Table 3.

Summary of research articles investigating the association between depressive symptoms and problem gambling and gaming

Authors	Country	Design and sampling method	Sample population	Sample characteristics	PG and PVG measure	DS measure	Findings
Problem gambling
Afifi, Nicholson, Martins, and Sareen (2016)	Canada (Manitoba)	5-year longitudinal survey	Representative sample of young adults	Time 1:	PGSI	CIDI-SF	Cross-sectional analyses indicated that at-risk or PG was associated with an increased risk of major depressive disorder (AOR = 2.33, 95% CI [1.47, 3.68])
		Random sampling, snowball recruitment, and convenience sampling		N = 679 51.8% female			Longitudinal findings indicated that at-risk or PG at T1 was associated with increased odds of major depressive disorder at Time 2 through 4 (AOR = 1.98, 95% CI [1.14, 3.44]). Major depressive disorder at T1 was not significantly associated with increased odds of at-risk or PG at Time 2 through 4 (P = 0.56).
				Mage = 18.9 (SD = NR, range 18–20)
				Time 4:
				N = 517
Bilevicius et al. (2018)	Canada (Manitoba)	1-month longitudinal survey	University students	Time 1:	PGSI	DASS depression subscale	DS were correlated with PG symptoms at both T1 (r = 0.14, P < 0.05) and T2 (r = 0.21, P < 0.01).
		Convenience sampling through an online participant pool of psychology students		N = 497			Mediation analyses indicated that after controlling for baseline PG, there was a significant positive indirect relationship between DS and PG which was partially mediated by high levels of shame (β = 0.021, 95% CI [0.006, 0.046]).
				Gender NR
				Mage = NR
				Time 2: N = 210
				76% female
				Mage = 19.71 (SD = 3.83, range NR)
Chinneck, Mackinnon, and Stewart (2016)	Canada (Manitoba)	4-year longitudinal survey	Representative sample of young adults	Time 1:	PGSI	CIDI-SF	At T1, DS and PG were positively correlated (r = NR). However, DS at T1 were unrelated to changes in PG over time. Further, PG at T1 was unrelated to changes in DS over time.
		Random sampling, snowball recruitment, and convenience sampling		N = 679
				51.8% female
				Mage = 18.92 (SD = 0.79, range 18–20)
				Time 4:
				N = 530
				Mage = 22.23 (SD = NR, range 22–24)
Cosenza, Ciccarelli, and Nigro (2019)	Italy	Cross-sectional survey	High-school students	N = 425	SOGS-RA	DASS depression subscale	DS was correlated with PG (r = 0.23, P < 0.001).
		Convenience sampling		45.5% male			Those with PG had higher levels of DS compared to the non-PG group. In the regression model, DS predicted PG (β = 0.015, P < 0.001).
				Mage = 17.12 (SD = 1.42, range 14–19)
Delfabbro and Grabosky (2006)	Australia	Cross-sectional survey	High-school students	N = 926	DSM-IV-MR-J	Negative Mood Checklist	Those reporting PG had greater negative mood (d = 0.49, P < 0.01) compared to those who did not report PG.
		Convenience sampling		51% male			In the regression model, DS was non-significant in predicting PG when accounting for other psychosocial predictors including self-esteem, health, social alienation, and relative deprivation. Only social alienation was significant.
				Mage = 14.5 (SD = 1.64, range 11–19)
Dowd et al. (2018)	Canada (Manitoba)	Cross-sectional survey	Representative sample of young adults	N = 566	PGSI	CIDI-SF	Results from the latent class analysis indicated that 27.4% of sample were the emotionally vulnerable type of problem gambler, with higher levels of DS. This was compared to a larger class of non-problem gamblers (59.90%) and impulsive problem gamblers (12.72%).
		Random sampling, snowball recruitment, and convenience sampling		47.8% male
				Mage = 19.97 (SD = 0.82, range 18–22)
Dussault et al. (2016)	Canada (Quebec)	9-year longitudinal survey (PG and DS measured over a 6-year period)	Boys living in economically disadvantaged areas	N = 1,004	Age 17: SOGS-RA	Age 17: CDI	Correlations between DS and PG at age 17 and 23 were of r = 0.14 (P < 0.01). DS and PG at age 23 were correlated at r = 0.15 (P < 0.01).
		Convenience sampling		100% male	Age 23:	Age 23: DISC-D	Longitudinal associations indicated that PG at age 17 predicted increases in DS at age 23 (β = 0.151, P < 0.001). DS at age 17 predicted increases in PG at age 23 (β = 0.131, P < 0.001). PG and DS at age 17 (P < 0.38) and age 23 (P < 0.66) were not concurrently associated.
