Recognition and Stigma of Gambling Disorder in Singapore

Abstract

Gambling Disorder (GD) is a highly stigmatised condition with serious psychological, social and financial consequences. Limited public recognition regarding GD may hinder help-seeking, shape beliefs about recovery and reinforce stigma. This study seeks to establish the extent of recognition of GD as well as stigma towards it in Singapore’s population using a vignette-based approach. Data from 595 participants from a nationwide vignette-based study on mental health literacy were analysed using weighted analysis and multivariable logistic and linear regression to address the aims. Participants received a vignette on GD and answered questions related to recognition of the condition, sociodemographic information, perception of help-seeking and chances of recovery for GD. Furthermore, the study also assessed stigma across three domains: “weak not sick”, “dangerous/unpredictable”, and “social distancing”. The majority of participants (75.63%) correctly identified the vignette as GD. Informal networks, non-medical professional support and community-based resources were highly recommended help-seeking sources. Majority of the respondents believed that individuals with GD who seek appropriate help can achieve full recovery while those who do not would experience worsening of the condition. Predictors of higher stigma towards GD included older age, female gender, Malay or Indian ethnicity, being married, having friends or family members with similar problem and a high monthly income. While recognition of GD was relatively high among respondents, stigma toward individuals with GD remains prevalent particularly among certain demographic groups. Data from this study can help to improve public health interventions and policy efforts to better support those with GD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10899-025-10457-0.

Introduction

Gambling is a popular and common activity worldwide. It is defined as a behaviour where a monetary wager is staked on the uncertain prospect of a larger financial outcome (Goudriaan & Clark, 2013). The proliferation of the internet has further heightened gambling’s accessibility, contributing to its surge in prevalence (Oyanedal et al., 2024). Moreover, the world witnessed a rise in casino integrated resorts for destination gambling and entertainment all across Asia due to their remarkable local economic returns. For instance, the establishment of the Integrated Resorts in 2010 were a strategic move by the Singapore government to diversify its economy and bolster tourism (Stanley, 2024), contributing significantly to GDP growth (Henderson, 2006). These resorts integrate high-end hotels, entertainment hubs and luxury shopping, allowing gambling to be more accessible to a wider demographic such as families and international tourists (Ahn & Back, 2018). However, the increased accessibility of gambling also raises concerns about the potential social consequences and public health risks, such as the exacerbation of mental health issues, financial instability, and family conflicts (World Health Organisation, 2020).

The majority of people who gamble do so recreationally, participating occasionally and responsibly without jeopardizing their well-being (Wood & Griffiths, 2015). In contrast, a smaller group of gamblers gradually exhibit persistent, recurrent problematic gambling behaviour that is associated with distress and impairment. Previously known as Pathological Gambling (Petry et al., 2013), this behaviour is now termed Gambling Disorder (GD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), classified under the Substance-Related and Addictive Disorders category (American Psychiatric Association, 2013) and in the International Classification of Diseases Version 11 (World Health Organisation, 2019) under the Mental, Behavioural and Neurodevelopmental disorder sub-section. It is one of the set of disorders considered to be a behavioural addiction (Fineberg et al., 2025; Bowden-Jones et al., 2022). Moreira et al. (2023) have identified several risk factors associated with the escalation of recreational gambling to GD. Key demographic factors include being male, single or married for less than five years, living alone, having a lower level of education, and experiencing financial instability. Psychological factors such as high impulsivity, cognitive distortions, and negative emotional states including stress and depression have also been identified as significant contributors. Furthermore, social factors such as early exposure to gambling, particularly during adolescence, and having family members with a history of gambling problems have been shown to elevate the risk of developing GD.

GD is highly prevalent in Asian societies including Singapore, in stark contrast to the relatively lower rates in Europe and North America (Williams et al., 2012; Winslow et al., 2015). The high GD prevalence rate in Asia might be attributed to how gambling is deeply embedded in many Asian cultures, particular among the Chinese communities, where it is often seen as a common social activity and is deemed culturally acceptable (Raylu & Oei, 2004). Dating back to more than 4000 years ago, gambling has evolved through the dynastic eras and has influenced gambling habits all around the world, especially in other Asian countries (Chan et al., 2019), and in particular, Singapore. This could be attributed to Singapore’s majority Chinese population with strong influences from the East. These influences have fostered collectivistic values and superstitions about luck, which perpetuate the culture of gambling (Chee & Lui, 2021). This prevalence of gambling is evident in how 40% of Singapore residents have gambled at least once in 2024 (National Council on Problem Gambling, 2024). This pervasive cultural normalisation of gambling may thus be the primary driver of the high prevalence rate of gambling in Singapore.

