Help-seeking and help expectations for gambling problems at different severity levels

Help-seeking and help expectations for gambling problems at different severity levels | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Help-seeking and help expectations for gambling problems at different severity levels Håkan Wall, Olof Molander, Virve Marionneau This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6112600/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Jul, 2025 Read the published version in Discover Public Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Treatment and help services for gambling problems range from formalised therapy to lower-threshold options such as helplines, digital health solutions and online self-help resources. Few people with gambling problems access these services. Lack of service reach may partly be explained by expectations and experiences on available services. Yet, little is currently known about what kind of services are expected and accessed by individuals gambling at different severity levels. Objectives: This study analyses help-seeking and help expectations amongst a sample of Swedish gambling helpline customers (N=108). Methods: Data were collected using an online survey. The survey collected data on demographic characteristics, prior use of different support and treatment services for gambling, use of the national self-exclusion registry, and screened participants for gambling problem severity. The analysis compares help expectations and received services between individuals with gambling disorder and those gambling at lower severity levels. Results: Results show a wide range of expectations regarding help services, including psychological support, support with CSOs, and financial counselling. Expectations were similar across individuals with and without gambling disorder. However, in terms of received services, those with more severe gambling problems tended to receive more online and self-help services than those gambling at lower severity levels. Most help-seekers had self-excluded from gambling but continued gambling regardless. Conclusions: Our results suggest a mismatch between harm severity and types of received help. More effective prevention of gambling harm would reduce the burden on help services and allow better targeting of services to address individual needs of help-seekers. Introduction Gambling places a burden on public health. The ICD-11 and the DSM-5 both recognise Gambling Disorder (GD) as a mental health disorder that is characterised by persisting gambling behaviours [ 1 ], [ 2 ]. In population samples, harmful gambling is usually measured as prevalence of problem gambling. Problem gambling is estimated to affect 2.2 percent of men and 1.0 percent of women globally. 8.7 percent of adults globally engage in gambling at some risk level [ 3 ]. Alongside addictive use, gambling can also lead to other significant economic, mental, physical, and relationship harms and even suicidality [ 4 ], [ 5 ]. These harms accrue to those who gamble, but also to their families and communities. The World Health Organisation [ 6 ] recently sounded alarm on the severe and global health consequences of gambling, highlighting the importance of effective prevention and treatment. It is therefore important to focus on how services to address gambling harms could be improved. Currently, help services for gambling-related problems include formalised treatment and therapy but also a range of lower-threshold options such as helplines [ 7 ]. Digital health solutions are also becoming common, including online resources, tests, online therapy, and online health applications [ 8 ], [ 9 ], [ 10 ]. Yet, existing studies show that few individuals use any help services for gambling, even when these are available [ 11 ], [ 12 ]. The choice not to seek help may depend on a range of personal and institutional barriers, such as shame, stigma, denial of problem severity, wanting to solve the problem alone, as well as lack of awareness of or access to services [ 13 ], [ 14 ], [ 15 ]. In addition, it is likely that individuals experiencing different severity levels of problem gambling may access help services differently and have different expectations of services. A systematic review on the prevalence of help-seeking for gambling problems showed that only 0.27 percent of people with low-risk gambling had ever sought help, compared to 3.73 percent of people gambling at moderate-risk levels and 20.63 percent of individuals with problem gambling [ 16 ]. However, the review did not differentiate results by help service type. Currently, little is known about what kind of services are accessed by individuals gambling at different severity levels, and what kind of services they expect when they do choose to seek help. This brief report focuses on help-seeking and help expectations in a sample of Swedish gambling helpline customers (N = 108). Helplines are amongst the most frequently available and used help resource for gambling. A recent review found over 80 gambling helplines operating globally [ 8 ]. Most helplines offer a range of services, including motivational interviewing, counselling, treatment referrals and online resources [ 8 ]. Due to the range of services available, and status as a low threshold service for gambling harms, helpline customers are not a uniform group [ 17 , 18 ]. Helpline customers are also likely to have diverging needs and expectations in terms of what kind of services they expect or receive. Methods 2.1. Context Sweden is one of the most digitalised societies globally, also in terms of gambling consumption. In 2023, 63 percent of total Swedish gambling consumption took place in the competitive part of the market, i.e., online casino games and betting [ 19 ]. The Swedish online gambling market has grown rapidly since online markets were opened to licensed operators in 2021. At a population level, gambling is also causing important harm in Sweden. In 2021, 1.2 percent of the population were classified as having a gambling problem [ 20 ]. The Swedish national gambling helpline, Stödlinjen, was founded in 1999 and provides anonymous support to individuals with gambling problems and to their concerned significant others (CSOs). In 2023, 1,200 individuals contacted the helpline for counselling. 22,500 individuals used the online problem gambling screener, and more than 400,000 visits were recorded on the helpline web page (Stödlinjen, 2023). 2.2. Data We conducted a survey amongst Swedish helpline clients during 2022–2023. The initial dataset contained 227 observations, however, 119 participants left incomplete or empty answers, rendering a final sample of 108 participants who provided complete answers. The survey was available on the Stödlinjen website between December 2022 and October 2023. We included participants who sought support for their own gambling issues (excluding family members and other CSOs) and who visited the gambling helpline website during the data collection period. Data were collected using an online survey that prompted respondents on demographic characteristics, prior use of different support and treatment services for gambling (including those provided by the helpline), use of the national self-exclusion registry (Spelpaus), and asked participants to fill a self-report measure assessing gambling problem severity, i.e. the Gambling Disorder Identification Test (GDIT; available in the public domain; www.gditscale.com ). GDIT is a comprehensive measure to assess diagnostic severity, including gambling behaviours, negative consequences/harms, type involvement, and expenditure. The GDIT has undergone extensive psychometric evaluations, demonstrating robust psychometric properties [ 21 ], [ 22 ], [ 23 ], [ 24 ]. The scale has also been validated among Swedish helpline customers [ 23 ]. A key advantage of the GDIT over other gambling measures is its alignment with DSM-5 criteria. A total score of ≥ 20 indicates GD severity, while ≤ 19 represents diagnostic subthreshold gambling patterns. 