The risk and development of work disability among individuals with gambling disorder: a longitudinal case-cohort study in Sweden

BACKGROUND

This longitudinal register study aimed to investigate the association between gambling disorder (GD) and work disability and to map work disability in subgroups of individuals with GD, three years before and three years after diagnosis.

METHODS

We included individuals aged 19-62 with GD between 2005 and 2018 (n = 2830; 71.1% men, mean age: 35.1) and a matched comparison cohort (n = 28 300). Work disability was operationalized as the aggregated net days of sickness absence and disability pension. Generalized estimating equation models were used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the risk of long-term work disability (>90 days of work disability/year). Secondly, we conducted Group-based Trajectory Models on days of work disability.

RESULTS

Individuals with GD showed a four-year increased risk of long-term work disability compared to the matched cohort, peaking at the time of diagnosis (AOR = 1.89; CI 1.67-2.13). Four trajectory groups of work disability days were identified: constant low (60.3%, 5.6-11.2 days), low and increasing (11.4%, 11.8-152.5 days), medium-high and decreasing (11.1%, 65.1-110 days), and constant high (17.1%, 264-331 days). Individuals who were females, older, with prior psychiatric diagnosis, and had been dispensed a psychotropic medication, particularly antidepressants, were more likely to be assigned to groups other than the constant low.

CONCLUSION

Individuals with GD have an increased risk of work disability which may add financial and social pressure and is an additional incentive for earlier detection and prevention of GD.

Gambling in Ireland: profile of treatment episodes from a national treatment reporting system

OBJECTIVES

Globally, problem gambling prevalence is estimated at between 0.1% and 5.8%. Problem gambling can have many negative consequences; including on physical, and psychological health, and social functioning. There is a need to better understand treatment uptake as only a small proportion seek treatment. This is the first Irish national study using routinely gathered health surveillance data to describe treated problem gambling. Results will inform service policy and planning.

METHODS

An analysis of episodes treated for problem gambling collected by the National Drug Treatment Reporting System was undertaken. Included were episodes entering treatment between 2008 and 2019 (n = 2999). Variables of interest included service types accessed, demographics, socioeconomic information, referral and assessment details, current problems (up to five) and treatment history.

RESULTS

The majority (93.8%) were male. One fifth (20.9%) lived with dependent children, 7.4% were homeless. There were high levels of employment (35.4%) and formal education qualifications; half (53.8%) had completed second or third level education. Problem gambling frequently co-occurred with problem use of other substances (47.3%), which was most commonly alcohol (85.6%), followed by cannabis (32.3%), cocaine (28.0%) and benzodiazepines (10.9%). The majority were treated at inpatient settings (56.1%) with many self-referrals (46.3%).

CONCLUSIONS

This study provides insights into treated problem gambling nationally. Monitoring and surveillance can play a crucial role in measuring the successful efforts and help inform planning and treatment. The findings may have implications for treatment pathways.

Gambling-Related Harms for Affected Others: A Finnish Population-Based Survey

Aims This study explores the prevalence of being a past-year affected other (AO) of a problem gambler by gender. The aims were to study the amount and type of gambling-related harms (GRHs) for subgroups of AOs and to distinguish GRH profiles for AO subgroups. Methods A total of 7186 adults aged 18 years and over participated in the Gambling Harms Survey evaluating year 2016. The data were analyzed using descriptive statistics and binary logistic regression. Results Of all respondents, 12.9% were defined as past-year AOs (women 13.7%; men 12.1%). The proportion of affected non-family members (ANFs) was 8.4%, and 5.6% were affected family members (AFMs). AFMs were usually women, and ANFs were usually men. Emotional, relationship, and financial harms were the most common types of harm. The odds of experiencing financial harm were highest for the 18- to 34-year-olds (OR 1.82) and for those whose partner/ex-partner had a gambling problem (OR 3.91). Having a parent/step-parent (OR 1.93) and child/stepchild (OR 3.64) increased the odds of experiencing emotional harm, whereas male gender (OR 0.50) and being an ANF (OR 0.58) decreased emotional harm. Relationship harm was evident for partners/ex-partners (OR 1.97-5.07). Conclusions GRH profiles for AO subgroups varied, which emphasizes the need for effective harm minimization strategies for those in need.

Is there a health inequality in gambling related harms? A systematic review

Background

Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency.

Primary and secondary outcome measures

Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 4) not available as a full article.

Methods

We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.

Results

A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.

Conclusion

Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10337-3.

Gambling at Work: A Qualitative Study of Swedish Elite Athletes, Coaches, and Managers

Considering the financial connections between sport and the gambling industry, more should be learned about gambling and problem gambling in this setting. This study explores how male athletes, coaches, and sports managers experience gambling activities and problems in their sports. Interviews were conducted with 30 male elite athletes, coaches, and managers in four sports. The interviews were analysed using content analysis, and the results indicated two main themes: 1) desire for and concerns with money and 2) in the shadow of performance, and three categories. The first main theme emerged as a result of the respondents recurring reference to money as the reason to different actions: It is important to win money,’too little’ or ‘too much’ money is described as reason for gambling, athletes status is affected by money and sponsor money from the gambling companies are considered important. ‘In the shadow of the performance’ captures the reason to and value of performance: The thrill and money are rewards for the gambling performance, everyday sporting life emphasizes performance both in training and matches. Lack of successful performance is perceived as a threat and evokes a fear of being seen as weak and being ejected from the team. This study identifies gambling as normalized within male elite sport. Preventing gambling problems calls for action at all levels of the involved socio-ecological framework. Management, coaches, and athletes need more knowledge of gambling and how to create a sustainable framework to prevent gambling problems.