GD, like many other mental disorders, is associated with much stigma (Quigley, 2022). Corrigan (2000) explains that stigma against mental disorders could be established by the Social Attribution Theory, where stigmatizing beliefs are formed by how people perceive the cause, controllability, and stability of the condition—and these attributions themselves can vary across sociodemographic group. Indeed, stigma associated with mental disorders arises from factors at the individual, cultural, and societal levels according to the Mental Illness Stigma’s Reasons and Determinants (MISReaD) study conducted in Singapore (Tan et al., 2020). Stigma often originates from perceptions that people with mental disorders are dangerous and unpredictable, leading individuals to avoid associating with them. This is exacerbated by dismissive public attitudes that frame mental disorders as personal weaknesses rather than legitimate health conditions (Jorm & Wright, 2008).

According to the World Health Organisation, estimates suggest that 1.2% of the world’s adult population has GD, which was lower than other mental disorders such as depression, with a prevalence of 5% (World Health Organisation, 2023a, 2023b). However, an epidemiological study in Finland suggests that the low prevalence of GD (0.018% in 2020) is actually a result of underdiagnosis and under-recognition. This information suggests that many individuals experiencing gambling-related harms do not receive a formal diagnosis, partly due to societal perceptions that gambling problems are not legitimate medical conditions or are perhaps untreatable. Moreover, GD is often accompanied by co-occurring mental disorders such as depression and anxiety, leading to missed opportunities for early intervention​ (Salonen et al., 2022; Lorains et al., 2011). In Singapore, the above-mentioned factors are compounded by stigma and local cultural norms (Tan et al., 2020). Specifically, the emphasis on family reputation and the perception that mental health issues should be managed privately worsens the existing barriers to treatment for sufferers of GD. This highlights the urgent need to target these factors in mental health and addiction frameworks.

The effects of stigma towards GD are highly detrimental (Quigley et al., 2020). Stereotypes of people with GD include perceptions of them being “compulsive”, “irresponsible” and “irrational”. Individuals experiencing public stigma often feel fear of judgement, internalised shame, and hold the belief that GD reflects personal weakness rather than a legitimate disorder, which often deter individuals from seeking treatment (Quigley, 2022). These individuals may also suffer from self-stigma and a diminished sense of self-worth, which further reduces their likelihood of seeking help. Indeed, only 1 in 5 people with problem gambling behaviours seek help internationally (Bijker et al., 2022). Furthermore, GD is linked to higher rates of co-morbid mental disorders, suicidality and social isolation (Armoon et al., 2023), highlighting the devastating effect it has on the self. GD also has equally devastating effects on the families of people with GD. Family members often bear a large financial and emotional burden of GD, facing strained relationships, domestic conflicts, poor mental health and legal challenges (Azemi et al., 2023). There is hence a need for a comprehensive approach to reduce stigma and support patient recovery.

A Polish study by Dąbrowska & Wieczorek (2020) took a qualitative approach, where they conducted in-depth, semi-structured interviews with 90 participants, including individuals diagnosed with GD and medical professionals, uncovering how stigma prevents those affected from seeking help. Many participants reported intense feelings of shame and fear of being judged, leading them to hide their struggles rather than disclose them to family or medical professionals. A common theme was the perception that gambling addiction is self-inflicted and, therefore, less deserving of sympathy than other mental disorders. Notably, women with GD experience heightened stigma compared to men, perhaps reflecting broader gender biases in society.

As our society collectively strives to destigmatise mental disorders, there is a pressing need for more research on stigma, particularly in the context of GD. This is especially relevant in Singapore, where limited studies have explored GD recognition and stigma within the unique cultural and environmental influences of a multi-ethnic society. With a population predominantly composed of Chinese (74.3%), followed by Malays (13.5%), Indians (9.0%), and other minority groups (3.2%) (Singapore Department of Statistics, 2021), understanding how stigma manifests across these diverse groups would be advantageous in developing effective interventions.

As such, this study investigated the recognition of GD in Singapore using a vignette-based approach to assess the public’s ability to correctly identify GD and explore the prevalence of stigmatizing attitudes, including perceptions of individuals with GD as ‘weak not sick,’ ‘dangerous/unpredictable,’ and the desire for social distancing. Additionally, the study examined sociodemographic factors—such as age, gender, ethnicity, education level, and prior experience with mental disorders—to identify which groups are more prone to stigmatizing GD. By analysing data of 595 participants from a nationally representative sample of 4195 Singapore residents who received the GD vignette, this research aimed to inform targeted interventions to reduce stigma, improve recognition of GD, and promote help-seeking behaviours among individuals affected by GD. These insights can inform targeted public health interventions, educational campaigns, and policy measures to foster a more supportive environment for them.

Methods

Study data were taken from the mental health literacy study (Mind Matters 2023) conducted on the general Singapore population. The study utilized a disproportionate stratified sampling approach, creating 12 strata based on combinations of age groups (18–35, 36–49, 50–65) and ethnicities (Chinese, Malay, Indian, Others). Participants were randomly selected from a national registry and recruited from September 2022 to February 2024. 8100 residents were first invited for the study. Of the 6739 eligible participants, 4195 participants completed the study (response rate = 62.25%). Written informed consent were obtained from all participants and/or their legally acceptable representative (for participants below 21 years old) prior to the survey. Interviews were then conducted face-to-face by a trained interviewer in English, Chinese, Malay or Tamil. The detailed study methodology has been published elsewhere (Tan et al., 2025).

