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

Abstract

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.

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

“…Demographic characteristics identified as risk factors for gambling problems and harms [ 17 ] were considered for inclusion in the propensity model: gender, country of birth, personal and parent’s highest level of education achieved, selected work status flags (FT student, unemployed, being unable to work due to infirmity, labourer), marital status, household composition (e.g. single, couple with children), personal and household income, and metropolitan/regional/rural residential location.…”

“…However, in some sense, these results simply kick the can further down the road, begging the question of which external metrics are most relevant, and how decrements on these benchmarks should themselves be interpreted. Recently, a case has been made for the central role of health utility as the key yardstick for scoring gambling screens [ 17 ]. In that paper, an approach was outlined for employing global health utility instruments to assess gambling.…”

“…Thus, unlike other attempts to estimate health utility impacts from gambling screens [ 31 ], this framework includes both propensity and causal modelling components, and requires identification of relevant risk-factors and co-morbid conditions. We again refer the reader to Browne et al [ 17 ] for a more detailed overview and rationale for this framework as applied to gambling-related harm, as well as a review of relevant risk-factors and comorbidities for gambling problems.…”

Online 8-week cognitive therapy for problem gamblers: The moderating effects of depression symptoms and perceived financial control

“…This heterogeneity needs to be considered when developing and evaluating interventions ( Abbott et al, 2018 ). Emotional and psychological distress (e.g., depression) and financial loss are two main harmful strains for the gambler ( Browne et al, 2020 ; Langham et al, 2015 ; Salonen et al, 2018 ) and may significantly affect treatment outcomes. Losing money can fuel gambling through feelings of hopelessness and lowered motivation to quit, which negatively affect recovery ( Gavriel-Fried, 2018 ).…”

Perception of Gamblers: A Systematic Review

“…The concept of "gambling harm" summarises a wide spectrum of negative consequences such as financial problems, disruptions to work/study, damage to the health, emotional and/or psychological distress, deterioration in relationships, cultural harms and criminal activities (Browne et al 2016). Due to its potential negative effects on health and well-being, harmful gambling can be placed in the same category as smoking, problematic alcohol and recreational drug use (Browne et al 2020). 1 One negative consequence of gambling is stigmatisation.…”