGSI
Telephone survey PGSI mini screen
Online tracker PGSI mini screen

Details

Problem Gambling Severity Index (PGSI)

Used in the Health Survey for England, Scottish Health Survey and the Welsh Problem gambling Survey.

The PGSI was specifically developed for use among the general population rather than within a clinical context by Ferris and Wynne (2001) (opens in new tab).

The PGSI consists of nine items and each item is assessed on a four-point scale: never, sometimes, most of the time, almost always. Responses to each item are given the following scores:

  • never = zero
  • sometimes = one
  • most of the time = two
  • almost always = three

When scores to each item are summed, a total score ranging from 0 to 27 is possible.

A PGSI score of eight or more represents a problem gambler. This is the threshold recommended by the developers of the PGSI and the threshold used in our reporting. The PGSI was also developed to give further information on sub-threshold problem gamblers.

Scores between three and seven represent ‘moderate risk’ gambling (gamblers who experience a moderate level of problems leading to some negative consequences) and a score of one or two represents ‘low risk’ gambling (Gamblers who experience a low level of problems with few or no identified negative consequences).

Thinking about the last 12 months…

  1. Have you bet more than you could really afford to lose?
  2. Have you needed to gamble with larger amounts of money to get the same feeling of excitement?
  3. When you gambled, did you go back another day to try to win back the money you lost?
  4. Have you borrowed money or sold anything to get money to gamble?
  5. Have you felt that you might have a problem with gambling?
  6. Has gambling caused you any health problems, including stress or anxiety?
  7. Have people criticized your betting or told you that you had a gambling problem, regardless of whether or not you thought it was true?
  8. Has your gambling caused any financial problems for you or your household?
  9. Have you felt guilty about the way you gamble or what happens when you gamble?

Scoring instructions

0Gamblers who gamble with no negative consequences
1-2Gamblers who experience a low level of problems with few or no identified negative consequences
3-7Gamblers who experience a moderate level of problems leading to some negative consequences
8 or moreGambling with negative consequences and a possible loss of control

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

Used in the Health Survey for England, Scottish Health Survey and the Welsh Problem gambling Survey.

The DSM-IV screening instrument is based on criteria from the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) (opens in new tab). The DSM-IV criteria form a tool created for diagnosis by clinicians of pathological gambling, and were not intended for use as a screening instrument among the general population in its original format.

An adapted version of the DSM-IV to use in a survey setting was developed for the British Gambling Prevalence Survey (BGPS) series and was subject to a rigorous development and testing process, including cognitive testing and piloting.

Each DSM-IV item is assessed on a four-point scale, ranging from ‘never’ to ‘very often’. Responses to each item can either be dichotomised to show whether a person meets the criteria or not, or allocated a score and a total score is produced.

Respondents are asked whether they:

  1. Are preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
  2. Need to gamble with increasing amounts of money in order to achieve the desired excitement
  3. Have repeated unsuccessful efforts to control, cut back, or stop gambling
  4. Are restless or irritable when attempting to cut down or stop gambling
  5. Gamble as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression.
  6. After losing money gambling, often return another day in order to get even (“chasing” one’s losses)
  7. Lie to family members, therapist, or others to conceal the extent of involvement with gambling
  8. Have committed illegal acts, such as forgery, fraud, theft, or embezzlement, in order to finance gambling
  9. Have jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling Rely on others to provide money to relieve a desperate financial situation caused by gambling

Scoring instructions

Each DSM-IV item is assessed on a four-point scale, ranging from ‘never’ to ‘very often.’ This is with the exception of ‘chasing losses’ which is rated on a scale ranging between ‘never’ and ‘every time I lost’. Responses to each item are dichotomised (that is, given a score of 0 or 1) to show whether a person meets the criteria or not. A total score between 0 and 10 is possible.

A threshold of meeting at least three of the DSM-IV criteria is used to define problem gambling. This cut-off point has been found to give good discrimination between criterion groups and has provided the closest match to prevalence estimated by other screening instruments.

Clinicians currently use an additional threshold of a DSM-IV score of 5 or more to represent pathological gambling.

The DSM-IV does not have recognised thresholds for low risk and moderate risk gambling.

The short-form Problem Gambling Severity Index (PGSI mini-screen)

Used in the telephone and online tracker surveys. The short-form Problem Gambling Severity Index (PGSI mini-screen) was developed for the Commission from the full 9-item PGSI by Dr. Rachel Volberg (Developing a Short Form of the PGSI (opens in new tab), 2012). This instrument is formed of three questions from the PGSI, which are scored on a 4 point scale from never to almost always. It is asked to all participants of a survey who have gambled at least once in the last 12 months.