Inclusion criteria were (1) Singapore resident, (2) aged between 18 and 65, (3) living in Singapore during the study period. Exclusion criteria were (1) not living in Singapore during the study period, (2) unable to contact due to incomplete or incorrect address, (3) unable to comprehend the interview in one of the four official languages of Singapore, or (4) physically or mentally unable to complete the interview. The ethical approval for the study was given by the National Healthcare Group Domain Specific Review Board (Reference no.: 2021/00695).

Measures

Using a vignette-based approach, participants were randomly assigned and presented one of seven vignettes, each describing a specific mental disorder (i.e., depression, schizophrenia, obsessive-compulsive disorder, alcohol use disorder, dementia, depression with suicidality, and gambling disorder). In the current study, only data from the GD vignette was used (supplementary material 1). Based on the participants’ gender and ethnicity, the name of character (denoted as ‘XX’) was matched accordingly to facilitate identification to the character.

Recognition of Mental Disorders

An open text question was asked after the presentation of vignette; ‘What do you think XX is suffering from?’. Participants were probed to name the condition causing the symptoms shown in the vignette. The entire response was recorded and coded according to the three categories: ‘Correct recognition’ where participants correctly identified the mental disorder as GD; ‘Recognised as mental disorder’, where participants identified it as other mental disorders or conditions (e.g. mentally unsound, not sane, depression); ‘Did not recognise’, where participants responded with general symptoms or did not think the symptoms were indicative of a mental disorder (e.g., gambling). Each response was coded by two team members to ensure consistent results. Consensus meetings were conducted with study team members to resolve any disputes.

Prior Experience with Mental Disorders

Two vignette specific questions pertaining to the participants’ experience with a mental disorder were asked. (1) ‘Have you ever had problems similar to XX?’ and (2) ‘Has anyone in your family or close circle of friends ever had similar problems to XX?’. Participants could respond with a ‘yes’ and ‘no’ to the questions.

Depression Stigma Scale (DSS)

The DSS was originally designed to measure stigma against people with depression. The scale comprises two dimensions: personal stigma and perceived stigma (Griffiths et al., 2008; Subramaniam et al., 2017). In our present study, we only included questions pertaining to personal stigma, while one question was dropped, ‘I would not vote for a politician if I knew they had been depressed’. All questions were rephrased and generalized in order to include all vignettes. With a total of eight items, two subscales were obtained from the responses (1) Weak not sick and (2) Dangerous/unpredictable. The questions were measured on a 5-point Likert-scale (1 = Strongly agree, 5 = Strongly disagree), with higher scores depicting stronger stigma. Internal consistency analysis revealed an acceptable reliability in our sample (Cronbach’s alpha = 0.68).

Social Distance Scale (SDS)

The SDS measures the avoidance behaviour of individuals towards people with a mental disorder (Link et al., 2011). Some questions include how willing one would be to move next door, befriend, work closely, etc. with XX? Responses were rated on a 4-point Likert Scale (1 = Definitely unwilling, 4 = Definitely willing). Items were summed and a higher score represented a greater desire for social distance. Internal consistency analysis revealed an acceptable reliability in our sample (Cronbach’s alpha = 0.86).

Help Seeking Behaviour

Participants were asked an open text question: ‘Who do you think XX should seek help from?’ in order to understand their perspective on help seeking behaviour for people with GD. Responses were coded according to six categories; namely, informal, medical, non-medical, government (civil service), community or others. Multiple answers could also be coded from their response.

Chances for Recovery

Participants were asked two questions to understand their perspective on the outcomes for the character: (1) What do you think will happen if XX seeks help? and (2) What do you think will happen if XX does not seek appropriate help? The following choices were provided for each question: (1) Full recovery with no further problems, (2) Full recovery but problems may come back, (3) Partial recovery but problems may come back, (4) No improvement, (5) Get worse.

Sociodemographic Factors

Age, gender, ethnicity, employment status, education level, marital status, and personal monthly income were collected from the participants.

Statistical Analysis

All analyses were performed using STATA S/E Version 15.0. Survey weights were included in analyses to ensure results were generalisable to the general population of Singapore. Categorical variables were presented as weighted percentages and unweighted frequencies while continuous variables were presented as weighted mean and standard deviations. Items for DSS and SDS were reverse coded as per literature and were kept continuous to allow better interpretation. Multivariable logistic regression was conducted to identify the correlates of correct recognition of GD with sociodemographic variables and prior experience with mental disorder included as independent variables. Thereafter, sociodemographic, prior experience and recognition of vignette were included as predictors in the multivariable linear regression with DSS and SDS scores as outcomes. All assumptions for the multivariable linear and logistic regressions were fulfilled and met in our models.

