This was a descriptive cross-sectional study with an analytical aim, conducted from December 2021 to November 2022. A minimum sample size was estimated (277) to reach the necessary statistical power, using Schwartz’s formula. Two-stage cluster probability sampling was used to select 30 clusters of 19 to 20 statistical units.

The dependent variable was online gambling addiction. The independent variables were sociodemographic and economic factors, biography, past history, social inquiry, pathological gambling consequences and gambling-related variables.

The DSM V diagnostic criteria for addiction to online gambling and the Hospital Anxiety and Depression Scale (HADS) diagnostic criteria for depression and anxiety were used to assess the subjects’ addiction to online gambling.

The HADS scale [11] is a screening instrument for anxiety and depressive disorders. It comprises 14 items rated from 0 to 3. Seven questions relate to anxiety (total A) and another seven to depression (total D), giving two scores (maximum score for each = 21).

Scores

Add up the points of answers: 1, 3, 5, 7, 9, 11, 13: Total A = _______

Add up the points of answers: 2, 4, 6, 8, 10, 12, 14: Total D = _______

Interpretation

In order to screen for anxiety and depressive symptoms, the following interpretation can be proposed for each of the scores (A and D):

· 7 or less: no symptomatology;

· 8 to 10: doubtful symptomatology;

· 11 and over: definite symptomatology.

Data analysis was performed using R 4.3.0 software. Quantitative variables were expressed as means with their standard deviation; categorical or quantitative variables were expressed as proportions with their confidence intervals. In bivariate analysis, a significant association between two variables was established for a p value < 0.05 (5% significance level). For the comparison of two quantitative variables, the linear correlation test was used, and the CHI² test was used for the comparison of qualitative variables or quantitative variables rendered categorical. The dependent variable was explained by the explanatory variables using binary logistic regression.

Of the individuals surveyed, 30.55% (176) are online gamblers. Among these, 142 are pathological gamblers (24.65%) as defined by the Diagnostic and Statistical Manual of Mental Disorders (Figure 1 and Figure 2) (DSM-5).

The prevalence of depression among pathological gamblers was 5.60%, and anxiety 45.80% (Table 2).

Almost all of those surveyed had a good relationship with the people around them. Among pathological gamblers, 87.3% lived in an environment that favored access to online gambling, while more than half (52.8%) had access to online games (Table 3).

Online gambling motivation in pathological gamblers and suicidal ideation.

The ambition to become rich (54.2%) or to please oneself remains the primary motivations of pathological gamblers (Figure 3), among whom almost two out of ten (18.3%) reported to have suicidal thoughts following a loss of stake or winnings while gambling (Table 4).

Type of games played by pathological gamblers

Betting on sports results also known as sports betting (sports lotto or 1xBet) was the most popular game among pathological gamblers (83.8%) (Table 5).

Probable repercussions of online gambling in pathological gamblers

The probable repercussions of online gambling among pathological gamblers include: anxiety (45.8%), debt accumulation (24.6%), family conflicts (9.9%) and depression (5.6%).

Multivariate analysis

Logistic regression revealed a significant association between pathological gambling and the following variables: age (OR = 0.91; IC 95%:0.87 - 0.96; p = 0.001), access to online gambling (OR = 9.48; IC 95%: 4.72 - 19.02; p < 0.001), access to video games (OR = 0.34; IC95%: 0.16 - 0.70; p = 0.003), exposure to gambling advertisements (OR = 8.92; IC95%: 4.63 - 17.19; p < 0.001), having gambling friends (OR = 9.10; IC 95%: 3.66 - 22.59; p < 0.001), accumulating debts (OR = 12.59; IC 95%: 4.09 - 38.75; p < 0.001), anxiety (OR = 2.39; IC 95%: 1.30 - 4.39; p < 0.001), and depression (OR = 0.06; IC 95%: 0.02 - 0.18; p < 0.001).

To achieve the objectives set out in the source thesis for the current publication, a descriptive, analytical cross-sectional study was carried out as part of a doctoral thesis in general medicine. Sampling was cluster probabilistic, with census of all people meeting the inclusion criteria enumerated. Determined using the Schwartz formula from the prevalence found in Canada in 2017 (66%), the sample size initially planned for 450 subjects was increased to 576 in order to obtain greater reliability of the results. The protocol was submitted to the Local Ethics Committee for Biomedical Reasearch of the University of Parakou (Comité Local d’Éthique pour la Recherche Biomédicale de l’Université de Parakou also known as CLERB-UP). Data collection was carried out by students at the end of their medical and epidemiological training, who had been briefed on the work. The collection technique used was a digital questionnaire to which eligible subjects were subjected. The survey form consisted of a questionnaire providing sociodemographic data, past history, biography, social survey, gambling-related characteristics, data on the diagnosis of pathological gambling (Diagnostic and Statistical Manual of Mental Disorders (DSM5), impact variables and Hospital Anxiety and Depression Scale (HADS) items to screen for anxiety and depression. The database was cleansed. The major limitation of this study was the subjective statements made by the respondents, which were used to create the database. As the proven reliability of these declarations cannot be established, they constitute a non-negligible bias factor. The other, albeit minimal, limitation of the study is that the scales used have not been validated in the Beninese sociocultural context. However, their international validation remains an asset to the present work.

