Contrasting Effects of Gambling Consumption and Gambling Problems on Subjective Wellbeing

The Effect of Inequality and Prosperity on the European Market for Gambling Machines: A Socioeconomic Panel Analysis

This study examines the potential influence of prosperity and inequality on gambling participation in Europe. We combined data from the Eurostat database, the Global Wealth Report, and the European Casino Association and estimated fixed effects panel regression models. We show that income inequality has a negative effect on the number of gambling machines that flattens for high values, while wealth inequality has a linear negative effect. Moreover, an increase in the disposable income of the lower quintiles leads to significant increases in the number of gambling machines per country. These findings are important for future researchers who relate any kind of economic variable to gambling as well as for policy makers, as our results suggest that the lower-income groups should be given the most attention with regards to gambling regulation.

How gambling problems relate to health and wellbeing in Australian households: Evidence from the Household Income and Labour Dynamics of Australia Survey

Gambling harms can impact the health and wellbeing of both individuals who gamble and those close to them. While harms occur across a spectrum of gambling risk levels, most research is conducted on people close to those gamblers who have severe problems. This study examined the health and wellbeing of people living with gamblers across the entire spectrum of gambling risk levels, via secondary analysis of the nationally-representative Household Income and Labour Dynamics in Australia Survey (HILDA). The subsample of interest comprised 13,698 respondents without a gambling problem of their own, aged between 15 and 84, and who lived in households where all residents completed the Problem Gambling Severity Index (PGSI). Health and wellbeing were measured via the SF-6D, the SF-36, and subjective wellbeing measures. Compared to those living in non-problem gambling households, participants living in problem-gambling households reported significantly lower mean SF-6D scores, lower scores on the SF-36 mental health domain, and significantly less satisfaction with both their financial situation and with feeling part of their local community. Participants living in moderate-risk gambling households also reported less satisfaction with their financial situation than those in non-problem gambling households. Conclusions: The results indicate that measurable impacts to the health and wellbeing of those living with gamblers occur predominantly at the more severe end of the risk level spectrum, except for financial dissatisfaction, which is also evident in those residing with gamblers categorised as moderate-risk.

Validating the short gambling harm screen against external benchmarks

BACKGROUND AND AIMS

The Short Gambling Harm Screen (SGHS) is currently the most frequently applied dedicated measure of gambling-related harm (GRH), though concerns relating to scale validity have been expressed. The current study aimed to address criticisms that several SGHS items do not depict genuine harms that may occur as a result of gambling, causing the scale to overestimate harm. Specifically, we aimed to test convergence between the SGHS and its constituent items with: (1) wellbeing, and (2) psychological distress.

METHODS

To test criterion validity of both the scale and the items, retrospective analyses of survey data from 2,704 Australian adults (36% non-gamblers; 64% gamblers) were conducted. Subjective wellbeing and psychological distress scores, captured using the Personal Wellbeing Index (PWI) and the Kessler-6 Psychological Distress Scale (K6), respectively, were used as external (non-gambling) benchmarks. A total of 428 (16%) respondents scored at least 1 on the SGHS.

RESULTS

Monotonic decreases and increases, corresponding to poorer personal wellbeing and higher psychological distress, were found with each additional SGHS score increase. Gamblers endorsing a single SGHS item reported lower wellbeing and higher psychological distress than both non-gamblers and gamblers who scored zero on the SGHS.

DISCUSSION AND CONCLUSION

These results show that the SGHS is a valid measure of GRH and contradict suggestions that low scores on the SGHS do not indicate true harm. The SGHS represents a valid and innovative short screening tool to measure GRH in population prevalence studies.

Legacy gambling harms: What are they and how long do they last?

BACKGROUND AND AIMS

Legacy gambling harms are negative consequences of gambling that extend past periods of low risk, moderate risk and problem gambling. Gambling harm is typically measured within a 12-month timeframe and is often restricted to examining harm amongst active gamblers. The present research aimed to explore whether people experienced gambling harms 12 months or more after the resolution of at-risk or problem gambling, and how long these legacy harms lasted.

METHODS

An online survey was conducted in New Zealand with past and current gamblers and concerned significant others (CSOs) of gamblers, N = 1,240 (50.8% female), that asked them about both past and current gambling harms.

RESULTS

A majority of both gamblers and CSOs of gamblers indicated that they still suffered from gambling harm even after most of their behavioural issues with gambling had been resolved, 12+ months ago. Legacy gambling harms reduced over time, with harms diminishing most quickly in the early years, and having an average half-life of 4 years. Harms involving community-relationships, church involvement, and domestic and other violence resolved more quickly than others.

DISCUSSION AND CONCLUSIONS

Legacy harms are common among ex-problem gamblers and should be considered in any full accounting of the impacts of gambling.

CONCLUSION

Understanding the time course and persistence of legacy harms from gambling can provide gamblers, treatment professionals and public health experts with insights into how to address gambling's long-term consequences.

Benchmarking gambling screens to health-state utility: the PGSI and the SGHS estimate similar levels of population gambling-harm

BACKGROUND

Both the Problem Gambling Severity Index (PGSI) and the Short Gambling Harms Screen (SGHS) purport to identify individuals harmed by gambling. However, there is dispute as to how much individuals are harmed, conditional on their scores from these instruments. We used an experienced utility framework to estimate the magnitude of implied impacts on health and wellbeing.

