Gambling Disorder (GD), according to the DSM-5, is characterized by persistent and recurrent gambling behavior causing significant psychological distress or social impairment (1). The World Health Organization (WHO) reports that approximately 0.1% to 6% of adults worldwide suffer from this disorder (2). GD affects mental health, causing anxiety, depression, and suicidal ideation. It also leads to financial crises, social isolation, family breakdowns, and criminal behavior, increasing public health burdens and social instability (3).

According to a 2021 report by the United Nations Office on Drugs and Crime (UNODC), the illegal sports betting market sees annual wagers of up to $1.7 trillion (UN 4). This figure unequivocally highlights the significant risks and potential harms associated with gambling. Additionally, internet gambling has proliferated with the rapid development of the digital age due to its convenience, interactivity, and anonymity. It has become the fastest-growing mode of gambling, fundamentally changing how gamblers participate and making gambling behavior more difficult to regulate and control (5, 6).

In China, small-scale gambling is often seen as a form of entertainment deeply rooted in cultural traditions. In recent years, the prevalence of gambling has surged, surpassing levels seen in many other countries, and this situation has been further exacerbated by the rise of online gaming, which has become the dominant form of gambling in China (7). Despite laws prohibiting all forms of gambling, societal tolerance remains high, contributing to the popularity of gambling, particularly during major festivals (3, 8). However, social acceptance of gambling does not extend to an understanding of GD, which is often stigmatized and attributed to moral failings (9). This complex legal and cultural context leads to individuals with GD hiding their problems and being reluctant to seek help due to fear of legal consequences and stigma (10). Studies credited by Slutske (11) indicated that only 10% of individuals with GD seek treatment.

Assessing the severity of gambling is crucial for the treatment of GD, helping to determine individual risk levels and formulate targeted treatment plans. Currently, various scales for measuring GD have been developed internationally. Among these, self-report scales such as the Canadian Problem Gambling Index (CPGI) and the South Oaks Gambling Screen (SOGS) are widely used (12). However, these tools primarily rely on self-reports. In clinical studies, self-reported outcomes from individuals with GD may be biased due to their awareness of having received an intervention, particularly in terms of reported gambling behaviors and perceptions. Conversely, outcomes measured by an independent, blinded professional would have a lower risk of bias when assessing treatment effect (13). Additionally, individuals with GD may underestimate or deny the severity of their problems due to social pressure or distorted self-perception (14). Studies have shown that the self-reports of people with GD often indicate lower severity than those observed by third parties (10).

Observer rating scales, such as the Yale-Brown Obsessive Compulsive Scale for Pathological Gambling (PG-YBOCS), may provide a more objective method of assessment, combining observation and questioning, which may increase diagnostic reliability when examining treatment effects (15, 16). Moreover, GD shares significant neurocognitive characteristics with obsessive-compulsive disorder (OCD), including ritualized behaviors, intrusive thoughts, and diminished impulse control (16). The PG-YBOCS developed by Pallanti et al. (16) specifically targets gambling-related thoughts and behaviors, measuring the severity of obsessive-compulsive disorder, especially for obsessions and compulsions. Multiple studies confirmed that PG-YBOCS can effectively distinguish different severity levels of GDs and has been widely used as a primary measure of treatment efficacy (17–20). PG-YBOCS has been translated into several languages, such as Japanese (21), demonstrating its cross-cultural applicability and importance in global addiction research.

In China, several self-report tools for GD exist, including the Chinese Version of the Canadian Problem Gambling Index, the South Oaks Gambling Screen and the Chinese Gambling Urge Scale (22–24). An observer rating scale administered by a professional, such as a psychologist or a clinical tester in clinical assessment has not been developed. Given the gap in GD assessment, the objective and standardized PG-YBOCS can effectively measure the severity of GDs. Localizing and validating the Chinese Version of PG-YBOCS (PG-YBOCS-C) is crucial for assessing and treating GDs in China, promoting clinical research in this field.

To our knowledge, this is the first study to focus on the reliability and validity of an observer rating scale for GD in Chinese mainland. The results confirm that PG-YBOCS-C is a reliable tool for assessing symptom severity in Chinese individuals with GD. This tool effectively fills the gap in the current research on GDs, providing the instrument for clinical assessment, and will help clinical staff to evaluate and develop treatment plans.