The societal costs of problem gambling in Sweden

BACKGROUND

Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings.

METHODS

A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data.

RESULTS

The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden.

CONCLUSIONS

Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Risk of problem gambling among occupational groups: A population and registry study

Aims:

To identify which occupational groups have elevated levels of regular gambling participation and at-risk and problem gambling, and to explore job-specific factors associated with elevated levels.

Methods:

Statistical analyses were performed on data from the 2015 Swedish population study on gambling and health. The principal registry variable was occupation, classified according to the Swedish version of the International Standard Classification of Occupations (ISCO-08). Two gambling variables were studied: regular gambling participation and at-risk and problem gambling, as measured by the Problem Gambling Severity Index (PGSI). For statistical regression analyses, socio-demographic data were used such as gender, income, and country of origin.

Results:

We found significant differences between occupational groups with regard to the two gambling variables. In general, manual jobs with predominantly male workers scored high, especially when there was no fixed workplace. Several significant differences remained when we controlled for gender. We also found support for three types of workers having elevated levels on the gambling variables: (1) building, construction and service, mobile, (2) vehicle drivers, and (3) monotonous manual indoor work. These results were confirmed by comparisons with propensity score matched controls.

Conclusion:

A policy implication of this study is that some occupational groups should be prioritised in the prevention of problem gambling. Theoretically, the study shows that occupational categories represent real-life cultures and contexts of gambling and non-gambling as distinct from the abstract socio-demographic factors that are usually considered in relation to gambling participation and problem gambling.

Participants' Experiences of a Workplace-Oriented Problem Gambling Prevention Program for Managers and HR Officers: A Qualitative Study

Workplace health promotion programs (WHPPs) refer to a set of health promotion and protection strategies implemented at a worksite and designed to meet the health and safety needs of employees. One important question for WHPPs is how middle management experience their participation in a WHPP. This study aims to explore this question further by applying a qualitative content analysis to interviews with thirteen managers and ten human resource officers participating in a WHPP focusing on problem gambling. The WHPP consisted of two components: policy implementation and skills-development training. The participants were interviewed about their experiences of these two components and the implementation process. The qualitative content analysis resulted in six themes: (1) Expectations of the skills-development training, (2) Experiences of and prior beliefs about problem gambling, (3) A good foundation, (4) The difficult conversation, (5) Appreciated aspects of the training sessions, and (6) Remaining obstacles. The results suggest that the presentation of cases, facts, and general knowledge was appreciated by most participants. However, participants also expressed that they would benefit from tailored interventions, more support in the policy implementation process, and following up on the results.

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation

Background

In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere.

Methods

Evaluation criteria, based on the programme’s official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff.

Results

Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common.

Conclusions

The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

Gambling-Related Employee Embezzlement: A Study of Swedish Newspaper Reports

It is well-known that severe problem gambling may lead to economic crime. This study explored a particular type of such criminality: embezzlement committed by problem gamblers in the workplace. The aim was to gain knowledge about the extent of such criminality in Sweden and the sums of money involved. The method used was a media study of newspaper reports, complemented with information about help-seeking problem gamblers obtained in interviews with therapists specializing in problem gambling and with peer counsellors in mutual support societies of problem gamblers. The results showed that gambling-related embezzlement occurs in all branches of the economy where employees have access to money. The sums embezzled can be huge and the crimes sustained over several years. However, this varies across professional categories, with bank managers embezzling larger sums of money than others, and for longer, before being detected. Although Swedish newspapers report on average about one case a month of gambling-related employee embezzlement, the true prevalence is likely to be at least 10 times higher. More efforts should be made to prevent embezzlement and other gambling-related harms in the workplace.On sait que le jeu problématique grave peut mener à la criminalité économique. Cette étude porte sur un aspect particulier de ce type de criminalité, soit le détournement commis par des joueurs problématiques dans leur milieu de travail. Elle vise à établir l’étendue de cette criminalité en Suède et les sommes d’argent en cause. À cette fin, on a effectué une analyse média des articles de journaux ainsi que des renseignements sur les joueurs problématiques ayant demandé de l’aide recueillis dans des entrevues avec des thérapeutes spécialisés en jeu problématique et avec des pairs-conseillers de groupes de soutien pour les joueurs problématiques. Il a été constaté que le détournement lié au jeu problématique se produit dans tous les secteurs de l’économie où les employés ont accès à l’argent. Les sommes détournées peuvent être considérables et les crimes, se perpétrer sur plusieurs années. La situation varie toutefois selon la catégorie des professions, les directeurs de banque détournant des sommes plus élevées que les autres, et pendant de plus longues périodes, avant d’être découverts. Bien que les journaux suédois ne rapportent en moyenne qu’un cas de détournement par un employé joueur pathologique par mois, cette étude laisse entendre que la prévalence réelle est probablement dix fois plus élevée. Il est conclu que plus d’efforts doivent être faits pour prévenir le détournement et les autres dommages liés au jeu dans le milieu de travail.