1. Global Addiction and Europad Palazzo dei Congressi Pisa, Italy 7 - 10 May 2013 Co-chairs: Prof I Maremmani (I) & Dr A Kastelic (SL) www.globaladdiction.org

2. Predicting Gambling Problems in Online Poker Players: Sex Differences in Personality Characteristics Development of a continuous scale based on DSM-IV for measuring gambling problems. Karin Österman, Johanna Nordmyr, Kaj Björkqvist, & Sandra Svedlund Åbo Akademi University, Finland

3. Abstract The aim of the study was to investigate sex differences in psychiatric comorbities of online gamblers with different degrees of gambling problems. The study also introduces a continuous scale based on DSM-IV, instead of more commonly used dichotomous scales, for measuring gambling problems. A total of 323 online poker players, 291 males and 32 females (mean age 28.9 yrs), filled in an internet-based survey. The questionnaire included continuous variables measuring gambling problems based on the DSM-IV (1994) criteria for pathological gambling. Sensation seeking, obsession-compulsion, depression, and external locus of control were also measured. Keywords: online gambling, gambling problems, sex differences Results showed that female gamblers tended to score higher on gambling problems than males. Gambling problems in males were predicted by sensation seeking, obsession- compulsion, and depression. Only depression predicted gambling problems significantly in females. Suicidal ideation correlated significantly with gambling problems for both men and women. In the general population, males have been found to have more gambling problems than females, but the findings of this study show that among actual players, gambling problems tended to be more severe among female players. It is thus concluded that female gamblers may run a higher risk for the development of problems than males. The findings might be useful for clinicians treating problem gamblers as well as for legislative efforts. The benefit of the use of a continuous scale for measuring gambling problems are recognised as far as the measurement of sex differences are concerned.

4. Introduction The growth of online gambling during the last decade has been enormous, and poker is by far the fastest growing part of the online gaming market (Goff & Garrahan, 2005). The most obvious reason for the rapid growth is the easy access of online gambling compared to land- based gambling, another might be the anonymity it provides. Furthermore, it combines two types of behavior which are both easily addictive: internet use, and gambling. Although the body of research on gambling problems is quite extensive, gambling on the internet is so far studied to a lesser extent. In general, pathological gamblers also suffer from other psychiatric problems, whether these are causes or consequences of their gambling. According to Black and Shaw (2008), psychiatric comorbidity is the rule, not the exception. Comparatively few sex differences regarding comorbidities and personality characteristics in relation to pathological gambling have been reported, considering the size of the problem. The reason for this is probably that more men than women gamble, and when female participants in studies are few, sex differences may go unnoticed, especially on the basis of null hypothesis testing. Many, if not the majority of studies on comorbidity, investigate men only.

5. Method Sample A total of 323 online poker players (mean age = 28.9 years, SD = 8.5) filled in an internet-based survey at a Finnish online poker gambling site. Of the respondents, 291 were males and 32 females. The youngest gambler reported himself to be 12 and the oldest one 62 years of age. Of the participants, six men and one woman reported themselves to be professional players. The survey was open for responding during a period of seven months. Gambling Problems, a Continuous Variable In order to measure gambling problems, a scale was constructed based exactly on the ten criteria for pathological gambling described in DSM-IV (American Psychiatric Association, 1994). In order to obtain a continuous variable, the ten criteria were provided with response alternatives on a five- point scale (ranging from 0 = not true at all, to 4 = very true). For every respondent, a total sum was computed and then divided by ten in order to obtain a scale ranging from 0 to 4.

6. Number of items Cronbach's Alpha Gambling Problems10.88 based on DSM-IV Sensation Seeking9.86 Zuckerman et al.,1964 External Locus of Control11.81 Strickland, 1973 Obsession-Compulsion5.77 Derogatis, 1975 Depression6.83 Derogatis, 1975 Table 1 Number of Items and Reliability Coefficients of the Scales in the Study Suicidal ideation was measured with one item: “ I have considered committing suicide ”, with response alternatives on a five-point scale ranging from 0 to 4 (0 = never, 4 = very often).

7. Results and Conclusions Gambling Problem Scores 00 – 11 – 22 – 33 – 4 Females18.8 %50.0 %21.9 %6.3 %3.1 % Males21.3 %62.2 %12.4 %3.1 %1.0 % Table 2 Scores of Females (n = 32) and Males (n = 291) on the Continuous Variable Gambling Problems (0-4) A tendency was found for females to score higher than males on gambling problems [t (321) = 1.94, p =.054, d =.36]. The effect size was low, but notable, which indicates an actual sex difference.

8. Figure 1. Results of two multiple linear regression analyses predicting gambling problems, one for males [above, n = 291, R =.62, R 2 =.39, Adj. R 2 =.38, F = 45.86, p >.001], and one for females [beneath, n = 32, R =.79, R 2 =.62, Adj. R 2 =.57, F = 11.16, p >.001]. β =.21, *** β =.11, ns β =.29, (*) β =.00, nsβ =.31, *** β =.64, ** β = -.18, ns

9. References American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press. Derogatis LR (1975). Brief Symptom Inventory (BSI). Baltimore, MD: Clinical Psychometric Research. Nowicki S, Strickland BR (1973). A locus of control scale for children. Journal of Consulting and Clinical Psychology, 40, 148- 154. doi: 10.1037/h0033978 Zuckerman M, Kolin EA, Price L, Zoob I (1964). Development of a sensation-seeking scale. Journal of Consulting Psychology, 28, 477–482. This study was supported by a grant from the Finnish Foundation for Alcohol Studies. In the present study, both male and female problem gamblers scored high on depression. While women tended to score high on external locus of control, in men, also obsession and sensation seeking, predicted gambling problems. These findings suggest somewhat different underlying psychological mechanisms, implying that different treatment strategies indeed might be required for the two sexes. Treatment programs for female gamblers have to focus not only on breaking the addiction, but also on treating depression, in order to be successful. Males, on the other hand, have to be treated for obsessive- compulsiveness, and sensation seeking as well as for depression. For both men and women clinicians should be aware of the high amount of suicidal ideation. Suicidal ideation correlated signifi- cantly positively with the continuous variable gambling problems, this was the case for both female and male gamblers [females, n = 32, r =.63, p <.001; males, n =291, r =.42, p <.001].