The high occurrence of cross-sectional studies does not allow us to clearly define the relationship’s direction between psychological distress and problem gambling. It is difficult to establish whether the former is a risk factor or an outcome of the latter. For example, it is unclear whether a high level of psychological distress is a consequence of frequent gambling or conversely whether people with psychological distress are particularly attracted to gambling. Predictably, a higher level of psychological distress was found in online gamblers more at risk of problem gambling than in low-risk gamblers (Gainsbury et al., 2014b; Granero et al., 2020; Hing et al., 2017; Hopley & Nicki, 2010). Anxiety and depression were the main experiences studied and reported by pathological gamblers at higher rates (Barrault & Varescon, 2013a; Barrault et al., 2017; Hopley & Nicki, 2010; Khazaal et al., 2017). In addition, mood disturbances such as hypomanic experiences and mood elevation are reported to a greater extent in the most problematic cluster (Lloyd et al.
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The surroundings and life contexts to which a person belongs play an important role in influencing gambling, as do individual and relational factors. Within the selected articles, variables acting at the contextual level were scarcely investigated. The university context, among all, is the only setting that has been investigated and for which there is evidence of a risk factor.
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