{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:36:53Z","timestamp":1790735813661,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AB Svenska Spel and regional hospital system","award":["non-project-specific"],"award-info":[{"award-number":["non-project-specific"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Gambling has been suggested as one of the potential mental health consequences of the COVID-19 pandemic. In earlier self-report studies, increased gambling has been reported by a limited proportion of respondents characterized with a high degree of problem gambling. The present study, carried out with the same methodology and in the same geographical setting, around seven months later in the pandemic, aimed to repeat and to extend the understanding of potential gambling changes in the population during COVID-19. An anonymous sample of web panel members was assessed, altogether 2029 individuals (52% women, 10% moderate-risk or problem gamblers). Results indicated that 6% reported increased gambling, and 4% reported decreased gambling during the pandemic. Having increased gambling was associated with more severe gambling problems (OR 2.78, 95% confidence interval 2.27\u20133.40), increased alcohol consumption (OR 2.92, 1.71\u20134.98), and psychological distress (OR 3.38, 1.83\u20136.23). In the group reporting increased gambling during COVID-19, moderate-risk\/problem gambling was very common (62%). Recent governmental policy interventions in the area were known to a minority (30%) of respondents, but awareness of the regulations was markedly more common in individuals with at least moderate-risk gambling (56%) and in self-excluders (78%). Reporting of any perceived influence from policy changes was low (3%), and divided between those reporting an increasing and decreasing effect, respectively. Increased gambling may be a consequence of COVID-19-related changes in everyday lives of individuals with problematic gambling patterns. Thus, a vulnerable group demonstrates higher rates of gambling migration and psychosocial problems, and may require particular attention in screening and treatment contexts, and further scientific evaluations.<\/jats:p>","DOI":"10.3390\/ijerph18052342","type":"journal-article","created":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T20:55:44Z","timestamp":1614459344000},"page":"2342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Changes of Gambling Patterns during COVID-19 in Sweden, and Potential for Preventive Policy Changes. A Second Look Nine Months into the Pandemic"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5800-8975","authenticated-orcid":false,"given":"Anders","family":"H\u00e5kansson","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, S-22100 Lund, Sweden"},{"name":"Region Sk\u00e5ne, Malm\u00f6 Addiction Center, Clinical Research Unit, S-20502 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7810-7065","authenticated-orcid":false,"given":"Carolina","family":"Widinghoff","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, S-22100 Lund, Sweden"},{"name":"Region Sk\u00e5ne, Malm\u00f6 Addiction Center, Clinical Research Unit, S-20502 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,27]]},"reference":[{"key":"ref_1","first-page":"20com02690","article-title":"Problem gambling during the COVID-19 pandemic","volume":"22","author":"Yayha","year":"2020","journal-title":"Prim. Care Companion CNS Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1097\/ADM.0000000000000690","article-title":"Gambling during the COVID-19 crisis\u2014A cause for concern?","volume":"14","author":"Potenza","year":"2020","journal-title":"J. Addict. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"554542","DOI":"10.3389\/fpubh.2020.554542","article-title":"Transitioning between online gambling modalities and decrease in total gambling activity, but no indication of increase in problematic online gambling intensity during the first phase of the COVID-19 outbreak in Sweden: A time series forecast study","volume":"8","author":"Lindner","year":"2020","journal-title":"Front. Publ. Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Price, A. (2020). Online gambling in the midst of COVID-19: A nexus of mental health concerns, substance use and financial stress. Int. J. Ment. Health Addict., 1\u201318.","DOI":"10.1007\/s11469-020-00366-1"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Shakil, M., Ashraf, F., Muazzam, A., Amjad, M., and Javed, S. (2021). Work status, death anxiety and psychological distress during COVID-19 pandemic: Implications for the terror management theory. Death Stud., 1\u20136.","DOI":"10.1080\/07481187.2020.1865479"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Song, W., Jin, X., Gao, J., and Zhao, T. (2020). Will buying follow others ease their threat of death? An analysis of consumer data during the period of COVID-19 in China. Int. J. Environ. Res. Publ. Health, 17.","DOI":"10.3390\/ijerph17093215"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tejedor, S., Cervi, L., P\u00e9rez-Escoda, A., Tusa, F., and