Association Between Status Anxiety, Materialism, and Gambling Behaviors: Findings from a Community-Based Cross-Sectional Study in Thailand

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Status anxiety is defined as a chronic fear of not meeting societal standards of 11 success, but the extent to which status anxiety is associated with gambling and interacts with 12 perceived materialism has not been explored. The objectives of this study are: 1) To assess the 13 extent to which status anxiety is associated with gambling behaviors, and; 2) To assess the 14 extent to which the association between status anxiety and gambling behaviors is modified by 15 materialism. 16

We conducted a community -based cross-sectional study in a peri -urban area of a 17 mid-sized city in southern Thailand in 2023. Participants eligible for inclusion were aged 18 18 years or older (sample size = 1,115). Gambling -related questions were included in a se lf-19 administered questionnaire. We categorized the participants into three groups: 1) those who 20 did not gamble in the past year; 2) past-year gamblers without problematic gambling behaviors, 21 and; 3) past -year gamblers with problematic gambling behaviors. We analyzed data using 22 descriptive statistics and multivariable regression analyses with complete case analysis. 23

Participants who reported status anxiety had a significantly higher prevalence of 24 problematic gambling behaviors compared to those who did not report status anxiety (12.3% 25 vs. 1.8%; Adjusted OR = 3.80; 95% CI: 1.35, 10.73). When stratified by materialism, we found 26 that among those who did not report perceived materialism, virtually no participants reported 27 problematic gambling behaviors (0% among those with status anxiety vs. 1.1% among those 28 without; adjusted OR not available). Among those who reported perceived materialism, the 29 association between status anxiety and problematic gambling behaviors was not statistically 30 significant. 31

Our findings provide evidence that status anxiety is significantly associated with 32 gambling behaviors. However, we did not find clear evidence of effect modification by 33 materialism. Limitations related to potential social desirability bias should be considered when 34 interpreting these results. 35

Gambling Behaviors, Status Anxiety, Materialism, Thailand 36 37 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

38 Gambling is a growing public health concern . More than 80% of countries worldwide have 39 legalized gambling, and online gambling has expanded notably from 2018 to 2021 [1]. The 40 prevalence of at-risk and pathological gambling is relatively rare, at under 4% of the general 41 population [2]. However, these conditions are associated with bankruptcy, domestic violence, 42 poor health [3], self -harm, and suicide [4–6]. These harms often extend to the gamblers’ 43 families and the broader population [7,8]. Risk factors include being male, single or recently 44 married, living alone, low education, and financial problems [4]. Given the burden of gambling 45 on public health, an assessment of the association between gambling and modifiable 46 psychological factors could be of interest to relevant stakeholders. 47 48 Status anxiety is defined as a chronic fear of not meeting societal standards of success [9,10]. 49 In socio-economically unequal societies, individuals often measure their worth through social 50 comparison, leading to status anxiety. The Spirit Level Theory posits that greater inequality 51 intensifies this pressure of social comparison [10]. In such contexts, individuals may seek rapid 52 validation or relief to compensate for perceived disadvantage through risky behaviors that give 53 large tangible rewards rapidly, including gambling [11]. Thus, we hypothesize that status 54 anxiety is associated with gambling behaviors. 55 56 Materialism is defined as valuing possessions as essential for life satisfaction and recognition 57 [12,13]. Those who equate wealth with self -worth may chase short-term gratification through 58