Results

Among the 4159 respondents in the overall study, 595 were randomly allocated the vignette for GD. The gambling subsample had a balanced gender distribution (50.17% female, 49.83% male). The majority of participants were Chinese (73.88%), Married (61.77%) and had attained post-secondary qualifications (70.04%) (Table 1 shows the distribution of sociodemographic characteristics of the sample).

Table 1.

Sociodemographic characteristics

	Weighted %	Unweighted n
Age group
18–34	33.76	199
35–49	24.71	171
50–65	41.53	225
Gender
Female	50.17	302
Male	49.83	293
Ethnicity
Chinese	73.88	163
Malay	13.54	196
Indian	9.08	184
Others	3.50	52
Marital Status
Never married	30.67	173
Currently married	61.59	377
Separated/Divorced/Widowed	7.74	45
Education level
Primary and below	5.92	40
Secondary school	24.04	145
Diploma/JC/ITE	32.64	213
University and above	37.40	197
Employment status
Currently employed	79.54	468
Unemployed	6.59	33
Economically inactive	13.87	94
Monthly personal income
Below 2000	28.19	204
2000–3999	29.98	188
4000–5999	20.31	101
6000–9999	16.18	61
10,000 and above	5.33	31
Have you ever had similar problems to XX?
No	92.21	543
Yes	7.79	52
Has anyone in your family or close circle of friends ever had similar problems to XX?
No	78.48	484
Yes	21.52	111

The majority of the 595 participants rating the GD vignette (75.63%) correctly identified the vignette as GD. Recognition varied by age, with younger participants (aged 18–34) demonstrating the highest correct recognition rate (88.4%), compared to 72.8% among those aged 35–49 and 70.5% among those aged 50–65 (supplementary Table 1).

A multivariable logistic regression model was employed to examine the sociodemographic predictors of correct recognition of GD. The analysis, presented in Table 2, revealed that gender, marital status, and prior personal experience with similar issues were significantly associated with recognition. Specifically, females had a lower likelihood of correctly recognizing GD compared with males (Odds Ratio (OR) = 0.35, 95% CI: 0.18–0.68, p < 0.01). Similarly, participants who were separated, divorced, or widowed exhibited reduced odds of accurate recognition relative to those who had never been married (OR = 0.22, 95% CI: 0.06–0.90, p = 0.04). In contrast, neither ethnicity, education, nor employment status demonstrated statistically significant associations with recognition of GD. Furthermore, individuals reporting previous personal experience with similar problems were less likely to correctly identify GD (OR = 0.24, 95% CI: 0.09–0.62, p < 0.01), whereas having a family member or close friend with similar issues did not significantly impact recognition (OR = 1.07, 95% CI: 0.47–2.41, p = 0.88).

Table 2.

Sociodemographic predictors of correct recognition of gambling disorder (n = 595)

	Odds ratio	95% CI		p-value
Age group
18–34 (ref)
35–49	0.45	0.15	1.32	0.15
50–65	0.36	0.12	1.05	0.06
Gender
Male (ref)
Female	0.35	0.18	0.68	< 0.01
Ethnicity
Chinese (ref)
Malay	1.16	0.64	2.10	0.63
Indian	0.80	0.45	1.43	0.46
Others	1.92	0.75	4.95	0.18
Marital Status
Never married (ref)
Currently married	0.50	0.17	1.48	0.21
Separated/Divorced/Widowed	0.22	0.06	0.90	0.04
Education level
University and above (Ref)
Primary and below	0.90	0.27	3.06	0.87
Secondary school	1.68	0.66	4.24	0.28
Diploma/JC/ITE	0.78	0.36	1.72	0.55
Employment status
Currently employed (ref)
Unemployed	1.54	0.37	6.35	0.55
Economically inactive	1.14	0.38	3.46	0.82
Monthly personal income
Below 2000 (ref)
2000–3999	0.71	0.28	1.79	0.46
4000–5999	1.41	0.50	3.92	0.51
6000–9999	3.61	0.94	13.89	0.06
10,000 and above	0.90	0.18	4.50	0.90
Have you ever had similar problems to XX?
No (ref)
Yes	0.24	0.09	0.62	< 0.01
Has anyone in your family or close circle of friends ever had similar problems to XX?
No (ref)
Yes	1.07	0.47	2.41	0.88

CI: confidence intervals

Table 3 shows the frequency of open-ended responses to the question about help-seeking. The most frequently recommended sources of help were informal networks (39.66%), followed by non-medical professional support (31.01%) and community-based resources (29.19%). While seeking help from medical sources (20.94%), government services (5.38%) and other sources (2.55%) were less recommended.

Table 3.