0 points: non-gambling; < 15 points: recreational or at risk gambling; 15–19 points: problem gambling; 20–24 points: mild GD; 25–29 points: moderate GD; ≥ 30 points: severe GD 2.3. Statistical methods Results are presented descriptively and using inference tests. To test associations between help-seeking behaviours and dichotomised GD levels, we conducted logistic regressions with dichotomised GD level as an outcome variable and actual help-seeking behaviour in the helpline as the predictor variable. For our study, we dichotomised our sample of 108 participants into two groups based on total GDIT scores: those reporting any degree of gambling disorder (GDIT 20+) were categorised as having GD (N = 89). Those experiencing lower severity gambling problems were categorised as ‘sub-threshold GD (N = 19). Help-seeking behaviours were also dichotomised. Responses reporting having called, chatted, emailed or had repeated calls with the helpline were collapsed into the binary variable ‘utilisation of counselling services’ while responses indicating searching the website for information and testing gambling habits via a self-test were collapsed into ‘utilisation of online services’. Results Table 1 shows our sample characteristics. Although our study was based on convenience sampling at the Swedish helpline, our data collection captured individuals gambling at varying severity levels. Table 2 presents results on how help-seekers in our sample found the gambling helpline. One third of participants had found the helpline using an internet search. Advertising and gambling company websites were also mentioned by approximately 10 percent of participants each. Table 1 Background characteristics and gambling behaviours, N = 108. Variable N = 108 Gender , n (%) Women 35 (32.4) Men 71 (65.7) Not stated 2 (1.9) Age, M (SD) 38.5 (14.2) Born in Sweden, n (%) 89 (82.4) Highest education, n (%) High school 61 (56.5) University 24 (22.2) Elementary school 11 (10.2) Other 12 (11.1) Source of income , n (%) Employment 81 (75.0) Studies 9 (8.3) Other 18 (16.7) Net income in SEK (1 SEK ~ 0.09 EUR), median (IQR) 25,000 (12,500) Gambling debts (yes) , n (%) 69 (63.9) Gambling variables GDIT total score, M (SD) 32.4 (13.9) GDIT category , n (%) Non-gambling 1 (0.9) Recreational or at risk gambling 12 (11.1) Problem gambling 6 (5.6) Mild Gambling Disorder 9 (8.3) Moderate Gambling Disorder 16 (14.8) Severe Gambling Disorder 64 (59.3) Type of gambling , n (%) Online slots 76 (70.4) Online betting 50 (46.3) Online Lotteries 23 (21.3) Table 2 How the participants found out about the helpline, N = 108. Variable, n (%) Via search engine on the Internet 36 (33.3) Don't remember 31 (28.7) Via gambling advertising 12 (11.1) Link from a gambling company website 10 (9.3) Link from a gambling company website directly to the Helpline's self-test 8 (7.4) Was recommended by a friend/colleague/family member or similar 4 (3.7) Was advised by a healthcare contact/self-help group or similar 3 (2.8) Social media 2 (1.9) Other 2 (1.9) Table 3 shows results on services that help-seekers were expecting to receive. Results show a variety of expected services amongst individuals with GD and individuals gambling at lower severity levels. On average, individuals reported 2.0 (SD = 1.5) expected services. In the full sample, the most reported expectations were to receive advice, support or motivation to change one’s gambling habits (59.3%), and to obtain information about problem gambling or GD (47.2%). 20.4 percent participants sought advice or referrals on financial matters. 14.8% expected to receive assistance in disclosing their gambling habits to a concerned significant other. 29.2 percent of those with GD reported expecting psychological support. An important part of those without GD (26.3%) also reported expecting ‘other’ types of services. Table 3 Expected service Variable, n (%) Full sample N = 108 Sub-threshold GD N = 19 GD N = 89 Information about gambling problems/disorder 21 (47.2) 7 (36.8) 44 (49.4) Advice, support or motivation to change my gambling 64 (59.3) 9 (47.4) 55 (61.8) Support to manage my mental health 28 (25.9) 2 (10.5) 26 (29.2) Support in telling a loved one about my gambling 16 (14.8) 3 (15.8) 13 (14.6) Referral or information about other support/treatment for gambling 20 (18.5) 4 (21.0) 16 (18.0) Advice on financial matters or referral to financial advice 22 (20.4) 4 (21.0) 18 (20.2) Other 17 (15.7) 5 (26.3) 12 (13.5) In terms of received services, we found that, overall, those without GD had sought more prior help (26%) compared to those with GD (16%). However, both groups had similar levels of prior contact with the helpline (63.2% and 68.5%, respectively). Table 4 shows results on the kinds of services that individuals in our sample had received. We found that online services were the most typical services received in the sample. Most study participants reported testing their gambling habits using the online self-test (48.2%) or seeking information via the website (41.2%). Moreover, we found that those with GD had lower odds of using counselling services compared to those with sub-threshold GD (OR = 0.3, p = 0.02). In contrast, individuals with GD utilised online services to a greater extent than those with sub-threshold GD. However, these differences were statistically inconclusive (OR = 2.7, p = 0.14). Table 4 Received service at the helpline Variable, n (%) Total sample N = 108 Sub-threshold GD N = 19 GD N = 89 Spoke on the phone with a counsellor 14 (13.0) 6 (31.6) 8 (9.0) Chatted with a counsellor 18 (16.7) 5 (26.3) 13 (14.6) Contact with a counsellor via email 10 (9.3) 3 (15.8) 7 (7.9) Verbally booked and then received a follow-up call with a counsellor at the appointed time 5 (4.6) 2 (10.5) 3 (3.4) Searched for information via the website 45 (41.2) 3 (15.8) 42 (47.2) Tested my gambling habits via the self-test 52 (48.2) 7 (36.8) 45 (50.6) Other 27 (25.0) 7 (36.8) 20 (22.5) Only 17.6 percent of our sample reported prior involved in problem gambling support or treatment outside of the helpline context. These services included treatment or internet-based treatment in public healthcare or private service provision (2.8–4.6%), as well as treatment and support via social services or through self-help groups (5.6%) (see Table 5 ). Table 5 Previous help-seeking outside the helpline Variable, n (%) N = 108 Treatment through healthcare 4 (3.7) Internet treatment via healthcare 3 (2.8) Support via Social Services 6 (5.6) Support via self-help groups 6 (5.6) Treatment via private service provision 6 (4.6) Other 6 (5.6) In addition to helpline services and referrals, most individuals in our sample had used the Spelpaus self-exclusion registry (58.3%, with time-periods ranging from one month to until further notice). However, a significant proportion of these individuals also reported having gambled despite being enrolled in Spelpaus (76.2%). Discussion