What is the harm? Applying a public health methodology to measure the impact of gambling problems and harm on quality of life.

Abstract

While the PGSI is indeed an established index of problem-gambling symptoms, it nevertheless does not quantify the degree of harm experienced by individuals at different points on the spectrum of gambling problems. The purpose of the present study was to establish the relationship between the PGSI category and health-related quality of life (HRQoL) decrements using a population health (PH) method. Harms reported by gamblers and affected others across the PGSI spectrums were transformed into 798 vignettes. A general population panel (N=786) and experts who work with gamblers (N=51) rated the impact of these vignette descriptions on quality of life using the Time Trade-Off task, and a Visual Analogue Scale incorporating 27 comparison conditions. Disability weights (DW) were then estimated for different levels of gambling symptoms. A DW of 0.44 was estimated for problem gamblers (PG), suggesting a reduction in the effective enjoyment of life by over 4 years for every 10 years in lifespan. Lower—but non-negligible—DWs of .14 and .29 were determined for low- and moderate-risk gamblers. Gambling is compared with a number of other conditions with respect to HRQoL impact. On average, PG harm appears to be similar to that of a manic episode of bipolar disorder and severe alcohol abuse disorder. We discuss advantages, and methodological challenges, in applying PH methods to measuring the severity of gambling problems in terms of HRQoL.Bien que l'indice du jeu excessif (PGSI) soit en effet un indice établi des symptômes liés aux problèmes de jeu, il ne quantifie pas le niveau de préjudice subi par les personnes situées à différents points sur le spectre des problèmes de jeu. Le but de l'étude a été d’établir la relation entre la catégorie PGSI et les écarts à la baisse en lien avec la qualité de vie liée à la santé (QVLS) en utilisant une méthode de santé de la population. Les torts signalés par les joueurs et les personnes touchées dans le spectre PGSI ont été transformés en 798 vignettes. Un groupe de population en général (N = 786) et des experts qui travaillent avec des joueurs compulsifs (N = 51) ont évalué l’incidence de ces descriptions de vignette sur la qualité de vie à l’aide de la tâche Time Trade-Off (marchandage de temps) et une échelle visuelle analogue intégrant 27 conditions de comparaison. Les poids d’incapacité (DW) ont ensuite été estimés pour différents niveaux de symptômes du jeu. Un DW de 0,44 a été estimé pour les joueurs compulsifs, ce qui laisse supposer une diminution de la jouissance réelle de la vie de plus de 4 ans pour chaque tranche de vie de 10 ans. Les DW inférieurs, mais non négligeables, de 0,14 et 0,29 ont été déterminés pour les joueurs à risque faible et modéré. Le jeu est comparé à un certain nombre d’autres conditions en ce qui concerne l’incidence de la qualité de vie liée à la santé (QVLS). En moyenne, le préjudice causé par un joueur compulsif s'apparente à celui d’un épisode maniaque de trouble bipolaire et d’un trouble sévère d’abus d’alcool. Nous discutons des avantages et des défis méthodologiques, en appliquant des méthodes de santé de la population pour mesurer la gravité des problèmes de jeu en termes de QVLS.

Prevalence of gambling-related harm provides evidence for the prevention paradox

“…In contrast, the PH approach emphasizes the distinction between risk factors – such as excessive gambling or psychological dependence and the sequelae – the negative consequences of such behaviors or conditions. Furthermore, the PH perspective encourages thinking about both gambling and negative consequences on a continuum, ranging from low/negligible to intense/severe, with progressively decreasing population prevalence toward the more severe end of the spectrum ( Browne, Rawat, et al., 2017 ; Li, Browne, Rawat, Langham, & Rockloff, 2016 ; Shaffer & Korn, 2002 ).…”

“…Browne, Rawat, et al. ( 2017 ) applied PH elicitation protocols to estimate the typical decrement to quality of life associated with each PGSI risk category. Adjusting for population prevalence, they found that at the population level, most harm (treated as a total decrement to quality of life) was attributable to lower risk categories.…”

“…( 2016 ) on 72 specific negative consequences of gambling confirms that they widely vary in terms of severity and prevalence. Browne, Rawat, et al’s ( 2017 ) approach to assessing population-level harm focused on a global decrement to health and well-being via PH “Burden of Disease” elicitation methods. However, it does not directly address the PP question, which is concerned with the relative prevalence of specific sequelae (e.g., credit card debt and depression) that arises from gambling ( Browne & Rockloff, 2017 ).…”

“…Alternatively, one can enumerate a plurality of harms, delineating a range of specific potential adverse consequences of excessive gambling involvement – ranging from relatively trivial to very severe. Analysis of prior survey data suggests that, although individuals vary considerably in the quality of harm (i.e., reporting differing profiles of specific harms), these specific consequences reflect an underlying continuum of varying degrees of overall harm ( Browne, Rawat, et al., 2017 ; Li et al., 2016 ). This can be measured with satisfactory accuracy using a dedicated short-form instrument ( Browne, Goodwin, & Rockloff, 2017 ).…”

The influence of marketing on the sports betting attitudes and consumption behaviours of young men: implications for harm reduction and prevention strategies

“…While academic research has traditionally focused on the harms associated with problem or pathological levels of gambling, research now suggests that gambling harm may also occur for those with low or moderate levels of gambling, with the burdens associated with gambling harms now comparable with those associated with alcohol misuse and major depression [3]. Each year, approximately 400,000 Australian adults experience gambling-related harm or are at moderate risk of experiencing harm [4].…”