The high occurrence of cross-sectional studies does not allow us to clearly define the relationship’s direction between psychological distress and problem gambling. It is difficult to establish whether the former is a risk factor or an outcome of the latter. For example, it is unclear whether a high level of psychological distress is a consequence of frequent gambling or conversely whether people with psychological distress are particularly attracted to gambling. Predictably, a higher level of psychological distress was found in on-line gamblers more at risk of problem gambling than in low-risk gamblers (Gainsbury et al., 2014b; Granero et al., 2020; Hing et al., 2017; Hopley & Nicki, 2010). Anxiety and depression were the main experiences studied and reported by pathological gamblers at higher rates (Barrault & Varescon, 2013a; Barrault et al., 2017; Hopley & Nicki, 2010; Khazaal et al., 2017). In addition, mood disturbances such as hypomanic experiences and mood elevation are reported to a greater extent in the most problematic cluster (Lloyd et al.
The results of this work could be useful in suggesting directions for the development of prevention programs targeted at offline and on-line gamblers, which could be aimed at strengthening or increasing protective factors and limiting and reducing risk factors. Moreover, this review provides some suggestions for distinguishing characteristics more associated with online problem gambling and non-problem ones. Finally, this review found that even if most risk and protective factors are in common between on-line and offline gamblers, there are some variables that are not. These factors could be important to consider in project prevention interventions aimed at targeted on-line gamblers and online problematic gamblers.
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