This brief research paper has investigated help seeking in terms of expectations and received services in a sample (N = 108) of Swedish helpline customers. We also compared help-seeking between those with GD and those gambling at lower severity levels. Our study has yielded several results that are important in further developing and targeting effective services to those who experience gambling-related problems. First, our results have shown that individuals expect a range of different services when contacting helplines. Expected services range from help with changing gambling habits to psychological support, referrals to other treatment, financial counselling, or support in telling CSOs about the situation. This result suggests that individuals contacting gambling help services are knowledgeable about the range of services that are available to them [ 8 ]. At the same time, this finding attests to the wide range of service needs that individuals with gambling problems may have. Services should adapt to differing needs and harms attached to gambling problems and address these with appropriate treatment and help options, including psychological support, but also financial and family counselling. Second, we found that while expectations regarding services were largely similar across our two groups of respondents, received services differed between the groups. Notably, those with GD had received significantly more online services than those without GD. Conversely, those without GD received more telephone counselling - both overall and in terms of recurring telephone contacts – than those with GD. This finding is somewhat surprising. Digital health services and online resources are intended as low-threshold and accessible options particularly for first-time help seekers (e.g., [ 10 ]. Our result suggests that these online resources continue to be the main source of support also for those with more severe problems. Online services can be more appropriate for some (van der Maas et al., 2019). Some prior research also suggests that the choice to use online help resources for gambling may be related to perceived ability and desire to change [ 25 ]. However, it would be crucially important to investigate whether those with more severe gambling problems are, in fact, reluctant to make contact and therefore prefer online services, or whether their higher use of online services relates to a mismatch between service needs and services provided. This can have a major impact on how helpline services and other help infrastructure should be set up. Third, and finally, our results showed that while most individuals in our dataset had signed up for the Swedish self-exclusion registry, over 77 percent of these individuals had continued gambling despite self-exclusion. Self-exclusions can be an important tool to reduce harmful gambling or GD symptoms, but the effectiveness of self-exclusions can also be reduced by factors such as lack of complete exclusion from all gambling offers [ 26 ]. In Sweden, over 120,000 individuals are already signed up to Spelpaus [ 27 ]. However, unlicensed offshore offers continue to be available to these individuals despite self-exclusion [ 28 ]. Our result therefore suggests that while self-exclusions can help some, they need to be implemented within the framework of a wider range of regulatory tools to reduce and prevent gambling problems. More effective system-level regulations [ 29 ], including enforcement against offshore gambling, are needed to reduce harmful supply side practices. 3.1. Implications Our results have implications on improving treatment services for problematic gambling. Help-seekers to helplines are not a uniform customer group. Instead, help-seekers have diverging needs and expectations with regard to services. All help-seekers need to be screened for harm severity and expectations to match them with appropriate services. Some help-seekers may prefer online services due to anonymity and accessibility [ 10 ], [ 25 ]. However, internet-based help services can also be less appropriate for others. Online services include high levels of attrition as well as lack of personal contact with help professionals which may function as barriers to recovery [ 10 ]. It is important that appropriate help is matched with expectations and needs. Otherwise, it is possible that even when help is available, it might not reach those who need it the most. Helplines provide a range of different services to help-seekers, ranging from telephone counselling to online self-help resources [ 8 ]. These different services need to be referred and targeted according to customer group needs. Furthermore, the gambling field is currently developing at a fast pace. New products and commercial practices, particularly online, risk increasing harms globally [ 5 ]. Helplines and other help services need to stay vigilant in addressing new and emerging phenomena and harms, and also adapt services to emerging customer needs and expectations. 3.2. Limitations Our study has been limited by a relatively small sample size. Our data collection was also based on convenience sampling. Whilst our data collection ran on the Stödlinjen website for almost a year, our sample consists of only a small minority of all individuals visiting the helpline online resources. Difficulties in recruiting more respondents may relate to continued stigma and reluctance to talk about gambling-related problems. It is possible that our sample is skewed towards individuals with more experience of different treatment and help services. As our data collection took place online, it is also possible that our data are skewed towards individuals seeking online services. Caution should therefore be used in interpreting our results. However, helplines also provide unique access to individuals with experience of gambling problems and help services. This type of group would have been difficult to research otherwise. Despite possible skews in the sample, our analysis has produced new insight on the service expectations and needs of different help-seeker groups. Going forward, these promising new results call for additional research to further improve and target help services. Conclusion This study has investigated help-seeking, expectations, and received services in a sample of Swedish gambling helpline customers. Our results have shown that individuals have a wide range of expectations with regard to help services. These expectations align with the harmful effects of gambling, including psychological support, support with CSOs, and financial counselling. Many of these expectations have also been met with received services. However, our results also show that those with more severe gambling problems receive more online and self-help services than those gambling at lower severity levels. It is important that all individuals who experience gambling harm receive help and support. However, our results suggest that there may be a mismatch between harm severity and types of help received. Gambling has negative impacts on an important part of the population. It is important to develop effective and well-targeted help and treatment interventions to support individuals and families dealing with problem gambling and gambling-related harms. At the same time, as also recently highlighted by the WHO [ 6 ], it is crucial to develop more effective strategies to prevent these problems and harms. Gambling disorder and problem gambling are driven by wide