Gambling-related harms to concerned significant others: A national Australian prevalence study

"It Was Never-Ending…": Investigating Gambling Harm Reported by Affected Others

Gambling-related harm can extend to family members, friends, and communities, however few population-representative studies explore affected other (AO) attributable harm measured with direct reference to gambling. Moreover, no study has employed the full 68-item Gambling Checklist for AOs to investigate harm according to the domains of harm outlined in a recent comprehensive harms taxonomy. Using data from a subsample of 197 AOs identified via a population-representative sample of 5000 respondents from the Fourth Social and Economic Impact Study of Gambling in Tasmania, this study employed a mixed-method design aiming to: (1) quantitatively estimate the rates of AO harms across each domain of harm; and (2) qualitatively analyse semi-structured interview data in a subset of 20 AOs to explore their lived experience of these harms. Overall, emotional/ psychological harm was the most commonly reported (90.36%, 95% CI: 85.32%, 93.79%), followed by relationship harm (75.63%, 95% CI: 69.10%, 81.17%), financial harm (60.91%, 95% CI: 53.87%, 67.53%), health harm (58.67%, 95% CI: 51.59%, 65.41%), work or study harm (32.63%, 95% CI: 26.29%, 39.68%), and other harm (19.17%, 95% CI: 14.18%, 25.40%). The qualitative narratives revealed the interconnected vulnerabilities experienced by AOs across the broad domains of harm. The findings emphasise the importance of targeted interventions, public health promotion, and comprehensive support services to address the diverse harms to AOs. Key areas for intervention include psychological and emotional support, financial guidance, and raising awareness to facilitate early detection of stress-related health conditions, with collaboration between services crucial for developing integrated support systems.

A qualitative investigation of the feasibility and acceptability of lower risk gambling guidelines

Effective and comprehensive harm reduction strategies to mitigate gambling-related harms are needed worldwide. The development of such strategies is however resource intensive. Using existing models in multiple contexts would thus be advisable. This study is part of a larger project investigating the feasibility and acceptability of the Canadian Lower Risk Gambling Guidelines (LRGG) within a Finnish cultural context. The Canadian guidelines recommend not gambling more than 1% of one's household income, not gambling more than 4 days per month, and to avoid regularly gambling at more than 2 types of gambling products.13 Focus group interviews were conducted (N = 37, 23 women, 14 men) across five subpopulations: individuals gambling at no-risk/low-risk levels, individuals with past experiences of problematic gambling, concerned significant others of those with gambling problems, professional gamblers, and social workers and health care professionals. The analysis utilised a deductive approach.While the subpopulations differed in their assessment of the LRGG in some regards, we were able to synthesise three concrete suggestions to adjust the Canadian LRGGs into the Finnish context. Participants proposed rephrasing the guidelines as follows: (1) Limit gambling to a fixed percentage of monthly personal income after taxes and other fixed expenses, (2) Restrict the number and duration of weekly gambling sessions, (3) Avoid regular participation in the most harmful forms of gambling, such as online casino games.Overall, the LRGG were considered as useful also in the Finnish context. However, our results suggest that some culturally specific rewording may be advisable. The main challenge in the implementation of the LRGG is that respondents across groups considered the guidelines to be aimed at someone else. Implementation therefore requires clear communication that these guidelines are for all individuals who gamble, not only those experiencing problems.

Affected Other Prevalence and Profiles: Findings from a Cross-Sectional Australian Population-Representative Gambling Study

Gambling-related harm can extend to family members and friends but few population-representative studies have investigated affected other (AO) prevalence estimates and profiles in the general population. Using data from the 5000 adult respondents in the Fourth Social and Economic Impact Study of Gambling in Tasmania, this study aimed to: (1) identify prevalence estimates of AO status and professional help-seeking; (2) establish the socio-demographic and gambling profiles of AOs; (3) extend the growing literature examining negative mental health characteristics experienced by AOs, after accounting for socio-demographic characteristics and other potential sources of harm; and (4) explore the degree to which gender moderates these relationships. Results found that 1 in 20 adults (5.11%, 95% CI: 4.33, 6.01) reported past-year AO status but only 1 in 7 AOs (14.15%, 95% CI: 9.01, 21.52) had ever sought help in relation to another person's gambling (i.e., < 1% of all adults). AOs were significantly more likely than non-AOs to be younger, Australian-born, employed, and living in households with children. They were significantly more likely than non-AOs to report depression symptoms, anxiety symptoms, binge drinking, tobacco use, and drug use, even after controlling for socio-demographics and other potential sources of harm. Finally, they were more likely to report their own gambling participation, problems, and harm but only 2.20% (95% CI: 0.69, 6.78) had ever sought help for their own gambling. These findings suggest that a considerable proportion of AOs in the general population may benefit from support to improve their own mental health and address their own gambling harm.