				Time 1:	SOGS
				Mage = NR, (range 14–17)
Edgerton, Melnky, and Roberts (2015)	Canada (Manitoba)	4-year longitudinal survey	Representative sample of young adults	Time 1:	PGSI	CIDI-SF	The increased probability of DS were associated with increased initial PG severity scores at Time 1 (β = 0.134, P < 0.05). However, this had no effect on the rate of change in PG severity.
		Random sampling, snowball recruitment, and convenience sampling		N = 679
				51.8% female
				Mage = NR (range 18–20)
Edgerton, Keough, and Roberts (2018)	Canada (Manitoba)	4-year longitudinal survey	Representative sample of young adults	Time 1:	PGSI	CIDI-SF	Correlations between DS and PG from Time 1 to 4 ranged from r = 0.001 (P > 0.05) to r = 0.09 (P < 0.05), the latter being between DS at T1 and PG at T4.
		Random sampling, snowball recruitment, and convenience sampling		N = 679			Five classes were identified, with only one class indicating PG: moderate and stable PG with no DS (2.06%). Overall, there was no evidence of reciprocal growth in PG and DS in any of the classes.
				51.8% female
				Mage = NR (range 18–20)
Ellenbogen, Derevensky, and Gupta (2007)	Canada (Ontario & Quebec)	Cross-sectional survey	High-school or junior college students	N = 5,313	DSM-IV-MR-J	RADS	Non-PG, females were more likely to report DS. However, among those with PG, both males and females reported higher rates of DS. Rates of DS among PG were approximately 2–4 times higher than for social gamblers.
		Convenience sampling		51.8% male
				Mage = 14.77 (SD = NR, range 12–18)
Martin, Usdan, Cremeens, and Vail-Smith (2014)	United States	Cross-sectional study	University students	N = 1,430	DSM-IV-MR-J	PHQ-9	Correlations for DS and PG were significant (r = 0.105, P < 0.01).
		Convenience sampling		64.4% female			When compared to non-PG, PG had higher rates of DS (40.0%, OR = 3.3, 95% CI [1.9, 5.6]).
				Mage = NR (first- or second-year university students)
Molde, Pallesen, Bartone, Hystad, and Johnsen (2009)	Western Norway	Cross-sectional study	High-school students (11th-13th grade)	N = 2,055	MAGS	HADS depression subscale	In the univariate logistic regression, DS predicted PG (OR = 14.4, P < 0.001). In the multivariate logistic regression, significant predictors of PG included gender, depression (OR = 9.23, P < 0.001), alcohol abuse and self-forgetting when gambling. DS had the largest odds ratio.
		Random sampling from total population of high-school students		52.9% male
				Mage = 17.3 (SD = 0.8, range 16–19)
Nigro, Cosenza, and Ciccarelli (2017)	Italy	Cross-sectional study	Middle- and high-school students	N = 1,010	SOGS-RA	DASS depression subscale	Significant correlations were reported between DS and PG (r = 0.279, P < 0.01). Problem gamblers also endorsed a greater mean score of DS compared to non-gamblers, non-problem gamblers, and at-risk gamblers (P = NR). In the linear regression, DS predicted severity of PG while controlling for gender, age, impulsivity, anxiety, and future/immediate implications of behavior (β = 0.129, P < 0.001).
		Convenience sampling		47.5% male
				Mage = 15.37 (SD = 2.05, range 12–19)
Nower, Gupta, Blaszczynski, and Derevensky (2004)	Canada (Quebec & Ontario)	Cross-sectional study	Three combined samples of high-school students (two in Quebec, one in Ontario)	N = 3,941	Sample 1 & 2 (S1 & 2): DSM-IV-MR-J	RADS	In all three samples, those with PG reported significantly higher DS compared to non-gamblers and social gamblers (P < 0.01; S1 = 23.1%; S2 = 24.5%; S3 = 20.4% clinically depressed).
		Convenience sampling		49.15% male	Sample 3 (S3): DSM-IV-MR-J &
				Mage = NR (range 12–18)
Pascual-Leone, Gomes, Orr, Kaploun, and Abeare (2011)	Canada (Ontario)	Cross-sectional study	University students	N = 200	SOGS	BDI-II	Descriptive statistics indicated that 7.5% (n = 15) of the sample were at-risk or problem gamblers. Correlations indicate that DS were not significantly correlated with PG scores (r = 0.117, P > 0.05). DS were not included in the regression analysis.
		Convenience sampling		88.5% female
				Mage = 21.41 (SD = 3.53, range NR)
Sanscartier, Edgerton, and Roberts (2018)	Canada (Manitoba)	Cross-sectional study	University students	N = 496	PGSI	CES-D	Latent class analysis results yielded a four-class solution: 1) casual gamblers; 2) skill-interactive gamblers; 3) chance-passive gamblers; and 4) extensive gamblers. Extensive gamblers and chance-passive classes had higher rates of PG compared to the casual and skill-based gamblers. Chance-passive gamblers had greater DS compared to casual gamblers (P < 0.05, η2 = 0.14). Chance-passive gamblers and extensive gamblers did not differ in DS.