availability, accessibility and visibility of commercial gambling in many societies. To protect public health, system-level regulatory controls are needed. More effective prevention is also key to lessening the burden on the treatment system, allowing for better targeting and implementation of treatment based on individual needs. Declarations Consent to participate All data collection was anonymous and did not require informed consent. Participants were provided information about the study and their rights, but they were not asked to sign a form to give informed consent. The study received ethics approval from the Regional Ethics Board of Stockholm, Sweden (ref. no. 2022-03651-01). However, at the beginning of the survey, before participants proceeded to the measures, they were presented with a landing page. This page included a brief summary of the study and outlined the eligibility criteria for participation. Additionally, the landing page provided a link to detailed study information, covering the study procedure, data storage, and contact details for the responsible researchers. Before participants could begin completing the survey, they had to verify that they had read the study information and accepted the terms of participation. Participants also had the option to decline participation; these individuals were redirected to a page informing them that they had declined participation. This research was carried out in accordance with relevant guidelines and regulations. Clinical trial number Not applicable. Consent to publish Not applicable. Funding statement HW received funding from the Swedish Research Council for Health, Working Life, and Welfare (Forte, grant number 2023 − 00898). OM reports no funding for the current study. VM received funding from The Finnish Ministry of Social Affairs and Health based on the provisions of section 52 of the Finnish Lotteries Act. Competing interests The authors have no conflicts of interest to declare that are relevant to the content of this article. Data availability The raw data supporting the conclusions of this article will be made available by the authors upon request, provided that the request complies with Swedish and EU laws governing the protection of identifiable data. Acknowledgements We would like to thank the Swedish gambling helpline Stödlinjen for their collaboration in the data collection for this study. References Almeida MSC, de Sousa Filho LF, Rabello PM, Santiago BM. International Classification of Diseases–11th revision: from design to implementation. Rev Saúde Pública. 2020;54:104. https://doi.org/10.11606/s1518-8787.2020054002120 . American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. Tran LT et al. The prevalence of gambling and problematic gambling: a systematic review and meta-analysis, Lancet Public Health , 2024, Accessed: Feb. 17, 2025. [Online]. 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Cite Share Download PDF Status: Published Journal Publication published 30 Jul, 2025 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 21 Apr, 2025 Reviews received at journal 17 Apr, 2025 Reviews received at journal 15 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers agreed at journal 03 Apr, 2025 Reviewers invited by journal 01 Apr, 2025 Editor assigned by journal 20 Mar, 2025 Submission checks completed at journal 19 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6112600","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":436858260,"identity":"095fd276-7689-4df5-9cfa-3798b676c589","order_by":0,"name":"Håkan Wall","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYBACAwY2CIOPnfkwQwJJWtiY2ZJJ1sJjTJzDzNmPJX4uYDgsD9Ty2eABQ50cQS2WPWmHpWcwHDZsY+bdnJDAcJiwVQYH0hukeRhuM4K0HEhgOJDYQFDL+efNv4Fa7NuYeR4DtdTVE9ZyI+0YyJZEoBZmoMOYEwg77MazNGseg//JbcxsxgYJBocNiXBYmvFtnoo023725seSPyrq5AnaAtWIwRgFo2AUjIJRQBEAAC5GM/7JpbzyAAAAAElFTkSuQmCC","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":true,"prefix":"","firstName":"Håkan","middleName":"","lastName":"Wall","suffix":""},{"id":436858266,"identity":"28727888-a641-4f59-aec8-47e7c87340f9","order_by":1,"name":"Olof Molander","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Olof","middleName":"","lastName":"Molander","suffix":""},{"id":436858271,"identity":"d98a9d6e-13d2-4d28-8fcc-c4617ac34a39","order_by":2,"name":"Virve Marionneau","email":"","orcid":"","institution":"University of Helsinki","correspondingAuthor":false,"prefix":"","firstName":"Virve","middleName":"","lastName":"Marionneau","suffix":""}],"badges":[],"createdAt":"2025-02-26 11:08:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6112600/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6112600/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-025-00853-7","type":"published","date":"2025-07-30T16:04:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88268158,"identity":"13a9fdee-db8f-4cc0-b400-9bac00daaddf","added_by":"auto","created_at":"2025-08-04 16:49:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":693589,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6112600/v1/9396b2ee-0094-4fa9-a875-7043f708ba9c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Help-seeking and help expectations for gambling problems at different severity levels","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGambling places a burden on public health. The ICD-11 and the DSM-5 both recognise Gambling Disorder (GD) as a mental health disorder that is characterised by persisting gambling behaviours [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In population samples, harmful gambling is usually measured as prevalence of problem gambling. Problem gambling is estimated to affect 2.2 percent of men and 1.0 percent of women globally. 8.7 percent of adults globally engage in gambling at some risk level [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Alongside addictive use, gambling can also lead to other significant economic, mental, physical, and relationship harms and even suicidality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These harms accrue to those who gamble, but also to their families and communities.\u003c/p\u003e \u003cp\u003eThe World Health Organisation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] recently sounded alarm on the severe and global health consequences of gambling, highlighting the importance of effective prevention and treatment. It is therefore important to focus on how services to address gambling harms could be improved.\u003c/p\u003e \u003cp\u003eCurrently, help services for gambling-related problems include formalised treatment and therapy but also a range of lower-threshold options such as helplines [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Digital health solutions are also becoming common, including online resources, tests, online therapy, and online health applications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Yet, existing studies show that few individuals use any help services for gambling, even when these are available [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The choice not to seek help may depend on a range of personal and institutional barriers, such as shame, stigma, denial of problem severity, wanting to solve the problem alone, as well as lack of awareness of or access to services [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, it is likely that individuals experiencing different severity levels of problem gambling may access help services differently and have different expectations of services. A systematic review on the prevalence of help-seeking for gambling problems showed that only 0.27 percent of people with low-risk gambling had ever sought help, compared to 3.73 percent of people gambling at moderate-risk levels and 20.63 percent of individuals with problem gambling [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the review did not differentiate results by help service type. Currently, little is known about what kind of services are accessed by individuals gambling at different severity levels, and what kind of services they expect when they do choose to seek help.