The Risk of Gambling Problems in the General Population: A Reconsideration
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The Risk of Gambling Problems in the General Population: A Reconsideration Glenn W. Harrison1,4,5 · Morten I. Lau2,6 · Don Ross3,4,5
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract We examine the manner in which the population prevalence of disordered gambling has usually been estimated, on the basis of surveys that suffer from a potential sample selection bias. General population surveys screen respondents using seemingly innocuous “trigger,” “gateway” or “diagnostic stem” questions, applied before they ask the actual questions about gambling behavior and attitudes. Modeling the latent sample selection behavior generated by these trigger questions using up-to-date econometrics for sample selection bias correction leads to dramatically different inferences about population prevalence and comorbidities with other psychiatric disorders. The population prevalence of problem or pathological gambling in the United States is inferred to be 7.7%, rather than 1.3% when this behavioral response is ignored. Comorbidities are inferred to be much smaller than the received wisdom, particularly when considering the marginal association with other mental health problems rather than the total association. The issues identified here apply, in principle, to every psychiatric disorder covered by standard mental health surveys, and not just gambling disorder. We discuss ways in which these behavioral biases can be mitigated in future surveys. Keywords Gambling disorder · Prevalence studies · Sample selection bias · Bias correction · Econometrics · Diagnostic stem questions · Comorbidities Prevalence studies of disordered gambling have been conducted in many countries over three decades (Williams et al. 2012). In consequence there is widespread consensus that gambling disorder, at least of a level of severity warranting clinical intervention, is a relatively rare mental disorder, though one that has become more common in many jurisdictions as a result of more widespread gambling opportunities. Based on the application of econometric methods for identification and control of sample selection bias, we question this consensus, concluding that prevalence of gambling problems in the general population is likely to be significantly larger than generally thought. The issues identified here apply,
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s1089 9-019-09897-2) contains supplementary material, which is available to authorized users. * Don Ross [email protected]; [email protected] Extended author information available on the last page of the article
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Vol.:(0123456789)
Journal of Gambling Studies
in principle, to every disorder for which prevalence is estimated using surveys based on psychiatric screening instruments, and not just gambling disorder. Scholarly research consistently finds high shares of commercial gambling revenue to be derived from proportions of populations that are much smaller than the large proportion who occasionally o
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