Help seeking behaviour for people with similar problems (open text)

	Weighted %	Unweighted n
Informal	39.66	263
Non-medical	31.01	184
Community	29.19	138
Medical	20.94	127
Government-civil service	5.38	31
Others	2.55	12

A majority of respondents (57.46%) believed that individuals with GD who seek appropriate help can achieve full recovery, although they acknowledged the possibility of relapse. An additional 22.41% expressed optimism that full recovery without recurrence of problems was achievable with appropriate intervention. In contrast, perceptions of recovery in the absence of intervention were largely pessimistic. An overwhelming 81.64% of respondents expected that individuals who do not seek help for GD would experience worsening of the condition (Table 4).

Table 4.

Chances of recovery for gambling disorder

	Weighted %	Unweighted n
What do you think will happen if XX seeks appropriate help?
Full recovery with no further problems	22.41	156
Full recovery, but problems may come back	57.46	329
Partial recovery, but problems may come	19.68	106
No improvement	0.45	2
Get worse	0.00	0
What do you think will happen if XX does not seek appropriate help?
Full recovery with no further problems	0.00	0
Full recovery, but problems may come back	0.27	4
Partial recovery, but problems may come	1.89	8
No improvement	16.20	86
Get worse	81.64	494

The results of the multivariable linear regression analysis to examine the predictors of stigma toward GD are presented in Table 5. Older individuals were more likely to perceive GD as a weakness rather than an illness, with those aged 50–65 scoring significantly higher than the 18–34 age group (beta coefficient (b) = 0.99, 95% CI: 0.32–1.66, p < 0.01). Ethnicity also played a role, as Malay (b = 0.74, 95% CI: 0.31–1.18, p < 0.01) and Indian (b = 0.57, 95% CI: 0.10–1.03, p = 0.02) participants were more likely than the Chinese reference group to endorse this belief. Marital status was also a significant factor, with currently married individuals scoring higher (b = 0.86, 95% CI: 0.26–1.47, p = 0.01) on the “weak not sick” stigma subscale compared to those who had never been married. Additionally, individuals who had friends or family members with similar problems were more likely to perceive GD as a personal weakness rather than an illness (b = 0.60, 95% CI: 0.04–1.16, p = 0.03).

Table 5.

Predictors of stigma towards gambling disorder

	Weak not sick (n = 583)				Dangerous/unpredictable (n = 581)				Social distancing (n = 576)
	b	95%	CI	p	b	95% CI		p	b	95%	CI	p
Age group
18–34 (ref)
35–49	0.30	−0.39	0.99	0.40	−0.29	−1.17	0.59	0.52	−0.57	−1.63	0.48	0.29
50–65	0.99	0.32	1.66	< 0.01	0.22	−0.59	1.02	0.60	−0.15	−1.17	0.87	0.78
Gender
Male (ref)
Female	−0.04	−0.51	0.43	0.87	−0.35	−0.97	0.28	0.27	0.25	−0.38	0.88	0.44
Ethnicity
Chinese (ref)
Malay	0.74	0.31	1.18	< 0.01	0.69	0.06	1.32	0.03	−0.38	−1.05	0.29	0.27
Indian	0.57	0.10	1.03	0.02	−0.05	−0.66	0.57	0.88	−0.17	−0.83	0.50	0.63
Others	0.10	−0.59	0.79	0.77	0.64	−0.33	1.62	0.19	0.32	−0.68	1.32	0.53
Marital Status
Never married (ref)
Currently married	0.86	0.26	1.47	0.01	1.13	0.30	1.96	0.01	0.89	−0.05	1.84	0.06
Separated	0.82	−0.16	1.8	0.10	1.21	−0.18	2.6	0.09	−0.28	−1.75	1.19	0.71
Education level
University and above (Ref)
Primary and below	0.36	−0.67	1.40	0.49	0.58	−1.04	2.20	0.48	−0.44	−2.17	1.28	0.61
Secondary school	0.67	−0.05	1.39	0.07	−0.38	−1.21	0.45	0.37	−0.75	−1.76	0.26	0.15
Diploma/JC/ITE	0.43	−0.15	1.02	0.15	0.15	−0.65	0.95	0.72	−0.56	−1.40	0.28	0.19
Employment status
Currently employed (ref)
Unemployed	0.19	−0.64	1.02	0.66	−0.07	−1.25	1.10	0.90	0.17	−2.02	2.35	0.88
Economically inactive	−0.21	−1.00	0.59	0.61	0.24	−1.11	1.59	0.72	−0.10	−1.47	1.27	0.88
Monthly personal income
Below 2000 (ref)
2000–3999	0.46	−0.16	1.08	0.14	0.16	−0.95	1.27	0.78	−0.25	−1.53	1.04	0.71
4000–5999	−0.05	−0.82	0.72	0.9	−0.53	−1.72	0.66	0.39	−0.75	−2.19	0.70	0.31
6000–9999	0.28	−0.68	1.24	0.57	−0.67	−2.02	0.68	0.33	0.14	−1.54	1.82	0.87
10,000 and above	−0.13	−1.41	1.16	0.85	−1.55	−3.04	−0.05	0.04	−0.42	−2.10	1.25	0.62
Have you ever had similar problems to XX?
No (ref)
Yes	−0.28	−1.29	0.73	0.59	−0.58	−1.70	0.53	0.30	−0.80	−1.79	0.20	0.12
Has anyone in your family or close circle of friends ever had similar problems to XX?
No (ref)
Yes	0.60	0.04	1.16	0.03	0.02	−0.77	0.81	0.96	−0.50	−1.33	0.34	0.24
Correct recognition
Did not recognise (ref)
Correctly recognised	0.08	−0.52	0.68	0.79	0.44	−0.30	1.18	0.24	0.08	−0.79	0.94	0.86