Parola, A. (2021). Higher education response in the times of Coronavirus: Perceptions of teachers and students, and open innovation. J. Open Innov. Technol. Mark. Complex., 7.","DOI":"10.3390\/joitmc7010043"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Thorell, L.B., Skoglund, C., Gim\u00e9nez de la Pe\u00f1a, A., Baeyens, D., Fuermaier, A.B.M., Groom, M.J., Mammarella, I.C., van der Oord, S., van den Hoofdakker, B.J., and Luman, M. (2021). Parental experiences of homeschooling during the COVID-19 pandemic: Differences between seven European countries and between children with and without mental health conditions. Eur. Child. Adolesc. Psychiatry, 1\u201313.","DOI":"10.31234\/osf.io\/dsy57"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/JOM.0000000000001962","article-title":"Job insecurity and financial concern during the COVID-19 pandemic are associated with worse mental health","volume":"62","author":"Wilson","year":"2020","journal-title":"J. Occup. Environ. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science","volume":"7","author":"Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"113687","DOI":"10.1016\/j.socscimed.2021.113687","article-title":"Psychological distress in North America during COVID-19: The role of pandemic-related stressors","volume":"270","author":"Zheng","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"553345","DOI":"10.3389\/fpubh.2020.553345","article-title":"Mitigating COVID-19 impact on the Portuguese population mental health: The opportunity that lies in digital mental health","volume":"8","author":"Andersson","year":"2020","journal-title":"Front. Publ. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1111\/add.15080","article-title":"Mitigating and learning from the impact of COVID-19 infection on addictive disorders","volume":"115","author":"Marsden","year":"2020","journal-title":"Addiction"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"H\u00e5kansson, A., J\u00f6nsson, C., and Kentt\u00e4, G. (2020). Psychological distress and problem gambling in elite athletes during COVID-19 restrictions\u2014A web survey in top leagues of three sports during the pandemic. Int. J. Environ. Res. Publ. Health, 17.","DOI":"10.3390\/ijerph17186693"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"H\u00e5kansson, A. (2020). Changes in Gambling Behavior during the COVID-19 Pandemic\u2014A Web Survey Study in Sweden. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17114013"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"568543","DOI":"10.3389\/fpsyg.2020.568543","article-title":"Brief research report: Impact of COVID-19 on online gambling\u2014A general population survey during the pandemic","volume":"11","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"611939","DOI":"10.3389\/fpsyt.2020.611939","article-title":"Effects on gambling activity from Coronavirus disease\u2014An analysis of revenue-based taxation of online- and land-based gambling operators during the pandemic","volume":"11","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gainsbury, S.M., Swanton, T.B., Burgess, M.T., and Blaszczynski, A. (2020). Impacts of the COVID-19 shutdown on gambling patterns in Australia: Consideration of problem gambling and psychological distress. J. Addict. Med., [online ahead of print].","DOI":"10.1097\/ADM.0000000000000793"},{"key":"ref_19","unstructured":"Johns Hopkins University. Coronavirus Resource Center (2021, January 20). COVID-19 Map. Available online: https:\/\/coronavirus.jhu.edu\/map.html."},{"key":"ref_20","unstructured":"(2021, January 20). Swedish Government, Available online: https:\/\/www.government.se\/articles\/2020\/06\/government-introduces-temporary-responsible-gambling-measures\/."},{"key":"ref_21","unstructured":"SBC News (2021, January 20). Spain order \u2018Social Shield\u2019 to Fast Track Gambling Advertising Window. Available online: https:\/\/sbcnews.co.uk\/europe\/2020\/04\/01\/spain-orders-social-shield-to-fast-track-gambling-advertising-window\/."},{"key":"ref_22","unstructured":"Reuters (2021, January 20). Sweden to Limit Online Betting during Coronavirus Outbreak. Reuters. Available online: https:\/\/www.reuters.com\/article\/us-health-coronavirus-sweden-gambling\/sweden-to-limit-online-betting-during-coronavirus-outbreak-idUSKCN2251WC."},{"key":"ref_23","unstructured":"The Guardian (2021, January 20). Coronavirus: Gambling Firms Urged to Impose Betting Cap of L50 a Day. Available online: https:\/\/www.theguardian.com\/sport\/2020\/mar\/22\/coronavirus-gambling-firms-urged-to-impose-betting-cap-of-50-a-day."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"599967","DOI":"10.3389\/fpsyt.2020.599967","article-title":"Gambling despite nationwide self-exclusion\u2014A survey in online gamblers in Sweden","volume":"11","author":"Widinghoff","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3389\/fpsyt.2017.00255","article-title":"Who seeks treatment when medicine opens the door to pathological gambling patients\u2014Psychiatric comorbidity and heavy predominance of online gambling","volume":"8","author":"Zaar","year":"2017","journal-title":"Front. Psychiatry"},{"key":"ref_26","unstructured":"Wynne, H., and Ferris, J. (2001). The Canadian Problem Gambling Index: Final Report, Canadian Centre on Substance Abuse (CCSA)."