In the last 12 months…

  1. Have you bet more than you could really afford to lose?
  2. Have people criticized your betting or told you that you had a gambling problem, regardless of whether or not you thought it was true?
  3. Have you felt guilty about the way you gamble or what happens when you gamble?

Scoring instructions

0Non-problem gambler - Gamblers who gamble with no negative consequences
1Low-risk gambler - Gamblers who experience a low level of problems with few or no identified negative consequences
2-3Moderate-risk - Gamblers who experience a moderate level of problems leading to some negative consequences
4+Problem gambler - Gambling with negative consequences and a possible loss of control

The scores are analysed to provide overall problem gambling rates, as well as by gender and age. As advised by Volberg following the development of the PGSI mini-screen, the screen must not be used to report or track changes in any further sociodemographic characteristics or gambling behaviour. Due to small base sizes in the above surveys the data should be treated with caution.

DSM-IV-MR-J screen - A revised version of the adult DSM-IV screening instrument as developed by Dr S. Fisher, 2000.

Using the DSM-IV-MR-J screen, a child who confirms that they had undertaken four or more of the behaviours / actions (from the overall screen of nine components outlined as follows) is considered a problem gambler, a score of two or three is used to identify an ‘at-risk’ gambler and a score of zero or one indicates a non-problem gambler.

If any of the following answer criteria are ticked, that qualifies as 1 point

How often have you found yourself thinking about gambling or planning to gamble?‘Often’
How often have you gambled to help you escape from problems or when you were feeling bad?‘Sometimes’ or ‘often’
Have you felt bad or fed up when trying to cut down on gambling?‘Sometimes’ or ‘often’
Have you needed to gamble with more and more money to get the amount of excitement you want?‘Sometimes’ or ‘often’
Have you ever spent much more than you planned to on gambling?‘Sometimes’ or ‘often’
Have you ever taken money from any of the following without permission to spend on gambling:
  • Dinner money or fare money
  • Money from family
  • Money from things you’ve sold
  • Money from outside the family
  • Somewhere else
If any one or more of these options are ticked, then qualifies for one point in total
Has your gambling ever led to the following:
  • Arguments with family/friends or others
  • Missing school
If any of the following are ticked, then qualifies for one point in total: ‘once or twice’, ‘sometimes’ or ‘often’
Has your gambling ever led to the following:
  • Telling lies to family/friends or others
‘Once or twice’ ‘sometimes’ or ‘often’
After losing money by gambling, have you returned another day to try to win back the money you lost?‘More than half the time’ or ‘every time’

Limitations

As with any screening instrument, there are a number of caveats that need to be considered when interpreting the problem gambling estimates that we publish, such as no screen for problem gambling is perfect.

Problem gambling prevalence rates should be considered alongside the confidence intervals for these estimates.

Estimates of problem gambling measured by either the DSM-IV or the PGSI should not be combined with PGSI low risk and moderate risk estimates to create an overall ‘at-risk’ figure. This is because these groups are not mutually exclusive (e.g. an individual could be classified as a problem gambler according to the DSM-IV and a moderate risk gambler according to PGSI and would therefore be counted twice in a combined ‘risk’ figure).

Prevalence rates fail to capture a number of important dimensions of harm, including those experienced by others than gamblers themselves (affected others), meaning they are potentially underestimating the scale of the problem.

The term ‘at-risk’ can imply that people who are classified as low or moderate risk gamblers on the PGSI are not experiencing harm now but will do in the future when in fact they are showing some signs of problematic behaviour now but remain below the threshold for ‘problem’ gambling.

The term ‘at-risk’ can also imply that people who are classified as low or moderate risk gamblers on the PGSI will progress up the scale to a ‘problem gambler’ however evidence from existing longitudinal studies (such as the Quinte Longitudinal Study of Gambling and Problem Gambling (opens in new tab) and the New Zealand National Gambling Study (opens in new tab)) suggests that some do and some don’t.

Ultimately, we need to move away from terms like ‘problem gambler’ and ‘at-risk’, towards a fuller understanding of how people are affected by gambling. These terms represent an individualising concept and we therefore recommend the population affected (including affected others) should be referred to ‘those harmed by gambling’.

Data and downloads

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