P2 "Investigating the Impact of Casino Exclusion: A Cross-Sectional Study Among Self- and Forced Excluders Focusing Gambling Behavior and Mental Health Problems"
Dipl.-Psych. Roxana Kotter
supervisors: Dr. rer. nat. habil. Anja Kräplin, Prof. Dr. Gerhard Bühringer
Duration: 11/2015 to 06/2018
Abstract
Introduction. Persistent and recurrent problematic gambling behavior is associated with significant mental health impairments. To prevent problematic and disordered gambling, many international jurisdictions provide a variety of responsible gambling strategies. Among these strategies, exclusion programs that ban gamblers voluntarily (self-exclusion) or involuntarily (forced exclusion) have become increasingly popular. This dissertation aimed 1) to provide a systematic review of the empirical evidence on land-based exclusion programs (Study 1). Furthermore, two empirical studies were conducted to examine 2) the role of voluntariness of exclusion (Study2), 3)the impact of exclusion on gambling behavior (Study 2), and 4) mental health problems in program participants (Study 3).
Methods. A systematic database and literature search was conducted following the PRISMAguidelines (Study1). Nineteen naturalistic studies met eligibility criteria. The quality of all included records was rated by adapting the Newcastle-Ottawa Scale. Results from records with higher quality were weighted stronger. To investigate the role of voluntariness of exclusion, 187 self-excluders and 28 forced excluders that were banned up to eight years completed an online survey (Study2). Gambling behavior was examined retrospectively with the Follow Up Questionnaire of the Bavarian State Coordination Center for Gambling Problems (Study 2). Mental health problems were examined in 58 casino excluders (Study3) using an additional face-to-face standardized diagnostic interviews (DIA-X CIDI) and several validated questionnaires (e.g., Stinchfield Questionnaire, SWLS, WHO-5 Index II, BSI).
Results. The systematic review (Study 1) showed wide ranges regarding post-exclusion rates of abstinence, reduced gambling behavior, and breaching the ban. Included studies consistently showed high rates of gambling disorder and other mental disorders at enrolment and several aspects of mental health were improved after exclusion. Investigations of voluntariness of exclusion (Study 2) showed similar post-exclusion gambling behavior of self- and forced excluders. However, forced excluders reported significant more gambling behavior before exclusion compared to self-excluders. Further examinations of gambling behavior (Study 2) showed significantly reduced gambling behavior of active (non-abstinent) excluded individuals in every gambling venue but not in gambling halls. Moreover, the majority of casino excluders reported impaired mental health compared to community samples (Study 3).
Discussion. Despite overall benefits of both self- and forced exclusion, the impact of these programs widely differs between studies and many individuals continue gambling after exclusion. The benefits of these programs could be maximized by improving access controls and consistently extending exclusions to other unbanned gambling venues. High rates of gambling disorder and other mental disorders as well as significant mental health impairments highlight the need for a multi-professional help-system including counseling and professional treatment opportunities beyond gambling related problems and improved early detection strategies.
Publications:
Studie 1:
Kotter, R., Kräplin, A., Pittig, A., & Bühringer, G. (2018). A systematic review of land-based self-exclusion programs: Demographics, gambling behavior, gambling problems, mental symptoms, and mental health. Journal of Gambling Studies. https://doi.org/10.1007/s10899-018-9777-8
Studie 2:
Kotter, R., Kräplin, A., & Bühringer, G. (2017). Casino self- and forced excluders’ gambling behavior before and after exclusion. Journal of Gambling Studies, 34(2), 597–615. https://doi.org/10.1007/s10899-017-9732-0
Studie 3:
Kotter, R., Kräplin, A., Pittig, A. & Bühringer, G. (submitted). Gambling problems seldom come alone: Prevalence and temporal relationships of mental health problems in casino excluders. International Gambling Studies.