At the end of the present study, the prevalence of pathological gambling calculated in the commune of Parakou was 24.65% using DSM V.

This prevalence is higher than those reported by several other authors in varying degrees: Berrada et al. in Morocco in 2009 (19%) [4] ; Afe et al. in Nigeria in 2022 (12.30%) [10] ; Hakasson et al. in Sweden in 2020 (10.00%) [9] ; Lever et al. in 2016 in France (9.90%) [12] ; Molde et al. in 2009 in Norway (4.40%) [5] ; Coste et al. in 2010 in France (3.70%) [13] and Huang et al. in 2007 in Canada (2.22%) [3] . The prevalence found in the present study is significantly lower than those found by other authors: Odame et al. in 2020 in Ghana (34.30%) [14] and Matthews et al. in 2009 in the United Kingdom (53%) [15] . The larger sample size as well as diagnostic tools different from ours easily explains these higher proportions.

Methodological differences, sample sizes and diagnostic tools used could account for this discrepancy. But the variability of different study environments should not be discounted. Easy exposure to screens, easy and low-cost access to the Internet, and many other environmental factors could vary the risk of pathological gambling online one way or another.

In the present study, sports betting (sports lotto or 1xBet) was the game most favoured by pathological gamblers (83.8%). This result is in line with those of Odame et al. in Ghana in 2021 and Livazović et al. in Croatia in 2019, who found a high proportion of gamblers in that game [14] [16] . There is no longer any need to demonstrate that 1xBet is the most devastating online game for the Beninese youth to date. Its easy access on connected phones and the small stakes accepted make it the game of all socio-economic strata who suffer the full brunt of its afflictions.

On the other hand, Hakansson et al. in 2020 in Sweden, in a study during the Covid 19 health crisis, reported a high proportion of gamblers in online horse betting [9] . This could be explained by the fact that, during this health crisis, restrictions on sporting activities led gamblers to take up other types of gambling.

In multivariate analysis, pathological gambling was significantly associated with the following factors: age (p = 0.001), access to online gambling (p < 0.001), access to video games (p = 0.003), exposure to gambling advertisements (p = 0.000), existence of gambling friends (p < 0.001), accumulation of debts (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001).

Indeed, Mehwash Mehroof et al. [19] in 2010 in the UK and Andreassen et al. [20] in 2016 also found a significant association between gambling addiction and anxiety. In addition, other authors have reported associated factors different from ours. Odame et al. in Ghana in 2020 [14] therefore found that gender was significantly associated with gambling addiction in multivariate analysis. Similarly, Model et al. [5] found in multivariate analysis that gender and alcohol abuse were associated with pathological gambling. Moñino-García M et al. [2] found in their study a significant association between pathological gambling and cannabis use, which is a more accessible substance in Spain than in Parakou.

The young age of pathological gamblers, hovering around 23, is an indicator to be taken into account. Indeed, young people’s access to the Internet, with its many social networks that present the model of socio-economic success as a life of luxury, drives many to seek easy gain at an early age. The recent proliferation of several online games has quickly added to the perdition of these young people, who firmly believe in a fortune to be made by chance. The different types of game played by pathological gamblers were: horse or other animal racing betting, sports betting, cryptocurrency games, scratch lottery games, games (multi game dames, sipa etc.) and card games. The absence of employment opportunities after long studies for most, the precariousness of the majority of civil servants and the obvious and extreme poverty of most craftsmen push the latter to invest their meager resources in gambling, which not only robs them but also makes them dependent on them. Preventive and curative action is needed in this segment. Exclusively preventive action should start with the younger generation, with appropriate education and presentation of the risks associated with online gambling. It is not uncommon to observe several addictive behaviors in the same individual. All those playing video games should therefore be considered as being at risk of online gambling addiction, and the necessary action should be taken within them. When we consider that children have easier access to video games today, a prevention resolution within them is all the more justified.

It’s easy to understand that, with the current development of artificial intelligence, the realism of the phenomena offered online, and the phishing technique employed by the designers of games that were initially harmless and without stakes, are rekindling the desire to gamble among a segment of the population that is vulnerable because of its young age. Access to online gambling is a real danger for young people, and one that is set to worsen in the coming years. Raising awareness in schools and other places where children and teenagers gather is the only useful weapon to protect future generations from this phenomenon, which is a silent devastator. An addiction requires three elements: the individual, the environment and the object of addiction. It is therefore not surprising to notice in the present work that environmental elements such as exposure to advertisements and the existence of online gambling friends are associated with pathological gambling. If preventive and curative action is to be fully effective, it will have to take those environmental factors into account. But the great difficulty will be to eliminate or protect against advertisements. Reinforcing the individual’s psychic capacities could be an alternative in this respect.

Anxiety and depression are factors associated with pathological gambling. It should be noted that it is not possible to play games of chance and money without losing a bet or winnings. The repetition of these losses, the investment of one’s meager resources in the hope of winning without success, and sometimes the debts contracted for the investment, constitute anxiogenic and/or depressogenic factors which obviously maintain a permanent state of anxiety or depression in pathological gamblers.