Vandenberg Brian, Livingstone Charles, Carter Adrian, O'Brien Kerry
Behavioural Sciences Research Laboratory, School of Social Sciences, Monash University, Menzies Building, 20 Chancellors Walk, Clayton, VIC 3800, Australia.
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
Addict Behav. 2022 Feb;125:107151. doi: 10.1016/j.addbeh.2021.107151. Epub 2021 Oct 14.
There is growing concern internationally about co-occurring gambling and homelessness. We systematically review prevalence estimates in help-seeking and community samples.
Adopting PRISMA guidelines, we searched CINAHL Plus, Cochrane Library, Embase, Ovid MEDLINE, PsychINFO, Proquest Central, PubMed, Scopus, Web of Science, and Google Scholar for relevant peer-reviewed articles in English. Primary outcomes examined in narrative and quantitative syntheses included prevalence of: (i) gambling in persons experiencing homelessness; (ii) harmful gambling in persons experiencing homelessness; and, (iii) homelessness in persons experiencing harmful gambling.
Searches identified 917 records after removing duplicates. After screening, 45 articles providing 54 prevalence estimates across 12 countries were included, with help-seeking (k = 37) and community based sample (k = 8) estimates pooled separately. Gambling prevalence (all timeframes) in help-seeking samples of persons experiencing homelessness is low (28.7%, 95% CI: 17.3-41.7, k = 14) compared to the general population (approximately 60-80%). However, harmful gambling prevalence (including problem, pathological, and disordered gambling) in help-seeking samples of persons experiencing homelessness is high (16.5%, 95% CI: 10.2-24.2, k = 20) compared to the general population (approximately 1-7%). Additionally, homelessness prevalence is high in help-seeking samples of persons experiencing harmful gambling (23.6%, 95% CI: 18.4-29.2, k = 4) compared to the general population (<1%). Meta-analysis found high between-study heterogeneity and risk of bias from small samples sizes.
There are high rates of harmful gambling in persons experiencing homelessness and, concurrently, high rates of homelessness in persons experiencing harmful gambling. Improvements in sampling and measurement are needed to strengthen robustness and generalizability of prevalence estimates, which can potentially inform the scale and targeting of clinical interventions, support services, and policy responses.
国际上对赌博与无家可归现象并发的关注度日益提高。我们系统回顾了求助样本和社区样本中的患病率估计情况。
采用PRISMA指南，我们在CINAHL Plus、Cochrane图书馆、Embase、Ovid MEDLINE、PsychINFO、Proquest Central、PubMed、Scopus、Web of Science和谷歌学术中搜索了相关的英文同行评审文章。在叙述性和定量综合分析中考察的主要结果包括：（i）无家可归者中的赌博患病率；（ii）无家可归者中的有害赌博患病率；以及（iii）有害赌博者中的无家可归患病率。
去除重复记录后，搜索共识别出了917条记录。经过筛选，纳入了45篇文章，这些文章提供了12个国家的5个患病率估计值，其中求助样本（k = 37）和社区样本（k = 8）的估计值分别进行了汇总。与一般人群（约60 - 80%）相比，无家可归者求助样本中的赌博患病率（所有时间段）较低（28.7%，95%置信区间：17.3 - 41.7，k = 14）。然而，与一般人群（约1 - 7%）相比，无家可归者求助样本中的有害赌博患病率（包括问题赌博、病态赌博和紊乱性赌博）较高（16.5%，95%置信区间：10.2 - 24.2，k = 20）。此外，与一般人群（<1%）相比，有害赌博者求助样本中的无家可归患病率较高（23.6%，95%置信区间：18.4 - 29.2，k = 4）。荟萃分析发现研究间存在高度异质性，且由于样本量小存在偏倚风险。
无家可归者中有害赌博的发生率很高，同时，有害赌博者中无家可归的发生率也很高。需要改进抽样和测量方法，以增强患病率估计的稳健性和可推广性，这可能为临床干预、支持服务和政策应对的规模和目标提供参考。