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s10899-010-9221-1","article-title":"Psychometric evaluation of the Problem Gambling Severity Index\u2014Chinese version","volume":"27","author":"Loo","year":"2011","journal-title":"J. Gambl. Stud."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1017\/S0033291702006700","article-title":"The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being","volume":"33","author":"Furukawa","year":"2003","journal-title":"Psychol. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/mpr.310","article-title":"Screening for serious mental illness in the general population with the K6 screening scale: Results from the WHO World Mental Health (WMH) survey initiative","volume":"19","author":"Kessler","year":"2010","journal-title":"Int. J. Meth. Psychiatric Res."},{"key":"ref_30","first-page":"66","article-title":"The total consumption model applied to gambling: Empirical validity and implications for gambling policy","volume":"36","author":"Rossow","year":"2019","journal-title":"Nordisk Alkohol Nark."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/S0272-7358(02)00101-0","article-title":"Pathological gambling. A comprehensive review","volume":"22","author":"Raylu","year":"2002","journal-title":"Clin. Psychol. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Donati, M.A., Cabrini, S., Capitanucci, D., Primi, C., Smaniotto, R., Avanzi, M., Quadrelli, E., Bielli, G., Casini, A., and Roaro, A. (2021). Being a gambler during the COVID-19 pandemic: A study with Italian patients and the effects of reduced explosion. Int. J. Environ. Res. Publ. Health, 18.","DOI":"10.3390\/ijerph18020424"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1007\/s10899-015-9523-4","article-title":"Gambling in the mist of economic crisis: Results from three national prevalence studies from Iceland","volume":"31","author":"Olason","year":"2015","journal-title":"J. Gambl. Stud."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/add.15241","article-title":"Setting limits: Gambling, science and public policy\u2014Summary of results","volume":"116","author":"Sulkunen","year":"2021","journal-title":"Addiction"},{"key":"ref_35","first-page":"1921","article-title":"The societal costs of problem gambling in Sweden","volume":"20","author":"Hofmarcher","year":"2020","journal-title":"BCM Public Health"},{"key":"ref_36","unstructured":"Chipman, M., Govoni, R., and Roerecke, M. (2021, January 20). The Distribution of Consumption Model: An Evaluation of its Applicability to Gambling Behaviour. Ontarioo Problem Gambling Research Centre. Available online: https:\/\/www.greo.ca\/Modules\/EvidenceCentre\/files\/ResSum_Chipman%20et%20al(2006)The_distribution_of_consumption_model.pdf."},{"key":"ref_37","first-page":"100182","article-title":"Television gambling advertisements: Extent and content of gambling advertisements with a focus on potential high-risk commercial messages","volume":"9","author":"Widinghoff","year":"2019","journal-title":"Addict. Behav. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.puhe.2020.03.023","article-title":"Spatial distribution of gambling exposure and vulnerability: An ecological tool to support health inequality reduction","volume":"184","author":"Papineau","year":"2020","journal-title":"Publ. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.annepidem.2020.11.005","article-title":"Leveraging epidemiological principles to evaluate Sweden\u2019s COVID-19 response","volume":"54","author":"Baral","year":"2020","journal-title":"Ann. Epidemiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3389\/fpsyt.2018.00426","article-title":"Primary and secondary diagnoses of gambling disorder and psychiatric comorbidity in the Swedish health care system\u2014A nationwide register study","volume":"9","author":"Karlsson","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/add.13172","article-title":"Gambling and gambling policy in Norway\u2014An exceptional case","volume":"111","author":"Rossow","year":"2016","journal-title":"Addiction"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1111\/j.1360-0443.2005.01219.x","article-title":"Complicity on the river bank: The search for the truth about problem gambling: Reply to the commentaries","volume":"100","author":"Orford","year":"2005","journal-title":"Addiction"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/5\/2342\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:30:00Z","timestamp":1760160600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/5\/2342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,27]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["ijerph18052342"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18052342","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,27]]}}}