		Convenience sampling		43.1% male
				Mage = 20.22 (SD = 1.77, range 18–25)
Stuhldreher, Stuhldreher, and Forrest (2007)	United States	Cross-sectional study	University students	N = 1,079	Four criteria for PG: gambling-related harms and help-seeking behaviors	BDI	Comparisons for DS were conducted for each of the four criteria for PG. Results indicate that for all four criteria there was a greater proportion of individuals with a positive score for DS.
		Convenience sampling		58% female
				Mage = 19.9 (SD = 1.6, range NR)
Wohl, Matheson, Young, and Anisman (2008)	Canada	Cross-sectional study	First-year university students reporting gambling in the past year	N = 125	DSM-IV-MR-J	BDI	DS scores varied between gamblers, where pathological gamblers endorsed significantly more DS (M = 14.87, SD = 5.70) than problem (M = 8.40, SD = 7.80) or recreational (M = 6.60, SD = 5.71) gamblers. This was the case for both males and females.
		Convenience sampling		58.4% male
				Mage = 20 (SD = 0.75, range NR)
Problem video gaming
Bonnaire and Baptista (2019)	France	Cross-sectional study	Online forums	N = 429	GAS Short Version	HADS depression subscale	Compared to non-PVG, PVG had higher DS (M = 15.4 vs M = 12.2, P < 0.001). This was significant for both males and females.
		Convenience sampling		71.3% male			In the logistic regression analysis, DS significantly predicted PVG (OR = 1.2, 95% CI [1.1–1.3], P < 0.001) while controlling for sex, anxiety and alexithymia.
				Mage = 20.7 (SD = 2.6, range 18–25)
Dang, Zhang, Leong, and Wu (2019)	China	1-year longitudinal study	University students with gaming experience	N = 282	DSM-5 criteria for IGD	DASS depression subscale	DS and PVG were significantly correlated at both time points (r = 0.26–0.42, P < 0.001). In the path analysis, DS were identified as a mediator in the relationship between trait emotional intelligence (TEI) and PVG. In the cross-sectional model, DS mediated the relationship between TEI and PVG, while also mediating the relationship between coping flexibility and PVG. Consistent findings are reported in the prospective model. The models indicated that DS were a significant concurrent mediator at both T1 and T2 (direct effects; T1: (β = 0.37, P < 0.001; T2: β = 0.29, P < 0.001).
		Convenience sampling		39.4% male
				Time 1:
				Mage = 20.47 (SD = 1.15, range NR)
Givron, Berrewaerts, Houbeau, and Desseilles (2018)	Belgium	Cross-sectional study	First-year university medical students	N = 210	PVP	MADRS-S	As the severity of DS increased (none, minor, moderate), the average PVG score increased from M = 1.9, M = 2.4, to M = 3.9, respectively. This change was significant (P = 0.001).
		Convenience sampling		29.5% male
				Mage = 18.5 (SD = 1.0, range 17–25)
Guillot et al. (2016)	United States	1-year longitudinal study (9–18-month range)	Emerging adults, former attendees of alternative high-schools, and prior participants in a school-based substance abuse prevention program	N = 503	Video Game Addiction (1 item)	Snaith-Hamilton Pleasure Scale	Anhedonia predicted greater levels of PVG one year later (OR = 1.33, 95% CI [1.11, 1.60], P = 0.003), while controlling for gender and high-school graduation.
		Convenience sampling		47.7% male
				Mage = NR (range 19–24)
Kircaburun, Griffiths, and Billieux (2019)	Turkey	Cross-sectional study	High-school students	N = 470	IGDT-10	SDHS	DS were positively correlated with PVG (r = 0.13, P < 0.001). A multiple mediation model was tested to examine the mediating role of DS (in addition to mindfulness and rumination) on the relationship between emotional intelligence (EI) and PVG. Results indicated that although the other mediators were significant, DS did not mediate the relationship between EI and PVG.
		Convenience sampling		40.4% male
				Mage = 16.29 (SD = 1.17, range 14–18)
Li, Liau, and Khoo (2011)	Singapore	Cross-sectional study	Adolescents with massively multiplayer online gaming experience	N = 161	Pathological gaming based on DSM-IV-R-PG	Asian adolescent depression scale	DS and PVG were positively correlated (r = 0.31, P < 0.01). Results of the path model, indicated that escapism mediated the relationship between DS and PVG (indirect effect [β = 0.09, P < 0.05]; direct effect from DS to escapism [β = 0.45, P < 0.01]), while DS mediated the relationship between actual-ideal self-discrepancies (AISD) and escapism (indirect effect [β = 0.09, P < 0.05]; direct effect from AISD to DS [β = 0.20, P < 0.01]), with escapism being directly related to PVG (β = 0.34, P < 0.01). The direct relationship between DS and PVG was non-significant (β = 0.13, P > 0.05).
