Accessing the invisible population of low-risk gamblers, issues with screening, testing and theory: a systematic review

Background: While it is a generally accepted fact that many gambling screening tools are not fit for purpose when employed as part of a public health framework, the evidence supporting this claim is sporadic. The aim of this review is to identify and evaluate the gambling screening tools currently in use and examine their utility as part of a public health approach to harm reduction, providing a holistic snapshot of the field. 

Methods: A range of index tests measuring aspects of problem gambling were examined, including the South Oaks Gambling Screen (SOGS) and the Problem Gambling Severity Index (PGSI), among others. This review also examined a range of reference standards including the Diagnostic Interview for Gambling Severity (DIGS) and screening tools such as the SOGS. 

Results: The present review supports the belief held by many within the gambling research community that there is a need for a paradigm shift in the way gambling harm is conceptualised and measured, to facilitate early identification and harm prevention. 

Discussion: This review has identified a number of meaningful deficits regarding the overall quality of the psychometric testing employed when validating gambling screening tools. Primary among these was the lack of a consistent and reliable reference standard within many of the studies. Currently there are very few screening tools discussed in the literature that show good utility in the domain of public health, due to the focus on symptoms rather than risk factors. As such, these tools are generally ill-suited for identifying preclinical or low-risk gamblers.