METHODS

We measured health utility using the Short Form Six-Dimension (SF-6D), and used this as a benchmark. All 2603 cases were propensity score weighted, to balance the affected group (i.e., SGHS 1+ or PGSI 1+ vs 0) with a reference group of gamblers with respect to risk factors for gambling harm. Weighted regression models estimated decrements to health utility scores attributable to gambling, whilst controlling for key comorbidities.

RESULTS

We found significant attributable decrements to health utility for all non-zero SGHS scores, as well as moderate-risk and problem gamblers, but not for PGSI low-risk gamblers. Applying these coefficients to population data, we find a similar total burden for both instruments, although the SGHS more specifically identified the subpopulation of harmed individuals. For both screens, outcomes on the SF-6D implies that about two-thirds of the 'burden of harm' is attributable to gamblers outside of the most severe categories.

CONCLUSIONS

Gambling screens have hitherto provided nominal category membership, it has been unclear whether moderate or 'at-risk' scores imply meaningful impact, and accordingly, population surveys have typically focused on problem gambling prevalence. These results quantify the health utility decrement for each category, allowing for tracking of the aggregate population impact based on all affected gamblers.

The effect of gambling problems on the subjective wellbeing of gamblers' family and friends: Evidence from large-scale population research in Australia and Canada

BACKGROUND AND AIMS

Excessive time and money spent on gambling can result in harms, not only to people experiencing a gambling problem but also to their close family and friends ("concerned significant others"; CSOs). The current study aimed to explore whether, and to what extent, CSOs experience decrements to their wellbeing due to another person's gambling.

METHODS

We analysed data from The Household Income and Labour Dynamics in Australia Survey (HILDA; N = 19,064) and the Canadian Quinte Longitudinal Study (QLS; N = 3,904). Participants either self-identified as CSOs (QLS) or were identified by living in a household with a person classified in the problem gambling category by the PGSI (HILDA). Subjective well-being was measured using the Personal Wellbeing Index and single-item questions on happiness and satisfaction with life.

RESULTS

CSOs reported lower subjective wellbeing than non-CSOs across both countries and on all three wellbeing measures. CSO status remained a significant predictor of lower wellbeing after controlling for demographic and socio-economic factors, and own-gambling problems. There were no significant differences across various relationships to the gambler, by gender, or between household and non-household CSOs.

DISCUSSION AND CONCLUSIONS

Gambling-related harms experienced by CSOs was reliably associated with a decrease in wellbeing. This decrement to CSO's wellbeing was not as strong as that experienced by the person with the first-order gambling problem. Nevertheless, wellbeing decrements to CSOs are not limited to those living with a person with gambling problems in the household and thus affect many people.

The Evolution of Gambling-Related Harm Measurement: Lessons from the Last Decade

Jurisdictions around the world have a self-declared mandate to reduce gambling-related harm. However, historically, this concept has suffered from poor conceptualisation and operationalisation. However, recent years have seen swift advances in measuring gambling harm, based on the principle of it being a quantifiable decrement to the health and wellbeing of the gambler and those connected to them. This review takes stock of the background and recent developments in harm assessment and summarises recent research that has validated and applied the Short Gambling Harms Screen and related instruments. We recommend that future work builds upon the considerable psychometric evidence accumulated for the feasibility of direct elicitation of harmful consequences. We also advocate for grounding harms measures with respect to scalar changes to public health utility metrics. Such an approach will avoid misleading pseudo-clinical categorisations, provide accurate population-level summaries of where the burden of harm is carried, and serve to integrate gambling research with the broader field of public health.

Gambling activity in the old-age general population

Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.

A framework for indirect elicitation of the public health impact of gambling problems

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

Positive play and its relationship with gambling harms and benefits

BACKGROUND

Engagement in responsible or 'positive play' strategies is known to be negatively associated with problem gambling, as indexed by measures such as the Problem Gambling Severity Index (PGSI). Less is known about whether positive play is associated with reduced harm or a greater ability to enjoy the recreational benefits of gambling.

AIMS

This study investigated the relationship between positive play and gambling harm after controlling for PGSI scores and whether positive play moderated the relationship between PGSI scores and harm. It also examined whether positive play was related to perceived benefits associated with gambling.

METHODS

The study utilised an online panel sample of 554 respondents who completed a survey that included the PGSI, measures of gambling harm drawn from Browne et al. (2016), and the newly developed Positive Play Scale (Wood et al., 2019). The study involved predominantly monthly gamblers with higher levels of gambling risk: 23% problem gamblers; 36% moderate risk; and 21% low risk gamblers.

RESULTS

The results indicated that positive play was negatively associated with reduced gambling harm. The behavioural Positive Play subscales relating to pre-commitment and honesty and control explained additional variation in harm after controlling for PGSI scores. Higher levels of positive play also moderated and reduced the relationship between the PGSI and gambling harm. Perceived benefits were, unexpectedly, found to be higher in problem gamblers and negatively related to positive play.

CONCLUSION

Behavioural measures of positive play appear to be useful moderating factors in understanding the relationship between problem gambling and harm. Higher-risk gamblers appear to experience both greater costs as well as benefits from gambling, which likely reflects a stronger personal need to engage in the activity.