National burden of gambling in Japan: an estimation from an online-based cross-sectional investigation and national epidemiological survey

BACKGROUND

Gambling is a popular leisure activity in many countries, often expected to boost regional economies. Nevertheless, its negative impacts remain a significant concern. Gambling disorder is recognized as the most severe consequence; however, even non- or low-risk gamblers may also face negative impacts. This study aimed to estimate the number of Japanese gamblers experiencing gambling-related harm (GRH) and its distribution across six life domains, financial, relational, emotional, health, social and other aspects, based on the severity of their problem gambling risk.

METHODS

This cross-sectional study relied on an online survey conducted between August 5 and 11, 2020. Participants aged 20 years and above, who engaged in gambling during 2019 were recruited via a market research company. The survey assessed the prevalence of GRH 72 items among four gambler risk groups (non-problem, low-, moderate-, and high-risk), as categorized by the Problem Gambling Severity Index. The data was adjusted for population weighting using representative national survey data: the 2017 Comprehensive Survey of Living Conditions and the 2017 Epidemiological Survey on Gambling Addictions.

RESULTS

Out of the 28,016 individuals invited to the survey, 6,124 participated in the screening, 3,113 in the main survey, and 3,063 provided valid responses. After adjusting the survey data, it was estimated that 39.0 million (30.8%) of Japan's 126.8 million citizens gambled in 2019. Among them, 4.44 million (11.4%) experienced financial harm, 2.70 million (6.9%) health harm, 2.54 million (6.5%) emotional harm, 1.31 million (3.4%) work/study harm, 1.28 million (3.3%) relationship harm, and 0.46 million (1.2%) other harm. Although high-risk gamblers experienced severe harm at the individual level, over 60% of gamblers who experienced GRHs were non- and low-risk gamblers, with the exception of other harm, at the population level.

CONCLUSIONS

The study highlighted the prevention paradox of gambling in Japan. While national gambling policies primarily focus on the prevention and intervention for high-risk gamblers, a more effective approach would involve minimizing GRH across the entire population.

Harm-to-self from gambling: A national study of Australian adults

Aims

Understanding how gambling harm is distributed is essential to inform effective harm reduction measures. This first national Australian study of gambling harm-to-self examined the extent, distribution, risk factors, and health related quality of life (HRQoL) impacts of this harm.

Methods

A Random Digit Dialling sample of 15,000 Australian adults was weighted to key population variables. Key measures included the Gambling Harms Scale-10 (GHS-10), PGSI, SF-6D, gambling behaviours, and demographics. Analyses included ordinal logistic regression.

Results

Amongst gamblers, 14.7% reported harm on the GHS-10, including 1.9% reporting high-level harm. While high-level harm occurred mainly in the problem gambling group (77.3%), other PGSI groups accounted for most of the more prevalent low (98.5%) and moderate (87.2%) harms reported. Proximal predictors of greater harm were use of online gambling and more frequent gambling on electronic gaming machines (EGMs), race betting sports betting, poker, skin gambling, scratchies, and loot box purchasing. Distal predictors were being younger, male, single, Aboriginal or Torres Strait Islander, and speaking a non-English language at home. At the population level, the greatest aggregate HRQoL impacts were amongst lower-risk gamblers, confirming the results of other studies regarding the 'prevention paradox'.

Conclusions

The distribution of harm across gambler risk groups indicates the need for preventive measures, not just interventions for problem gambling. Reducing harm requires modifying product features that amplify their risk, especially for EGMs, race betting and sports betting that are both inherently risky and widely used. Gambling harm exacerbates health disparities for disadvantaged and vulnerable groups, requiring targeted resources and support.

How gambling harms others: The influence of relationship-type and closeness on harm, health, and wellbeing

Background and aims

Concerned significant others (CSOs) can experience gambling-related harm, impacting their health and wellbeing. However, this harm varies depending on the type and closeness of the relationship with the person who gambles. We sought to determine the type and closeness of relationships that are more likely to experience harm from another person's gambling, and examine which aspects of health and wellbeing are related to this harm.

Methods

We examined survey data from 1,131 Australian adults who identified as being close to someone experiencing a gambling problem. The survey included information on relationship closeness, gambling-related harm (GHS-20-AO), and a broad range of health and wellbeing measures; including the Personal Wellbeing Index (PWI), the 12-item Short Form Survey (SF-12), and the Positive and Negative Affect Schedule Short Form (PANAS-SF).

