Surprisingly high prevalence rates of severe psychological distress among consumers who purchase loot boxes in video games.

Loot boxes are randomised rewards available in some video games, often purchasable for real-world money. Loot boxes have been likened to conventional forms of gambling and may satisfy legal requirements to be considered bona fide gambling in some jurisdictions. Research has consistently shown that people with problem gambling symptoms report spending more on these mechanisms than people without such symptoms. However, a significant gap in our current understanding is whether engaging with these mechanisms is associated with harm. Here we examine the prevalence rates of severe psychological distress among purchasers of loot boxes relative to non-purchasers. A reanalysis of two cross-sectional surveys collected online via online collection platforms. Participants were 2432 Aotearoa New Zealand, Australian, and United States residents recruited through online survey. Our results show that purchasers of loot boxes are at approximately 1.87 times higher risk of severe psychological distress on a standardised clinical screening tool than people who do not purchase loot boxes. These relative risk rates are not due to gender, age, spending on other video game related purchases, or problem gambling symptoms. Individuals who purchased loot boxes appeared to also have higher risk of severe psychological distress irrespective of demographic characteristics or problem gambling status. Loot boxes appear to be associated with significantly higher risk of experiencing psychological harm even for players without problem gambling symptoms.