General Practitioners' Management of Individuals with Gambling Disorder: A Systematic Review of Practices, Knowledge, Attitudes and Beliefs.

Gambling disorder (GD) has a significant impact on individuals, the healthcare system, and the society. The vast majority of individuals with GD do not use healthcare services for their GD. Since primary care is the first point of contact, exploring barriers to GD treatment is of utmost importance. For this systematic review, we searched five major databases up to October 2024 and included empirical studies describing the practices of general practitioners (GPs) and emergency department physicians regarding GD, as well as their knowledge, attitudes, and beliefs about GD management. We retained six quantitative and six qualitative articles that reported GP data on GD management; however, no studies conducted in emergency departments met our inclusion criteria. The narrative synthesis revealed that none of the GPs routinely screened for GD, only 7-14% treated GD themselves, and approximately half referred these individuals to mental health specialists. While more than half of GPs were knowledgeable about GD-related harms, only 17-38% were confident in their knowledge of GD or care pathways. Although over 65% acknowledged their potential role in managing GD, multiple barriers to care were identified. These included negative attitudes, such as attributing gambling-related harms to individual character weakness, insufficient training on GD screening tools and treatment modalities, and the low prioritization of GD treatment within the healthcare system. Given the higher risk of GD among individuals with mental health disorders (e.g., depression, anxiety) and substance use disorders, prioritizing GD screening and treatment for these high-risk groups in primary care is essential.