\u003c/p\u003e \u003cp\u003eThis brief report focuses on help-seeking and help expectations in a sample of Swedish gambling helpline customers (N\u0026thinsp;=\u0026thinsp;108). Helplines are amongst the most frequently available and used help resource for gambling. A recent review found over 80 gambling helplines operating globally [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Most helplines offer a range of services, including motivational interviewing, counselling, treatment referrals and online resources [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Due to the range of services available, and status as a low threshold service for gambling harms, helpline customers are not a uniform group [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Helpline customers are also likely to have diverging needs and expectations in terms of what kind of services they expect or receive.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1. Context\u003c/h2\u003e\n\u003cp\u003eSweden is one of the most digitalised societies globally, also in terms of gambling consumption. In 2023, 63 percent of total Swedish gambling consumption took place in the competitive part of the market, i.e., online casino games and betting [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. The Swedish online gambling market has grown rapidly since online markets were opened to licensed operators in 2021. At a population level, gambling is also causing important harm in Sweden. In 2021, 1.2 percent of the population were classified as having a gambling problem [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe Swedish national gambling helpline, St\u0026ouml;dlinjen, was founded in 1999 and provides anonymous support to individuals with gambling problems and to their concerned significant others (CSOs). In 2023, 1,200 individuals contacted the helpline for counselling. 22,500 individuals used the online problem gambling screener, and more than 400,000 visits were recorded on the helpline web page (St\u0026ouml;dlinjen, 2023).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2. Data\u003c/h2\u003e\n\u003cp\u003eWe conducted a survey amongst Swedish helpline clients during 2022\u0026ndash;2023. The initial dataset contained 227 observations, however, 119 participants left incomplete or empty answers, rendering a final sample of 108 participants who provided complete answers. The survey was available on the St\u0026ouml;dlinjen website between December 2022 and October 2023. We included participants who sought support for their own gambling issues (excluding family members and other CSOs) and who visited the gambling helpline website during the data collection period.\u003c/p\u003e\n\u003cp\u003eData were collected using an online survey that prompted respondents on demographic characteristics, prior use of different support and treatment services for gambling (including those provided by the helpline), use of the national self-exclusion registry (Spelpaus), and asked participants to fill a self-report measure assessing gambling problem severity, i.e. the Gambling Disorder Identification Test (GDIT; available in the public domain; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.gditscale.com\u003c/span\u003e\u003c/span\u003e). GDIT is a comprehensive measure to assess diagnostic severity, including gambling behaviours, negative consequences/harms, type involvement, and expenditure. The GDIT has undergone extensive psychometric evaluations, demonstrating robust psychometric properties [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. The scale has also been validated among Swedish helpline customers [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. A key advantage of the GDIT over other gambling measures is its alignment with DSM-5 criteria. A total score of \u0026ge;\u0026thinsp;20 indicates GD severity, while\u0026thinsp;\u0026le;\u0026thinsp;19 represents diagnostic subthreshold gambling patterns.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e0 points: non-gambling;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;15 points: recreational or at risk gambling;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e15\u0026ndash;19 points: problem gambling;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e20\u0026ndash;24 points: mild GD;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e25\u0026ndash;29 points: moderate GD;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;30 points: severe GD\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3. Statistical methods\u003c/h2\u003e\n\u003cp\u003eResults are presented descriptively and using inference tests. To test associations between help-seeking behaviours and dichotomised GD levels, we conducted logistic regressions with dichotomised GD level as an outcome variable and actual help-seeking behaviour in the helpline as the predictor variable.\u003c/p\u003e\n\u003cp\u003eFor our study, we dichotomised our sample of 108 participants into two groups based on total GDIT scores: those reporting any degree of gambling disorder (GDIT 20+) were categorised as having GD (N\u0026thinsp;=\u0026thinsp;89). Those experiencing lower severity gambling problems were categorised as \u0026lsquo;sub-threshold GD (N\u0026thinsp;=\u0026thinsp;19).\u003c/p\u003e\n\u003cp\u003eHelp-seeking behaviours were also dichotomised. Responses reporting having called, chatted, emailed or had repeated calls with the helpline were collapsed into the binary variable \u0026lsquo;utilisation of counselling services\u0026rsquo; while responses indicating searching the website for information and testing gambling habits via a self-test were collapsed into \u0026lsquo;utilisation of online services\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows our sample characteristics. Although our study was based on convenience sampling at the Swedish helpline, our data collection captured individuals gambling at varying severity levels. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents results on how help-seekers in our sample found the gambling helpline. One third of participants had found the helpline using an internet search. Advertising and gambling company websites were also mentioned by approximately 10 percent of participants each.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBackground characteristics and gambling behaviours, N\u0026thinsp;=\u0026thinsp;108.