		Convenience sampling		49.1% male
				Mage = 14.04 (SD = 0.73, range 13–15)
Liu et al. (2018)	China	Study 1: 4-year longitudinal study	Study 1: University students with experience playing online games, spending on average 20% of their daily time gaming	Study 1:	Chinese Internet Addiction Scale	SCL-90 depressive symptoms	Across the four time points, higher DS at T1 were associated with greater PVG severity from Time 2 to 4 (r = 0.25–0.30, P < 0.01). Higher PVG at T1 was associated with greater DS at Time 2 to 4 (r = 0.19–0.27, P < 0.01). Results from the cross-lagged path models indicated that although there is a temporal interrelationship between DS and PVG, the impact of DS on PVG (β = 0.118, 0.126, 0.127; P < 0.001) is greater than the impact of PVG on DS (β = 0.070, 0.066, 0.070; P < 0.05).
		Convenience sampling		N = 563
				78% male
				Time 1:
				Mage = 18.31 (SD = 0.89, range 16–21)
Männikkö, Billieux, and Kääriäinen (2015)	Finland	Cross-sectional study	Adolescents and young adults	N = 293	GAS	Depression (frequency of feeling depressed)	DS and PVG were positively correlated (r = 0.17, P < 0.01). Those with PVG endorsed greater DS than those with no-PVG (22.6% vs 6.5%, P < 0.001). In the linear regression model, DS were a significant predictor of PVG (β = 0.18, P < 0.01) when controlling for occupation, education level, age, gaming frequency, health, exercise, life satisfaction, and preference for online interaction.
		Random sampling stratified for age and gender		51% male
				Mage = 18.7 (SD = 3.4, range 13–24)
Vadlin Åslund, Hellström, and Nilsson (2016)	Sweden	Cross-sectional study	Sample 1:	Sample 1:	GAIT	DSRS-A	In the multivariable logistic regression analysis adjusting for sex, age, school bullying, and family maltreatment, attention problems, and anxiety, adolescents with DS were 2.47 times more likely to be PVG (95% CI [1.44, 4.25], P < 0.001).
		Sample 1: Total population sampling	Community sample of adolescents	N = 1,868
		Sample 2: Consecutive sampling at child and adolescent psychiatric clinics	Sample 2:	55.4% female
			Clinical sample of adolescents in psychiatric clinics	Mage = 13.9 (SD = NR, range 12–16)
				Sample 2:
				N = 242
				69.8% female
				Mage = 15.39 (SD = NR, range 12–18)
Van Rooij et al. (2014)	Netherlands	Cross-sectional study	High-school students	N = 8,478	VAT	Depressive Mood List (Dutch translation)	Analyses were conducted separately by gender. In males, DS were associated with an increase in PVG (d = 0.91, P < 0.001). In females, DS associated with an increase in PVG (d = 1.23, P < 0.001).
		Stratified sampling of schools based on region, urbanization and education level		49% male
				Mage = 14.2 (SD = 1.1, range NR)

Note. BDI = Beck Depression Inventory, CDI = Child Depression Inventory, CES-D = Center for Epidemiologic Studies Depression Scale, CIDI-SF = Composite International Diagnostic Interview-Short Form, DASS = Depression Anxiety Stress Scale, DISC-D = Diagnostic Interview Schedule for Children for Depressive Symptoms, DS = depressive symptoms, DSM-IV-R-PG = Diagnostic and Statistical Manual - IV - Revised - Pathological Gambling, DSRS-A = Depression Self-Rating Scale Adolescent Version, GAIT = Gaming Addiction Identification Test, GAS = Game Addiction Scale, HADS = Hospital Anxiety and Depression Scale, IGD = Internet Gaming Disorder, IGDT-10 = Internet Gaming Disorder Test, MADRS-S = Montgomery and Asberg Depression Rating Scale, MAGS = Massachusetts Gambling Screen DSM-IV subscale, PG = problem gambling, PGSI = Problem Gambling Severity Index, PHQ-9 = Patient Health Questionnaire-9, PVG = problem video gaming, PVP = Problem Video Game Playing, RADS = Reynolds Adolescent Depression Scale, SCL-90 = Symptom Checklist, SDHS = Short Depression Happiness Scale, SOGS = South Oaks Gambling Screen, SOGS-RA = South Oaks Gambling Screen – Revised Adolescent, VAT = Video Game Addiction Test.