goods or high -risk financial opportunities [12,14]. Research on materialism, social 59 comparison, and stress demonstrates that materialistic values heighten anxiety about one’s 60 socioeconomic standing, which in turn drives maladaptive coping behaviors such as gambling 61 [15]. Thus, there is a potential synergistic effect between materialism and status anxiety, 62 particularly in how these components drive harmful behaviors such as gambling. We 63 hypothesize that the association between status anxiety and gambling behavior is particularly 64 strong among those who exhibit materialistic tendencies, and weaker among those who do not. 65 66 Thailand is a middle-income country experiencing rapid socio-economic development, albeit 67 with large income disparities, potentially risin g status anxiety in the population [16,17]. In 68 Thailand, social mobility is strongly tied to displays of wealth . Gambling, though officially 69 restricted, remains culturally normalized through informal lotteries and social betting[18] and 70 is widespread in the general population [16,17]. Thus, Thailand provides an ideal setting to 71 examine how social comparison (status anxiety) and materialism interact to influence 72 gambling. Findings from such a study can contribute potentially useful basic information for 73 stakeholders in mental health and gambling control and prevention. The objectives of this study 74 are: 1) To assess the extent to which status anxiety is associated with gambling behaviors, and; 75 2) To assess the extent to which the association between status anxiety and gambling behaviors 76 is modified by materialism. 77 78 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint

79 Study design and setting 80 We conducted a community -based cross -sectional study in the service catchment area of a 81 primary care center (sub -district health promotion hospital) in the peri -urban area of a mid -82 sized city in southern Thailand in 2023. 83 84 Study population and sample size calculation 85 The study population consisted of adults residing in the selected community area. Participants 86 were eligible for inclusion if they were 18 years or older and able to read and write in Thai. 87 Individuals with cognitive impairments were excluded f rom the study. This research was part 88 of a broader investigation examining the association between economic distress and behavioral 89 health outcomes, particularly anxiety disorders. The required sample size was calculated using 90 the epicalc package in R, assuming an anxiety prevalence of 7.2% among those experiencing 91 economic distress and 3.2% among those who did not, based on previous findings [19]. Using 92 a 95% confidence level and 80% power [20], the min imum required sample size was 458 93 participants per group, totaling 916 participants. However, considering prior research 94 indicating that 58.9% of respondents had experienced economic distress and 41.1% had not 95 [19], the final sample size was adjusted to 1,115 adult community members to reflect this 96 distribution. 97 98 Study variables 99 Exposure (Status anxiety): Status anxiety was defined as worries about being in a relatively 100 low social position compared to others, or concerns about limited opportunities for upward 101 mobility [21,22]. It was measured using five items adapted from Day and Fiske’s 102 conceptualization of status anxiety in the English [23] and Spanish versions [24]. We have also 103 added extra questions to reflect the original conceptualization of the construct [21]. The items 104 assessed participants’ concern and worry regarding their current and future social standing 105 (e.g., “I worry that my social status will not change”, “I sometimes worry that I might become 106 lower in social standing ”). Responses were recorded in a binary format (1 = agree, 0 = 107 disagree). We considered participants who answered that they agreed with one or more 108 statements to have status anxiety, and those who did no t agree with any of the statements to 109 not have status anxiety. 110 Outcomes (Gambling behaviors): Gambling behaviors were assessed using questions 111 adapted from the Thailand Student Behavioral Health Survey 2016 [25], which was designed 112 to be a self -administered questionnaire appropriate for individuals who read at up to the 7th 113 grade level and thus deemed to be appropriate for the general population. We asked participants 114 about their lifetime and past-year history of gambling and problematic gambling. Problematic 115 gambling questions were closely aligned with the NORC Diagnostic Screen for Gambling 116 Problems - Self Administered (NODS -SA) and included 10 items. Example items include: 117 “Have there ever been periods lasting two weeks or longer when you spent a lot of time thinking 118 about your gambling experiences or ways of getting money to gamble with? ” and “Have you 119 tried and not succeeded in stopping, cutting down, or controlling your gambling three or more 120 times in your life? ”. We then categorized the participants into three groups: 1) those who did 121 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint not gamble in the past year; 2) past -year gamblers without problematic gambling behaviors, 122 and; 3) past-year gamblers with problematic gambling behaviors. We also added one question 123 regarding lottery purchase as a separate behavior due to the Thai State Lottery being legal as 124 opposed to other forms of gambling, with the wording being the same as in a previous study of 125 health behaviors among Thai adults [19]. 126 Effect Modifier (Perceived Materialism ): Perceived materialism refers to an individual’s 127 belief that personal success, status, and happiness are primarily achieved through the 128 acquisition and ownership of material goods [26]. To measure perceived materialism, we used 129 the 6 -items Richin and Dawson Material Value Scale [27]. We measured the participant's 130 materialistic value level based on three domains: the use of possessions to judge the success of 131 others and oneself ("Success"), the centrality of possessions in a person's life ("Centrality"), 132 and the belief that possessions and their acquisition led to happiness and life satisfaction 133 ("Happiness"). We chose the 6 -items version to allow for minimal number of questions (to 134 accommodate for time) without the need to alter the measurement procedure [27]. Example 135 items included: “I am very concerned that I won't be able to achieve my academic or career 136 goals”, “I worry that my social status will not change”, “I feel anxious when someone asks me 137 “What is your income?””. 138 Demographic and Socioeconomic Characteristics: The investigator adapted questions used 139 in routine, nationally representative surveys on behavioral health [19] to measure the 140 demographic characteristics (sex, gender, age, ethnicity, marital status, religion) and 141 socioeconomic status (education, income, occupation) of the study participants. 142 143 Study instrument 144 The study instrument was a self -administered questionnaire with five sections: Section A. 145 Participant characteristics; Section B. Behavioral Health; Section C. Experience of Economic 146 Distress; Section D. Personal Finance; Section E. Perceptions of Socioeconomic Environment. 