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;108\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot stated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, M (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBorn in Sweden, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest education, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of income\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNet income in SEK (1 SEK\u0026thinsp;~\u0026thinsp;0.09 EUR), median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,000 (12,500)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGambling debts (yes)\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGambling variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGDIT total score, M (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.4 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGDIT category\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-gambling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecreational or at risk gambling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem gambling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild Gambling Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate Gambling Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere Gambling Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of gambling\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnline slots\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76 (70.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnline betting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnline Lotteries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHow the participants found out about the helpline, N\u0026thinsp;=\u0026thinsp;108.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVia search engine on the Internet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026apos;t remember\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVia gambling advertising\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLink from a gambling company website\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLink from a gambling company website directly to the Helpline\u0026apos;s self-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas recommended by a friend/colleague/family member or similar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas advised by a healthcare contact/self-help group or similar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows results on services that help-seekers were expecting to receive. Results show a variety of expected services amongst individuals with GD and individuals gambling at lower severity levels. On average, individuals reported 2.0 (SD\u0026thinsp;=\u0026thinsp;1.5) expected services. In the full sample, the most reported expectations were to receive advice, support or motivation to change one\u0026rsquo;s gambling habits (59.3%), and to obtain information about problem gambling or GD (47.2%). 20.4 percent participants sought advice or referrals on financial matters. 14.8% expected to receive assistance in disclosing their gambling habits to a concerned significant other. 29.2 percent of those with GD reported expecting psychological support. An important part of those without GD (26.3%) also reported expecting \u0026lsquo;other\u0026rsquo; types of services.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eExpected service\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFull sample N\u0026thinsp;=\u0026thinsp;108\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSub-threshold GD N\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGD N\u0026thinsp;=\u0026thinsp;89\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInformation about gambling problems/disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44 (49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdvice, support or motivation to change my gambling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport to manage my mental health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport in telling a loved one about my gambling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReferral or information about other support/treatment for gambling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdvice on financial matters or referral to financial advice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18 (20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn terms of received services, we found that, overall, those without GD had sought more prior help (26%) compared to those with GD (16%). However, both groups had similar levels of prior contact with the helpline (63.2% and 68.5%, respectively).\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows results on the kinds of services that individuals in our sample had received. We found that online services were the most typical services received in the sample. Most study participants reported testing their gambling habits using the online self-test (48.2%) or seeking information via the website (41.2%). Moreover, we found that those with GD had lower odds of using counselling services compared to those with sub-threshold GD (OR\u0026thinsp;=\u0026thinsp;0.3, p\u0026thinsp;=\u0026thinsp;0.02). In contrast, individuals with GD utilised online services to a greater extent than those with sub-threshold GD. However, these differences were statistically inconclusive (OR\u0026thinsp;=\u0026thinsp;2.7, p\u0026thinsp;=\u0026thinsp;0.14).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eReceived service at the helpline\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal sample N\u0026thinsp;=\u0026thinsp;108\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSub-threshold GD N\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGD\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;89\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpoke on the phone with a counsellor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChatted with a counsellor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContact with a counsellor via email\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVerbally booked and then received a follow-up call with a counsellor at the appointed time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSearched for information via the website\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTested my gambling habits via the self-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45 (50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOnly 17.6 percent of our sample reported prior involved in problem gambling support or treatment outside of the helpline context. These services included treatment or internet-based treatment in public healthcare or private service provision (2.8\u0026ndash;4.6%), as well as treatment and support via social services or through self-help groups (5.6%) (see Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePrevious help-seeking outside the helpline\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;108\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment through healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternet treatment via healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport via Social Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport via self-help groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment via private service provision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn addition to helpline services and referrals, most individuals in our sample had used the Spelpaus self-exclusion registry (58.3%, with time-periods ranging from one month to until further notice). However, a significant proportion of these individuals also reported having gambled despite being enrolled in Spelpaus (76.2%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis brief research paper has investigated help seeking in terms of expectations and received services in a sample (N\u0026thinsp;=\u0026thinsp;108) of Swedish helpline customers. We also compared help-seeking between those with GD and those gambling at lower severity levels. Our study has yielded several results that are important in further developing and targeting effective services to those who experience gambling-related problems.