# b: Beta coefficient. CI: confidence intervals. p: p-value

In terms of the perception of GD as “dangerous/unpredictable”, Malay (b = 0.69, 95% CI: 0.06–1.32, p = 0.03) participants had higher scores on this stigma subscale. Similarly, those who were currently married (b = 1.13, 95% CI: 0.30–1.96, p = 0.01) held stronger beliefs that individuals with GD were dangerous/unpredictable compared to those who had never been married.

Monthly personal income level was generally not associated with stigma, with one exception: individuals earning SGD10,000 and above had significantly lower scores on the “dangerous/unpredictable” scale (b = −1.55, 95% CI: −3.04, −0.05, p = 0.04), indicating that higher-income individuals were less likely to perceive those with GD as dangerous. As for the social distancing measure, no significant sociodemographic predictors were found.

Lastly, recognition of GD was not significantly associated with any of the stigma measures, suggesting that identifying the disorder correctly does not necessarily reduce stigmatizing attitudes.

Discussion

There is a scarcity of research examining public perception and stigma associated with GD in Singapore, highlighting a clear research gap that this study aimed to address. This is the first national study to investigate the recognition, help-seeking behaviours, and stigma associated with GD using a multivariable approach, expanding our understanding of how GD is perceived in Singapore.

The recognition of GD varied significantly across demographic groups. While the majority of respondents correctly identified GD (75.63%), younger participants (aged 18–34) exhibited notably higher recognition rates (88.4%) compared to those aged 35–49 (72.8%) and 50–65 (70.5%). This disparity may reflect greater exposure to mental health literacy campaigns or digital information sources among younger individuals (Clarklin et al., 2024). Conversely, lower recognition rates among older adults could indicate not only gaps in public health messaging but also cultural factors—such as the normalisation of gambling as a social activity (Stansbury et al., 2015).

Sociodemographic factors such as gender and marital status were significant predictors of correct recognition. Women were less likely than men to correctly identify GD, which may reflect gender differences in exposure to or perceptions of gambling-related issues. This finding may be explained by the fact that men have higher level of engagement with gambling compared to women (Stoletenburg et al., 2007), leading to greater familiarity with gambling-related harms and their clinical presentation. Additionally, individuals who were separated, divorced, or widowed were less likely to correctly identify GD, which may be partly attributed to their greater likelihood of experiencing GD themselves (Syvertsen et al., 2023).

From our study, having personal experience with similar problems was negatively associated with recognition, suggesting that first-hand exposure to gambling-related harms may not necessarily translate into accurate identification of the disorder. This counterintuitive finding might be explained by cognitive biases, such as normalisation of gambling behaviour within personal contexts, making it harder to recognize the threshold at which gambling transitions from a habit to a disorder (Russel et al., 2018). Furthermore, a study about the impaired awareness of GD suggests that individuals with gambling problems, including those who have experienced gambling-related harms themselves, may have difficulty recognising GD due to denial or minimising the severity of their condition (Shah et al., 2020).

In terms of help-seeking, we found that the most recommended source of help for persons described in the GD vignette was informal support from family and friends. This aligns with research in Singapore indicating that individuals often prefer seeking help from informal networks for mental disorders such as alcohol abuse, depression, and schizophrenia (Picco et al., 2016). However, relying primarily on informal sources is concerning, as they may lack sufficient knowledge or the relevant mental health literacy to recognize GD and encourage appropriate professional intervention. Notably, medical professionals such as psychiatrists and general practitioners were recommended less frequently, which may reflect public perceptions that GD does not require medical treatment. Indeed, medical doctors play a more limited role in the treatment of GD, typically focusing on the management of co-morbidities such as depression and anxiety. Although medical interventions such as the use of selective serotonin reuptake inhibitors (SSRIs) or opioid antagonists have been explored, current evidence suggests that these approaches serve mainly as adjuncts rather than primary treatments for gambling behaviours themselves (Toneatto & Ladouceur, 2003). Instead, non-medical interventions, such as counselling, psychotherapy, and community self-help groups like Gamblers Anonymous, remain the cornerstone of effective GD management. Among these, cognitive-behavioural therapies continue to be the most empirically supported and widely recommended interventions for GD (Ioannidis et al., 2025). About one-third of respondents were aware of these non-medical and community sources, this serves as a positive indicator of broader knowledge regarding help-seeking for GD.