Results

CSOs in relationships where finances and responsibilities are shared were more likely to be harmed by another person's gambling problem, particularly partners (current and ex) and family members. This harm was most strongly associated with high levels of distress and negative emotions, impacting the CSO's ability to function properly at work or perform other responsibilities.

Discussion and Conclusions

Support and treatment services for CSOs should consider addressing the psychological distress and negative emotions commonly experienced by CSOs.

Validation of the 7-Item Domain-General Gambling Harm Scale (DGHS-7)

Introduction

Gambling can cause negative consequences affecting finances, work/study, physical and mental health, relationships, law abidingness, and the community. Although existing measures enable investigations of gambling harms, there is still a need for a brief measure covering the full range of gambling related harms.

Methods

We validated a 7-item domain-general harm scale (DGHS-7) using data from a cross-sectional survey of United Kingdom residents reporting gambling within the last 12 months (n = 2558, 62.4% women, mean age 40.1 years (SD = 12.5)). The DGHS-7 was investigated in terms of factor structure, measurement invariance, and convergent validity with a comprehensive 72-item checklist of gambling harm, the Short Gambling Harms Screen (SGHS), and the Problem Gambling Severity Index (PGSI). Discriminative validity was checked against the Personal Wellbeing Index (PWI). Internal consistency was also calculated.

Results

Confirmatory factor analysis supported a one-factor solution (χ² = 136.991, df = 14, χ²/df = 9.785, p <.001, CFI = 0.999, RMSEA = 0.059, 90% CI [0.050, 0.068]). Measurement invariance was supported for gender and binary categorization of age and income (ΔCFI = 0.001). The DGHS-7 correlated strongly with the 72-item checklist (r_s = 0.824), the SGHS (r_s = 0.793), the PGSI (r_s = 0.768), and moderately with the PWI (r_s = -0.303). Cronbach's alpha = 0.91 and ordinal alpha = 0.96 indicated good internal consistency.

Conclusions

Psychometric support was found for a brief measure covering all recognized domains of gambling harm. The DGHS-7 is useful for researchers needing a generic and short measure for epidemiological and other studies calling for short scales.

Trajectories of wellbeing in people who live with gamblers experiencing a gambling problem: An 18-year longitudinal analysis of the Household, Income and Labour Dynamics in Australia (HILDA) survey

In cross-sectional gambling studies, friends, family, and others close to those experiencing gambling problems (concerned significant others 'CSOs') tend to report detriments to their quality of life. To date, however, there have been no large, population-based longitudinal studies examining the health and wellbeing of CSOs. We analyse longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey to examine the 18-year trajectories of general, social, health and financial wellbeing of household CSOs (n = 477) and compare these to those without a gambling problem in the household (n = 13,661). CSOs reported significantly worse long-term wellbeing than non-CSOs in their satisfaction with life, number of life stressors, and social, health and financial wellbeing. However, both social and financial wellbeing showed a temporal effect, declining significantly for CSOs at times closer to the exposure to the gambling problem. This finding suggests a causal link between living in a household with a person with a gambling problem and decreased CSO social and financial wellbeing. Policy responses, such as additional social and financial support, could be considered to assist CSOs impacted by another person's gambling problem.

Legacy Gambling Harms: What Happens Once the Gambling Stops?

Purpose of Review

Legacy gambling harm refers to adverse consequences that extend past the period where people are actively gambling at harmful levels. These harms can affect the gambler, people close to them and the wider community. This article reviews current research that investigates legacy harms; the types of legacy harm, how long they last and whether evidence suggests these harms are real or instead imagined injuries or reflections on past regrets.

Recent Findings

Legacy harms to individuals can be broadly categorised as including financial, relationship, emotional/psychological, health, culture, work/study and criminal/deviance harms. In addition, legacy harms affect entire communities by drawing funds and social capital away from vulnerable communities, leaving them socially, culturally and materially impoverished. Most legacy harms that accrue to gamblers have a half-life of 4 years, although financial harms last somewhat longer at 5 years. Greater distance in time from a past gambling issue is reliably and positively related to health and well-being indicators, including the Health Utility Index and the Australian Unity Wellbeing Index, which suggests that legacy gambling harms are real and have a lasting impact on well-being, rather than just imagined hardship from prior gambling difficulties.

Summary

These findings suggest programme and policy development to support gamblers in reducing and managing their legacy harms, rather than focusing only on relapse prevention.