147 The English and Thai versions were developed concurrently, with the Thai texts being 148 authoritative, except for the personal finance measurement questions (Section D), the Status 149 Anxiety scale (Section E), and the Materia lism measurement tool (Section E), in which the 150 English-language texts are considered authoritative. For the questions in which the English 151 version is authoritative, the investigator translated the questions into Thai, back -translated the 152 questionnaire int o English using a machine -assisted translation tool and resolved the 153 discrepancies between the two versions to finalize the Thai questionnaire. 154 155 Data collection 156 The investigator made 1 ,115 copies of the study questionnaire and attached a copy of the 157 participant information sheet and two copies of the self-administered consent form to the front 158 page of the questionnaire (one for the participant’s own record, and one for the investigator). 159 The investigator then contacted the health department of the municip ality office of the study 160 area and requested a meeting with the health officer and local village health volunteers, who 161 functioned as community liaisons between the health department and local residents. The 162 investigator then briefed the health officer and the health volunteer regarding the study 163 procedures and distributed the study questionnaire to the health volunteers, to be distributed to 164 the local residents who met the study criteria at the health volunteers’ own convenience. The 165 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint investigator also gave each health volunteer opaque, sealable envelopes for participants to place 166 their own completed questionnaire for collection by the health volunteer. The investigator then 167 gave 20 THB notes to the health volunteers, with the number of notes matching the number of 168 questionnaires that each health volunteer received. The investigator then informed the health 169 volunteer that each participant who returned the questionnaire inside an opaque envelope 170 would be given one 20 THB note, provided that the seal on the opa que envelope was not 171 broken. The investigator then asked the health volunteer to choose a day of collection at their 172 convenience within the time limit of the study to distribute the questionnaires to local residents 173 under their care who met the study criteria. The investigator also informed that for each opaque 174 envelope returned, the investigator would pay 20 THB to the health volunteer. The municipality 175 health officer then helped to collect the plastic boxes with the completed questionnaires inside 176 the sealed opaque envelopes from the health volunteers, and the investigator collected the 177 boxes from the health officer. 178 179 Data management 180 The investigator designed a data entry form using the KoboToolbox platform. Those involved 181 with data entry included the investigator, junior colleagues, as well as a hired data entry staff 182 who received remuneration of 10 THB per questionnaire copy. The investigator instructed all 183 of those involved in data entry to adhere to what was writ ten on the questionnaire only. The 184 investigator then hired a data analytics consultant to perform data cleaning according to the 185 study questionnaire. 186 187 Data analyses 188 We used descriptive statistics to summarize the characteristics of the study participants. We 189 then performed bivariate analyses using cross -tabulation and logistic regression analyses to 190 describe the extent to which status anxiety was associated with gambling behavior. As the Thai 191 State Lottery was legal and lottery purchase was asked separately from other forms of 192 gambling, we decided to analyze the data separately by including vs. excluding lottery as a 193 form of gambling. Thus , we ran two models: one where lottery purc hase was not considered 194 gambling, and the other where lottery purchase was considered gambling. We also stratified 195 each cross-tabulation and model by whether participants reported any materialistic view. We 196 used the Breslow -Day Test for Homogeneity of Odds Ratios to assess the homogeneity of 197 associations across strata . All multivariate regression analyses adjusted for sex, age, marital 198 status, education, income, subjective social status compared to people of the same gender and 199 age, and history of economic distress within the past 12 months, which were found to be 200 independent predictors of behavioral health outcomes in previous studies [28–32]. We 201 performed all analyses using complete case analysis, i.e., the investigator excluded all 202 participants who answered "Don't know" or "Refuse to answer" or left blank spac es on the 203 questionnaire from the analyses. 204 205 Ethical considerations 206 Each copy of the data collection set included a copy of the study questionnaire, as well as a 207 copy of the participant information sheet and two copies of the self-administered consent form 208 on the front page of the questionnaire (one for the participant’s own record, and one for the 209 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint investigator). This study was conducted in accordance with the Declaration of Helsinki. The 210 protocols for this study have been approved by the Human Research Ethics Unit, Faculty of 211 Medicine, Prince of Songkla University (REC.65-146-18-2). 212 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint

213 A total of 1,112 residents of the study community answered the study questionnaire (Table 1). 214 Most participants were female, married. Slightly less than half of the participants had post -215 secondary education, and slightly less than half had 10,000 THB or less in monthly personal 216 income. Approximately one-third of the participants reported agreeing with at least one status 217 anxiety statement. Slightly less than eight percent of the participants had illegally gambled 218 within 12 months before the survey, but more than half had purchased a lottery within the same 219 period, nearly all of whom had purchased a lottery within the past 30 days before the survey. 220 221 With regard to the association between status anxiety and gambling behaviors (when lottery 222 was not considered as gambling) ( Table 2), we found that those who reported status anxiety 223 had significantly higher prevalence of problematic gambling behaviors than those who did not 224 report status anxiety (12.3% vs. 1.8%, Adjusted OR = 3.80; 95% CI = 1.35, 10.73). When 225 stratified by materialism, we found that among those who did not report perceived materialism, 226 virtually no one had problematic gambling behaviors (0% among those with status anxiety vs. 227 1.1% among those without status anxiety, adjusted OR N/A), and the association was non -228 significant among those who reported perceived materialism (Adjusted OR = 3. 17; 95% CI = 229 0.95, 10.57). Breslow -Day Test of heterogeneity indicated that these differences were not 230 statistically significant (p -value = 0.2985), i.e., that there was no significant effect 231 modification. 232 233 Similar analyses of the association between sta tus anxiety and gambling, when lottery was 234 considered as a form of gambling ( Table 3), showed similar differences in the prevalence of 235 problematic gambling behaviors between those who reported and did not report status anxiety 236 overall (12.6% vs. 1.8%; Adjusted OR = 5.87; 95% CI = 1.80, 19.07). The association was also 237 significant among those who reported materialism (14.0% vs. 2.2%; Adjusted OR = 5.01; 95% 238 CI = 1.16, 21.69). The Breslow -Day Test of heterogeneity, however, was not statistically 239 significant (p-value = 0.2957). 240 241 Comparison of demographic characteristics between those who answered all status anxiety 242 questions and those who did not ( Table 4) showed that those who answered all status anxiety 243 questions had slightly higher proportion of bachelor's degree holders and a higher proportion 244 of those who earned more than 20,000 THB per month. Those who did not answer all status 245 anxiety questions were also more likely to refuse to answer questions regarding gambling, but 246 the prevalence of past -year gamblin g and gambling behaviors were lower in this group 247 compared to those who answered all status anxiety questions. Thus, the extent to which 248 selection bias occurred in this study due to non-response was unclear. 249 250 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint

251 In this community-based survey, we assessed the extent to which status anxiety is associated 252 with gambling behaviors, and the extent to which materialism modified the association. We 253 found a statistically significant association between status anxiety and gambling behaviors. 254 However, we did not find statistically significant heterogeneity of the association among those 255 who reported perceived materialism compared to the association among those who did not. The 256 findings of this study may be of interest to sta keholders in mental health and community 257 development. 258 259 The significant association between status anxiety and gambling behaviors in our findings 260 supported our hypothesis that status anxiety can drive people toward high-risk behaviors. These 261

align with the Spirit Level Theory [9,10]. On the other hand, effect modification by 262 materialism was not statistically significant . Gambling behavior was very low among those 263 who did not report materialism, and much higher among those who reported materialism, 264 especially those who also had status anxiety. These findings align with the “ Material 265 Reinforcement” behavioral model, which states that people who are materially oriented are 266 more inclined toward behaviors offering immediate gratification, including gambling [12,14]. 267 The mechanism through which status anxiety and materialism interact has not been 268 documented in detail, and thus remains an open question. Future studies should incorporate the 269 qualitative or mixed method design to further explore the role of status anxiety as a determinant 270 of health behaviors. 271 272 The strength of our study was the integration of concepts in psychology and sociology into the 273 study of gambling behaviors, which future studies can further expand. There are also a number 274 of limitations that should be considered in the interpretation of our study findings. Firstly, this 275 study was conducted bef ore the discussions in parliament regarding the legalization of 276 gambling at integrated resorts [33]. In such a context, w e could not preclude the potential for 277 social desirability to influence our study findings. Secondly, the cross-sectional design limits 278 the ability to draw causal conclusions, making it unclear whether status anxiety and materialism 279 cause gambling behaviors or if these relationships are mutual. Thirdly, we selected our study 280 participants by convenience sampling of residents of only one municipality. Thus, selection 281 bias and lack of representativeness could not be precluded from the study findings. Future 282 studies should consider a mixed methods design to yi eld additional insights regarding the 283 nature of the association between status anxiety, materialism, and gambling. 284 285 286 287 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint

288 In this community -based survey, we found that status anxiety was significantly 289 associated with gambling behaviors, but we did not find evidence of clear effect modification 290 by materialism. However, the prevalence of gambling behaviors was very low among 291 participants without perceived materialism and very high among participants with perceived 292 materialism. Our findings provide basic information regarding the potential roles of status 293 anxiety and materialism in gambling, particularly problem gambling. Limitations regarding the 294 potential influence of social desirability , the study design, selection bias, and limited 295 generalizability should be considered as caveats in the interpretation of the study findings. 296 297 298

299 The authors wish to thank all participants, the community health volunteers, and the 300 public health officials in the study area. The authors also wish to thank one of his colleagues 301 for liaising with the municipality's public health officers, which made the study possible. The 302 authors wish to thank Mr. Guanjie Li for his comments on the initial draft manuscript, which 303 substantially contributed to its improvement. 304 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint

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Characteristics of the Study Participants (n=1112) 401 Characteristic Frequency (%) or mean ± SD Sex assigned at birth (n = 1091) Male 416 (38.1%) Female 674 (61.8%) Other 1 (0.1%) Age (years) (mean ± SD) (n=1022) 45.8 ± 14.5 Marital Status (n = 1051) Single 261 (24.8%) Married 598 (56.9%) Cohabitation 84 (8.0%) Widowed / divorced / separated 105 (10.0%) It’s complicated 3 (0.3%) Highest Level of Education Completed (n = 1046) Junior High School or Lower 343 (32.8%) High School or Equivalent 235 (22.5%) Associate’s Degree or Equivalent 146 (14.0%) Bachelor’s Degree 306 (29.3%) Graduate Degree 16 (1.5%) Personal Monthly Income (n = 1059) No more than 5,000 THB 88 (8.3%) 5,001 - 10,000 THB 359 (33.9%) 10,001 - 20,000 THB 540 (51.0%) 20,001 - 30,000 THB 53 (5.0%) 30,001 - 40,000 THB 11 (1.0%) 40,001 - 50,000 THB 3 (0.3%) More than 50,000 THB 5 (0.5%) Status anxiety perception (answering “agree”) I feel anxious that I will be stuck in my position for life (n=762) 172 (22.6%) I am very concerned that I won't be able to achieve my academic or career goals (n=824) 218 (26.5%) I worry that I might become lower in social standing (n=844) 194 (23.0%) I am concerned that my current position in life is too low (n=843) 186 (22.1%) I worry that my social status will not change (n=828) 160 (19.3%) Status anxiety: Answering “Agree” to at least one statement (n=690) 251 (36.4%) Gambling Behavior* (n = 931) Did not gamble in the past year 862 (92.6%) Past-year gambling without problematic gambling behaviors 27 (2.9%) Past-year problematic gambling behaviors 42 (4.5%) Lottery Purchase (Legal or Underground) (n = 969) Did not purchase lottery in the past 12 months 447 (46.1%) Purchased lottery within the past 12 months but not within the past 30 days 50 (5.2%) Purchased lottery within the past 30 days 472 (48.7%) . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint *Not including purchase of lottery (legal or underground) within the past 12 months 402 . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint Table 2. Association between status anxiety and gambling behaviors (not including the lottery), overall and stratified by perceived materialism Did not gamble in the past year Past-year gambling w/o problematic gambling behaviors Past-year problematic gambling behaviors Crude OR (95% CI) Gambling w/o problematic behavior vs. did not gamble Crude OR (95% CI) Problematic gambling behaviors vs. did not gamble Adjusted OR (95% CI) Gambling w/o problematic behavior vs. did not gamble* Adjusted OR (95% CI) Problematic gambling behaviors vs. did not gamble* Overall association No status anxiety (n=394) 370 (93.9%) 17 (4.3%) 7 (1.8%) Reference Reference Reference Reference Status anxiety (n=220) 189 (85.9%) 4 (1.8%) 27 (12.3%) 0.46 (0.15,1.39) 7.55 (3.23,17.66) 0.57 (0.14,2.38) 3.80 (1.35,10.73) Among those who did not report materialism No status anxiety (n=180) 167 (92.8%) 11 (6.1%) 2 (1.1%) Reference Reference Reference Reference Status anxiety (n=14) 14 (100%) 0 (0%) 0 (0%) N/A N/A N/A N/A Among those who reported materialism No status anxiety (n=181) 171 (94.5%) 6 (3.3%) 4 (2.2%) Reference Reference Reference Reference Status anxiety (n=182) 153 (84.1%) 4 (2.2%) 25 (13.7%) 0.75 (0.21,2.69) 6.99 (2.38,20.52) 1.39 (0.08, 23.17) 3.17 (0.95,10.57) Breslow-Day Test (Past-year gambling without problematic behavior vs. Did not gamble in the past year) p-value = 0.408 Breslow-Day Test (Past-year problematic gambling behaviors vs. Did not gamble in the past year) p-value = 0.2985 *Adjusted for sex, age, marital status, education, income, subjective social status compared to people of the same gender and age, and history of economic distress within the past 12 months . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint Table 3. Association between status anxiety and gambling behaviors (including the lottery), overall and stratified by perceived materialism Did not gamble in the past year Past-year gambling w/o problematic gambling behaviors Past-year problematic gambling behaviors Crude OR (95% CI) Gambling w/o problematic behavior vs. did not gamble Crude OR (95% CI) Problematic gambling behaviors vs. did not gamble Adjusted OR (95% CI) Gambling w/o problematic behavior vs. did not gamble* Adjusted OR (95% CI) Problematic gambling behaviors vs. did not gamble* Overall association No status anxiety (n=380) 190 (50.0%) 183 (48.2%) 7 (1.8%) Reference Reference Reference Reference Status anxiety (n=214) 75 (35.0%) 112 (52.3%) 27 (12.6%) 1.55 (1.09, 2.21) 9.77 (4.08, 23.4) 1.63 (1.00, 2.64) 5.87 (1.80, 19.07) Among those who did not report materialism No status anxiety (n=175) 93 (53.1%) 80 (45.7%) 2 (1.1%) Reference Reference Reference Reference Status anxiety (n=14) 7 (50.0%) 7 (50.0%) 0 (0%) 1.16 (0.39,3.46) N/A 0.96 (0.21, 4.37) N/A Among those who reported materialism No status anxiety (n=178) 81 (45.5%) 93 (52.2%) 4 (2.2%) Reference Reference Reference Reference Status anxiety (n=178) 63 (35.4%) 90 (50.6%) 25 (14.0%) 1.24 (0.8,1.93) 8.04 (2.66,24.28) 1.60 (0.88,2.92) 5.01 (1.16, 21.69) Remark: Past-year lottery purchase was classified as past-year gambling without problematic gambling behaviors Breslow-Day Test (Past-year gambling without problematic behavior vs. Did not gamble in the past year) p-value = 0.9097 Breslow-Day Test (Past-year problematic gambling behaviors vs. Did not gamble in the past year) p-value = 0.2957 *Adjusted for sex, age, marital status, education, income, subjective social status compared to people of the same gender and age, and history of economic distress within the past 12 months . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint Table 4. Comparison of demographic characteristics and gambling status between participants who answered all status anxiety measurement questions and participants who did not (column percent) Characteristic Did not answer all status anxiety questions (n=422) Answered all status anxiety questions (n=690) P-value Sex assigned at birth, n (%) Male 256 (63.1%) 418 (61.1%) 0.566 Female 150 (36.9%) 266 (38.9%) Age (years) (mean ± SD) (n=1022) 46.9 ± 14.7 45.2 ± 14.4 0.075 Marital Status, n (%) Single 90 (23.2%) 171 (25.8%) 0.324 Married 234 (60.3%) 364 (54.9%) Cohabitation 30 (7.7%) 54 (8.1%) Widowed / divorced / separated 34 (8.8%) 71 (10.7%) It’s complicated 0 (0.0%) 3 (0.5%) Highest Level of Education Completed, n (%) Junior High School or Lower 140 (37.0%) 203 (30.4%) 0.005 High School or Equivalent 97 (25.7%) 138 (20.7%) Associate’s Degree or Equivalent 49 (13.0%) 97 (14.5%) Bachelor’s Degree 89 (23.5%) 217 (32.5%) Graduate Degree 3 (0.8%) 13 (1.9%) Personal Monthly Income, n (%) No more than 5,000 THB 34 (8.9%) 54 (8.0%) 0.014 5,001 - 10,000 THB 139 (36.2%) 220 (32.6%) 10,001 - 20,000 THB 200 (52.1%) 340 (50.4%) 20,001 - 30,000 THB 8 (2.1%) 45 (6.7%) 30,001 - 40,000 THB 2 (0.5%) 9 (1.3%) 40,001 - 50,000 THB 1 (0.3%) 2 (0.3%) More than 50,000 THB 0 (0.0%) 5 (0.7%) Gambling Behavior*, n (%) Did not gamble in the past year 303 (71.8%) 559 (81.0%) <0.001 Past-year gambling without problematic gambling behaviors 6 (1.4%) 21 (3.0%) Past-year problematic gambling behaviors 8 (1.9%) 34 (4.9%) Refused to answer or no data 105 (24.9%) 76 (11.0%) P-values are those of Pearson chi-square test . CC-BY-NC-ND 4.0 International licenseIt is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint The copyright holder for thisthis version posted November 17, 2025. ; https://doi.org/10.1101/2025.11.16.25340338doi: medRxiv preprint