\u003c/p\u003e \u003cp\u003eFirst, our results have shown that individuals expect a range of different services when contacting helplines. Expected services range from help with changing gambling habits to psychological support, referrals to other treatment, financial counselling, or support in telling CSOs about the situation. This result suggests that individuals contacting gambling help services are knowledgeable about the range of services that are available to them [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. At the same time, this finding attests to the wide range of service needs that individuals with gambling problems may have. Services should adapt to differing needs and harms attached to gambling problems and address these with appropriate treatment and help options, including psychological support, but also financial and family counselling.\u003c/p\u003e \u003cp\u003eSecond, we found that while expectations regarding services were largely similar across our two groups of respondents, received services differed between the groups. Notably, those with GD had received significantly more online services than those without GD. Conversely, those without GD received more telephone counselling - both overall and in terms of recurring telephone contacts \u0026ndash; than those with GD. This finding is somewhat surprising. Digital health services and online resources are intended as low-threshold and accessible options particularly for first-time help seekers (e.g., [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our result suggests that these online resources continue to be the main source of support also for those with more severe problems.\u003c/p\u003e \u003cp\u003eOnline services can be more appropriate for some (van der Maas et al., 2019). Some prior research also suggests that the choice to use online help resources for gambling may be related to perceived ability and desire to change [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, it would be crucially important to investigate whether those with more severe gambling problems are, in fact, reluctant to make contact and therefore prefer online services, or whether their higher use of online services relates to a mismatch between service needs and services provided. This can have a major impact on how helpline services and other help infrastructure should be set up.\u003c/p\u003e \u003cp\u003eThird, and finally, our results showed that while most individuals in our dataset had signed up for the Swedish self-exclusion registry, over 77 percent of these individuals had continued gambling despite self-exclusion. Self-exclusions can be an important tool to reduce harmful gambling or GD symptoms, but the effectiveness of self-exclusions can also be reduced by factors such as lack of complete exclusion from all gambling offers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In Sweden, over 120,000 individuals are already signed up to Spelpaus [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, unlicensed offshore offers continue to be available to these individuals despite self-exclusion [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our result therefore suggests that while self-exclusions can help some, they need to be implemented within the framework of a wider range of regulatory tools to reduce and prevent gambling problems. More effective system-level regulations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], including enforcement against offshore gambling, are needed to reduce harmful supply side practices.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Implications\u003c/h2\u003e \u003cp\u003eOur results have implications on improving treatment services for problematic gambling. Help-seekers to helplines are not a uniform customer group. Instead, help-seekers have diverging needs and expectations with regard to services. All help-seekers need to be screened for harm severity and expectations to match them with appropriate services. Some help-seekers may prefer online services due to anonymity and accessibility [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, internet-based help services can also be less appropriate for others. Online services include high levels of attrition as well as lack of personal contact with help professionals which may function as barriers to recovery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is important that appropriate help is matched with expectations and needs. Otherwise, it is possible that even when help is available, it might not reach those who need it the most. Helplines provide a range of different services to help-seekers, ranging from telephone counselling to online self-help resources [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These different services need to be referred and targeted according to customer group needs. Furthermore, the gambling field is currently developing at a fast pace. New products and commercial practices, particularly online, risk increasing harms globally [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Helplines and other help services need to stay vigilant in addressing new and emerging phenomena and harms, and also adapt services to emerging customer needs and expectations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Limitations\u003c/h2\u003e \u003cp\u003eOur study has been limited by a relatively small sample size. Our data collection was also based on convenience sampling. Whilst our data collection ran on the St\u0026ouml;dlinjen website for almost a year, our sample consists of only a small minority of all individuals visiting the helpline online resources. Difficulties in recruiting more respondents may relate to continued stigma and reluctance to talk about gambling-related problems. It is possible that our sample is skewed towards individuals with more experience of different treatment and help services. As our data collection took place online, it is also possible that our data are skewed towards individuals seeking online services. Caution should therefore be used in interpreting our results.\u003c/p\u003e \u003cp\u003eHowever, helplines also provide unique access to individuals with experience of gambling problems and help services. This type of group would have been difficult to research otherwise. Despite possible skews in the sample, our analysis has produced new insight on the service expectations and needs of different help-seeker groups. Going forward, these promising new results call for additional research to further improve and target help services.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study has investigated help-seeking, expectations, and received services in a sample of Swedish gambling helpline customers. Our results have shown that individuals have a wide range of expectations with regard to help services. These expectations align with the harmful effects of gambling, including psychological support, support with CSOs, and financial counselling. Many of these expectations have also been met with received services. However, our results also show that those with more severe gambling problems receive more online and self-help services than those gambling at lower severity levels. It is important that all individuals who experience gambling harm receive help and support. However, our results suggest that there may be a mismatch between harm severity and types of help received.