When asked about chances of recovery from GD if appropriate help was sought, the most frequently reported response was “Full recovery, but problems may come back” (57.46%). This finding indicates that most people had a positive outlook for people with GD, albeit with the risk of relapse. If appropriate help was not sought, a strong majority (81.64%) believed that the condition would “get worse” which highlights the perceived importance of seeking appropriate help when a person suffers from GD. This aligns with clinical evidence indicating that untreated GD can lead to severe psychological, financial, and social consequences (Fong, 2005). These findings thus suggest that there is a need to bridge the gaps in knowledge that therapeutic and community interventions are necessary for GD and there are appropriate governmental agencies that provides helpful resources to people with GD.

The study also examined various forms of stigma towards GD in Singapore. Culturally, the stigmatisation of mental disorders is deeply influenced by the Chinese ideology of ‘face’ which emphasizes maintaining one’s social image and dignity (Yang, 2007). In Singapore’s Chinese-majority society, group harmony and reputation are highly valued. Individuals often strive to “save face” and protect their family’s standing in the community, hence mental disorders are frequently concealed to avoid bringing shame to the family. Associative stigma also extends to family members and caregivers of individuals with mental disorders. These dynamics, rooted in collectivist values that prioritize social conformity and reputation, collectively hinder help-seeking behaviours, limit public discourse, and create barriers to implementing effective public health interventions (Tan et al., 2020). Media representations also often laud societal ideals of independence, financial success, and productivity. Those suffering from mental disorders are conversely portrayed as burdensome and irresponsible individuals, perpetuating public fear and misunderstanding of mental disorders like GD (Tan et al., 2020).

GD is also frequently misunderstood and dismissed as a moral failing rather than a treatable behavioural disorder, adding to the stigma surrounding it. In Australia, Hing et al. (2015) conducted a vignette-based online survey with 2,000 participants, revealing that while problem gambling was viewed as less socially damaging than alcohol addiction, it remained more stigmatized than mild psychological distress. A major factor influencing stigma was the belief that gambling addiction stems from individual weakness rather than external or psychological causes, which led respondents to assign blame and distance themselves from those affected (Hing et al., 2016).

In our study, older adults aged 50 to 65 were more likely to perceive GD as a personal weakness rather than an illness. This is consistent with research showing that older individuals are more inclined to view people with gambling problems as lacking self-control (Rockloff & Schofield, 2004). Interestingly, Malay and Indian participants were more likely to endorse these beliefs compared to the Chinese reference group. While collectivist values in Chinese culture are more broadly associated with greater stigma towards mental disorders (Yang, 2007; Tan et al., 2020), gambling is often viewed as a communal activity that strengthens social bonds and reinforces group cohesion, particularly during festivals like the Chinese Lunar New Year, family gatherings, or significant life events (Clarke et al., 2006). An example would be during the wakes of Chinese funerals, where gambling may take place to keep mourners engaged as families and friends stay awake overnight during vigils to guard the body of the deceased (The Straits Times, 1996). As such, problem gambling may not be perceived as sharply as a mental disorder among Chinese individuals, potentially leading to lower stigma in this context compared to other ethnic groups.

Individuals of Malay ethnicity were more likely to perceive those with GD as dangerous/unpredictable. This aligns with the fact that the majority of Malays in Singapore are Muslim, and gambling is explicitly prohibited (haram) in Islam due to its association with moral corruption, spiritual harm, and the breakdown of social responsibility. Religious teachings emphasize that gambling (maisir) is a sin that fosters impulsivity and greed (Qur’an 5:90–91), which may contribute to heightened stigmatisation of people with GD as spiritually corrupt and morally deviant (Loo & Phua, 2016). Cultural norms within Malay-Muslim communities, such as the prioritization of communal harmony, might also pathologize GD as a threat to family stability (Muthaliff, 2020). Additionally, limited exposure to secular public health messaging about mental disorders such as GD in Malay-language media, could perpetuate misconceptions about its causes and symptoms (Ting et al., 2025).

Individuals who were currently married exhibited higher stigma scores on the “weak not sick” scale. This may reflect stronger endorsement of traditional social values emphasizing personal responsibility, self-control, and the importance of fulfilling familial obligations. From this perspective, gambling problems may be viewed as moral failings rather than medical conditions.

Interestingly, individuals who had close friends or family members with gambling problems also endorsed greater beliefs that GD reflects personal weakness. This finding is somewhat unexpected, as it might be anticipated that closer personal exposure to the harms of GD would foster greater empathy and understanding of its clinical nature. However, it is possible that the prolonged emotional strain and frustration experienced by family members may lead to increased blame toward the individual, rather than recognition of GD as a mental disorder. Prior studies have shown that family members and loved ones often experience intense emotional exhaustion, contributing to perceptions that the gambler’s behaviour is voluntary rather than illness-driven (Dowling et al., 2014; Hodgins et al., 2007). Such attitudes may further reduce the likelihood of encouraging affected individuals to seek professional help, compounding the already low treatment rates observed for GD.