In this study, item analysis revealed that PG-YBOCS-C have good discrimination, indicating significant power in differentiating individuals with varying symptom severity. The scale showed high internal consistency with a Cronbach’s α of 0.965. Each of the 10 items demonstrated good discriminatory ability, and all item scores correlated significantly with the total score, further validating the scale’s internal consistency. Test-retest reliability over two weeks showed a coefficient of 0.722, emphasizing the scale’s stability and repeatability. The content validity index (SCVI) was 0.912, confirming expert agreement on the relevance of these items to gambling symptoms. This highlights the scale’s applicability and professionalism in the field of gambling research, supported by its robust content validity. The findings are consistent with the findings of Yokomitsu et al. (2020) in Japan.

Many researchers have proposed that impulse control disorder is a core symptom of addictive behavior, including GD. Addictive behavior is often described as compulsive (33). Given the similarities between OCD and GD (16), particularly in terms of ritual behavior and the compelling urge to gamble, as well as the correlations between OCD-like symptoms and gambling severity (34), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (35) has been adapted for pathological gambling (PG-YBOCS) (16). Contrary to the two-dimensional structure of Y-BOCS (obsessive thoughts and compulsions) (36), Pallanti et al. (16) identified a unidimensional structure for the PG-YBOCS. This also proves that compulsive behaviors in OCD tend to be more complex and specific, often disconnected from direct impulses (37). Our findings align with this unidimensional model, indicating that addictive behavior is intrinsically linked to the urge itself, making the two inseparable (e.g. gambling behavior may intensify corresponding urges, creating a vicious cycle) (38).

To examine the effectiveness of PG-YBOCS-C in assessing the severity of GD, the G-SAS was employed, a tool that has been proven reliable and effective in measuring symptom severity and monitoring treatment progress (28). The significant positive correlations between PG-YBOCS-C and G-SAS indicated that PG-YBOCS-C is an effective measure of GD severity, as further evidenced by its significant positive correlation with a single-item GES scale measuring gambling eagerness. Furthermore, consistent with previous findings, the significant positive correlations between PG-YBOCS-C and BIS-11 suggested that higher impulsivity levels are associated with more severe GDs (25). The significant negative correlation between PG-YBOCS-C and SCS (39) suggested that individuals with low self-control are less able to inhibit impulses for immediate gratification, making them more susceptible to engaging in risky behaviors, including GDs.

This study highlighted the practicality and effectiveness of the PG-YBOCS-C in the Chinese cultural context, providing a reliable observer rating tool for assessing GD symptoms in Chinese clinical practice. It addressed the need for gambling assessment tools to be adapted to the unique social and cultural landscape (7). As a clinician-administered tool, it reduces the tendency to underreport gambling behaviors due to shame or bias, thereby enhancing the accuracy and reliability of assessments. Owing to its concise and structured format, the PG-YBOCS-C is well-suited for application in clinical triage, risk screening, and symptom monitoring. It can also be combined with other tools to provide a more comprehensive assessment (such as self-report scales).

Although this study validated PG-YBOCS-C as an effective clinical tool, there were some limitations of the study. First, despite efforts to recruit a broad participant base, the sample size remained relatively small, potentially limiting the generalizability of the results. Given the limited sample size, this study only conducted EFA to examine the structural validity of the scale. While the EFA results suggested a strong unidimensional structure explaining 72.8% of the total variance, the use of EFA alone may carry certain limitations, such as potential overfitting and reduced generalizability of the factor structure. Additionally, the sample consisted exclusively of men, which may lead to gender biases. Furthermore, as the sample was drawn solely from mainland China, the applicability of the findings to other regions, such as Hong Kong and Macau, may be constrained due to differing sociopolitical contexts. Even so, the results of this study still provided a favorable tool for clinical research in the area of GD in the Chinese Mainland. To enhance the diversity and representativeness of the findings, future studies should include more diverse samples from various regions.

In conclusion, the results of the present study indicate that the PG-YBOCS-C is a reliable and valid measure for assessing the severity of GD in the Chinese mainland. Our findings validate that the scale is a reliable observer rating tool for assessing the severity of gambling symptoms in these individuals.