Despite the above findings, many studies use a methodology that makes it difficult to separate relevant factors, including the frequency of participation in each form and access to gambling. First, some studies have measured Internet gambling as individual gambling activities rather than a form of access to specific gambling 안전놀이터activities (e.g., [15, 42]), making it impossible to identify the impact of specific Internet gambling on the problem. Second, the study statistically controls engagement in multiple forms by using the sum of the gambled activities while retaining the original or transformed activity indicators in the regression model. This may lead to biased results because of the collinearity between the scale of complex involvement and the scale of activity derived directly from it . In addition, this method of control of involvement essentially controls the participation in individual activities and may distort and suppress the estimation of the impact of problem gambling.
Problem While the severity of gambling안전놀이터 is an important factor to consider in establishing the impact of a particular activity, overall psychological distress is also important. Several studies have shown that reduced mental health and psychological distress predict a higher severity of problem gambling [2, 44]. One study in Australia suggested that land-based gamblers reported greater psychological distress than internet-based gamblers  and that there could be covariates associated with distress in addition to the experience of the problem. Although gambling disorders are highly coexisting with other mental disorders [4, 45, 46], most studies have not observed the direction of causality. Therefore, it is important to consider the inherent relationship between psychological distress and participation in a particular gambling activity and a particular mode of access. Purpose of this study
This study aimed to investigate the association between problem gambling severity and gambling frequency on psychological distress to understand the unique contribution of specific gambling activities to these mental health issues.
Based on prior literature, we hypothesized that the frequency of involvement in various online and land-based gambling activities positively correlates with both the severity of problematic gambling and psychological distress. Considering the existing literature suggesting that the use of EGM is associated with gambling problems, the second hypothesis was that involvement in onshore and online EGM would be positively correlated with the severity of problem gambling. We conducted multiple regression to explore the inherent relationship between the frequency of participation by each gambling activity modality (online and land-based), 1) severity of problem gambling, and 2) psychological distress, and we also investigated all demographic predictors. The participants must be at least 18 years old, have good internet access, and understand English well.
Participants were recruited from a database of research participants held by the market research company Qualtrics. The entire panel and survey response rate were not provided to the survey team. The survey was completed between March 30 and April 5, 2017. After removing participants who completed two online surveys, 998 (99.7%) participants were retained for further analysis (Table 1). All participants provided informed consent electronically. The ethical approval of the study was conducted by the Human Research Ethics Committee of the University of Sydney. The survey includes standard demographic details (age, gender, household income, etc.), online and onshore gambling behavior, attitudes toward online gambling sites, motivation for online gambling, the severity of problem gambling, and psychological harm.