Debt stress partly explains the relationship between problem gambling and comorbid mental health problems
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Connects with: @drentea2015 @oksanen2018
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swanton2020 - p. 2
ities and Investments Commission, 2018). There are strong links between financial problems such as indebtedness and poor mental health (Brown et al., 2005; Fitch et al., 2011; Hojman et al., 2016; Richardson et al., 2013; Turunen and Hiilamo, 2014). Debt stress (i.e., worry regarding the ability to repay debts) is one potential psychological mechanism underlying this relationship (Drentea and Reynolds, 2012, 2015; Sweet, 2018; Sweet et al., 2013).
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Gambling problems primarily stem from spending more money and time gambling than is affordable (Ladouceur, 2004). Borrowing money to relieve gambling-related financial problems is one of nine diagnostic criteria for gambling disorder (American Psychiatric Association, 2013). Easy access to consumer credit may facilitate excessive gambling or provide an alternative source of funds to cover day-to-day expenses due to money lost gambling (Håkansson, 2020; Oakes et al., 2020).
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Some studies examine gambling-related debt as a predictor of distress and suicidality (Battersby et al., 2006; Gray et al., 2020; Maccallum and Blaszczynski, 2003), but few have investigated this relationship in detail. Oksanen et al. (2018) conducted a noteworthy study examining consumer credit use and debt problems as mediators between problem gambling and psychological distress. The researchers collected cross-sectional data by surveying young adults from Finland and the US. Past-year problem gambling predicted lifetime consumer credit use, which predicted debt problems (defined as lifetime experience of default or debt collection).
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This study aimed to investigate the role of debt stress in explaining comorbid mental health problems among Australian gamblers. Debt stress was proposed as a mediator given evidence that it may have more robust correlations with mental health than self-reported financial measures (e.g., aggregate debt value), and therefore potentially be a better proxy for debt problems (Richardson et al., 2013).
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Respondents had to be at least 18 years of age, an Australian resident, able to read and write English fluently, and have spent money gambling in the past 30 days. An a priori power analysis conducted using G*Power 3.1 indicated that for two predictors, 80% power, and a significance level of 0.05, the minimum sample size was 126 participants (Faul et al., 2009).
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Participants reported whether they had spent any money on eight different gambling activities during the past 30 days. Gambling activities were derived from the Household, Income, and Labour Dynamics in Australia survey (Armstrong and Carroll, 2017). Days per month is the recommended timeframe for assessing gambling frequency (Walker et al., 2006). Gambling frequency scores were calculated based on the gambling activity in which the participant was most frequently involved, and could range from 2 (participated between 1 and 3 times in the past 30 days) to 30 (daily involvement).
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Dunn and Mirzaie’s (2016) 4-item version of the Debt Stress Index assesses the respondent’s level of worry regarding the total debt in their name (Drentea and Lavrakas, 2000). The scale items represent a single factor and load separately from depression and anxiety, despite positive correlations with these constructs (Drentea and Reynolds, 2012). The scale demonstrated excellent internal consistency (Cronbach’s α = 0.95).
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The 17-item National Opinion Research Centre’s DSM Screen for Gambling Problems (NODS) assesses past-year presence and severity of problem gambling (Gerstein et al., 1999). To align the measure with DSM-5 criteria, the ‘illegal acts’ item was excluded from analysis to create a modified 16-item scale, which showed excellent internal consistency (Cronbach’s α = 0.93) (Stinchfield, 2014).
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NODS
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The K6 is a widely-used six-item screen for non-specific clinicallyrelevant psychological distress (Kessler et al., 2002). The scale was modified to use a 12-month timeframe (Prochaska et al., 2012) so that all outcome measures employing a timeframe referenced the same period (Walentynowicz et al., 2018). Internal consistency was excellent (Cronbach’s α = 0.94).
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The 7-item depression subscale of the 21-item Depression Anxiety Stress Scales (DASS-21) is a commonly-used screening tool (Lovibond and Lovibond, 1995). The timeframe was adjusted to one week in the past 12 months when participants were at their worst emotionally (Walentynowicz et al., 2018). The scale showed excellent internal consistency (α = 0.96).
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The Personal Wellbeing Index–Adult (PWI) is a 7-item measure of subjective wellbeing across seven domains (Cummins et al., 2003). The scale showed excellent internal consistency (α = 0.93).
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The 14-item problem gambler version of the Problem Gambling Family Impact Measure (PG-FIM) assesses financial, responsibility, and psychosocial impacts of gambling problems on families