Furthermore, married individuals exhibited higher stigma scores in the “dangerous/unpredictable” scale, strongly suggesting that marital status may shape attitudes toward GD. Indeed, severe gambling problems can cause marital problems. According to the National Gambling Impact Study, the lifetime divorce rate for pathological gamblers was 53.5% while the rate for non-gamblers was 18.2% (National Gambling Impact Study Commission, 2007). On the other hand, spouses of individuals with gambling problems might have chosen to separate or divorce because they experienced the financial and emotional burden related to the gambling problems (Kimani & Aomo, 2023). Thus, the fear of these negative outcomes can amplify the perception of individuals with GD as threats to familial and societal well-being, reinforcing stigmatising beliefs (Banks et al., 2018).

In terms of how different income levels differ on the "dangerous/unpredictable scale", higher-income individuals (monthly income of $10,000 and above) were less likely to associate GD with these characteristics. Affluent individuals are more likely to have access to financial buffers and social capital, which can insulate them from the most visible harms of problem gambling such as bankruptcy, crime, or family breakdown, thereby diminishing their perception of GD as socially dangerous (Castrén et al., 2018). Additionally, higher-income groups may possess greater mental health literacy and be more likely to view GD through a medical or psychological lens, reducing the association with dangerousness or moral failing (Yu et al., 2015).

Lastly, recognition of GD was not significantly associated with reduced stigma of GD. This finding contradicts ideas that increased awareness and recognition of the condition leads to reduced stigma (Shim et al., 2022), highlighting the complexity of stigma in GD. Public health campaigns aimed at improving recognition must also address underlying stigma to ensure that increased awareness translates into more supportive attitudes and help-seeking behaviours.

While our findings offer valuable insights, they should be interpreted with certain limitations in mind. Some participants may have provided socially desirable responses when reporting their attitudes toward GD and help-seeking behaviours. Although a representative sample was used, non-respondents may have held different views on stigma and recovery of GD, potentially influencing the generalizability of the results. Additionally, while respondents were asked about their preferred sources of help (open text), it would have been better to allow ranking of interventions in order of importance, so as to gain insight into how different interventions are prioritized. Lastly, given the cross-sectional nature of this study, causality cannot be fully determined between the variables. Despite these limitations, this study provides valuable insights into the public’s recognition of GD, associated stigma, and perceptions of recovery. Strengths of this research include the use of vignettes that reflect common presentation of GD, the inclusion of a linguistically and culturally diverse sample, and rigorous data collection protocols that ensured high-quality responses. These findings contribute to the broader understanding of GD stigma and inform targeted public health interventions aimed at improving recognition, reducing stigma, and promoting appropriate help-seeking behaviours.

Conclusion

While correct recognition of GD was relatively high among the respondents, stigma toward individuals with GD remained prevalent, particularly among older adults, Malay and Indian participants, those who were currently married, and individuals who had family or friends with gambling problems. Efforts are still needed to address misconceptions that frame GD as a personal weakness rather than a treatable condition, as well as to challenge perceptions of individuals with GD as dangerous or unpredictable. Public health initiatives should consider integrating more targeted interventions that not only improve recognition of GD but also emphasise the pathology of the condition. While it is understandable to criticize the harmful consequences of severe gambling behaviour, it is essential to separate the behaviour from the individual. The appropriate professional help and support should be extended to those struggling with GD, rather than reinforcing stigma against them. Ultimately, fostering a more informed and empathetic understanding of GD is essential to improving help-seeking behaviours, reducing discrimination, and ensuring individuals with GD receive the support they need.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contributions

RT: Writing – review & editing, Writing – original draft. ET: Writing – review & editing, Methodology, Formal analysis. SShah: Project administration, Methodology, Conceptualization, Writing – review & editing, Investigation, Supervision. YT: Writing – review & editing, Investigation. SG: Writing – review & editing, Investigation. BW: Writing – review & editing, Data curation. WO: Writing – review & editing, Investigation. EA: Formal analysis, Writing – review & editing. SShaf: Investigation, Conceptualization, Methodology, Writing – review & editing. ST: Conceptualization, Writing – review & editing. SC: Conceptualization, Methodology, Writing – review & editing, Funding acquisition, Supervision. MS: Project administration, Conceptualization, Writing – review & editing, Funding acquisition, Methodology, Supervision.

Funding Sources

The author(s) declare that financial support was received for the research and/or publication of this article. This work was supported by the National Medical Research Council (NMRC) Health Services Research Grant and Tote Board Singapore under the Strategic Initiative for Mental Health. The funding bodies of the study had no role in study design; the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the manuscript for publication.

Data Availability

The study data and codes are available from the senior author, SShah, upon reasonable request.

Declarations

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.