\u003c/p\u003e \u003cp\u003eGambling has negative impacts on an important part of the population. It is important to develop effective and well-targeted help and treatment interventions to support individuals and families dealing with problem gambling and gambling-related harms. At the same time, as also recently highlighted by the WHO [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], it is crucial to develop more effective strategies to prevent these problems and harms. Gambling disorder and problem gambling are driven by wide availability, accessibility and visibility of commercial gambling in many societies. To protect public health, system-level regulatory controls are needed. More effective prevention is also key to lessening the burden on the treatment system, allowing for better targeting and implementation of treatment based on individual needs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data collection was anonymous and did not require informed consent. Participants were provided information about the study and their rights, but they were not asked to sign a form to give informed consent. The study received ethics approval from the Regional Ethics Board of Stockholm, Sweden (ref. no. 2022-03651-01). However, at the beginning of the survey, before participants proceeded to the measures, they were presented with a landing page. This page included a brief summary of the study and outlined the eligibility criteria for participation. Additionally, the landing page provided a link to detailed study information, covering the study procedure, data storage, and contact details for the responsible researchers. Before participants could begin completing the survey, they had to verify that they had read the study information and accepted the terms of participation. Participants also had the option to decline participation; these individuals were redirected to a page informing them that they had declined participation. This research was carried out in accordance with relevant guidelines and regulations. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHW received funding from the Swedish Research Council for Health, Working Life, and Welfare (Forte, grant number 2023 − 00898). OM reports no funding for the current study. VM received funding from The Finnish Ministry of Social Affairs and Health based on the provisions of section 52 of the Finnish Lotteries Act.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data supporting the conclusions of this article will be made available by the authors upon request, provided that the request complies with Swedish and EU laws governing the protection of identifiable data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Swedish gambling helpline Stödlinjen for their collaboration in the data collection for this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlmeida MSC, de Sousa Filho LF, Rabello PM, Santiago BM. 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Front Psychiatry. 2022;13:992309. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyt.2022.992309\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2022.992309\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUkhova D, Marionneau V, Nikkinen J, Wardle H. Public health approaches to gambling: a global review of legislative trends. Lancet Public Health. Jan. 2024;9(1):e57\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2468-2667(23)00221-9\u003c/span\u003e\u003cspan address=\"10.1016/S2468-2667(23)00221-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6112600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6112600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Treatment and help services for gambling problems range from formalised therapy to lower-threshold options such as helplines, digital health solutions and online self-help resources. Few people with gambling problems access these services. Lack of service reach may partly be explained by expectations and experiences on available services. Yet, little is currently known about what kind of services are expected and accessed by individuals gambling at different severity levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e This study analyses help-seeking and help expectations amongst a sample of Swedish gambling helpline customers (N=108).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data were collected using an online survey. The survey collected data on demographic characteristics, prior use of different support and treatment services for gambling, use of the national self-exclusion registry, and screened participants for gambling problem severity. The analysis compares help expectations and received services between individuals with gambling disorder and those gambling at lower severity levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eResults show a wide range of expectations regarding help services, including psychological support, support with CSOs, and financial counselling. Expectations were similar across individuals with and without gambling disorder. However, in terms of received services, those with more severe gambling problems tended to receive more online and self-help services than those gambling at lower severity levels. Most help-seekers had self-excluded from gambling but continued gambling regardless.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Our results suggest a mismatch between harm severity and types of received help. More effective prevention of gambling harm would reduce the burden on help services and allow better targeting of services to address individual needs of help-seekers.\u003c/p\u003e","manuscriptTitle":"Help-seeking and help expectations for gambling problems at different severity levels","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 12:14:41","doi":"10.21203/rs.3.rs-6112600/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-21T09:39:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-17T10:18:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-16T02:17:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60229581732764725106843304928023123144","date":"2025-04-07T14:29:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184696567393312502439057613394978719340","date":"2025-04-03T21:14:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-01T10:25:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-20T15:33:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-19T13:50:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-03-19T13:49:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52625241-e44c-43c2-98d4-e12c5cadb28c","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:39:51+00:00","versionOfRecord":{"articleIdentity":"rs-6112600","link":"https://doi.org/10.1186/s12982-025-00853-7","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-07-30 16:04:59","publishedOnDateReadable":"July 30th, 2025"},"versionCreatedAt":"2025-04-02 12:14:41","video":"","vorDoi":"10.1186/s12982-025-00853-7","vorDoiUrl":"https://doi.org/10.1186/s12982-025-00853-7","workflowStages":[]},"version":"v1","identity":"rs-6112600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6112600","identity":"rs-6112600","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}