Gambling-harm in Affected Others

Executive Summary

• YouGov studies have provided the only evidence on prevalence of affected others in GB adults (7% in 2019, 6% in 2020)

• Harms in affected others, on a population level, are shifted towards the more harmful levels relative to the harms in gamblers

• Despite limited attention towards affected others in RET, on a population-level, harm in affected others is likely to account for a similar amount of harm than harm from own gambling

• Our conservative estimate illustrates that harm in adult affected others amounts to 0.94m years of healthy life lost annually (or 5.6% of all DALYs) (excludes harm in 19% of the population who are under 16)

• RET should look to rapidly accelerate efforts in addressing gambling-harm in affected others and specifically in children, who can be gamblers themselves and/or affected others, and are particularly vulnerable to severe and long-lasting harms

Background

• According to a Gambling Commission briefing paper for Local Authorities and local Public Health providers: "The numbers of those who experience harm as a result of gambling by others will be considerably greater than the number of people who harm themselves"

• Despite the mixed and extremely limited evidence on prevalence and the lack of disability weight studies in the UK population, we seek to clearly illustrate the significance of harm in affected others on a population-level in GB

• We present a conservative analysis to in-part quantify the total cost of healthy life (DALYs), in affected others of gambling-harm, by measuring years of life lost due to Disability (YLD)

Methods

• A disability weight is a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (equivalent to death)

• Years Lost due to Disability (YLD) are calculated by multiplying the prevalence and disability weights

Results

Disability Weights in Affected Others

A disability weight study in New Zealand (2018) grouped harm statements from affected others (n=223) and own gambling (n=329) for evaluation by general population and experts

• Disability weights for affected others and for own gambling in NZ were reported together

In Australia (2017), the harm in affected others (n=247) was reported as similar in severity to harm in gamblers (n=551), though slightly higher:

• at low-risk (DW=.17 versus .13)

• and moderate-risk levels (.33 versus .29)

• at the problem gambler level, disability weights for affected others were estimated significantly lower than those for the gambler (.36 versus .44)

Prevalence of gambling-harm in Affected Others

YouGov Covid-19 report by GambleAware, of a nationally representative GB population, reflected a self-reported affected others prevalence among adults of 7% in Oct 2019 (n=12,161) and 6% in May 2020 (n=9,067).

• Clear description of how prevalence was measured is absent in this report. However, we inferred a two-question process of 1) know someone who has had a problem with gambling either currently or in their past, 2) feel they have personally experienced negative effects as a result of person's gambling behaviour in the past 12 months

• YouGov studies primarily reported on gamblers and found significantly higher prevalence of gambling-harm due to own gambling of 13% and 12% in 2019 and 2020, respectively

• Utility of these results are limited by the lack of questions affecting sensitivity and ability to indicate the severity of harms experienced

Ratios from a single study in Australia, indicate that there are an average of 6, 3, and 1, affected others for problem-gamblers, moderate-risk harm gamblers, low-risk harm gamblers, respectively:

(Distribution of gambling-harm prevalence used from BGPS 2010 on a 2020 GB population estimate):

• 7.2% of the population suffer problem-gambling harm as affected others (39.8%, 3, 860, 000)

• 5.4% of the population suffer moderate-risk gambling harm as affected others (29.9%, 2, 900, 000)

• 5.5% of the population suffer low-risk gambling-harm as affected others (30.4%, 2, 950, 000 individuals)

• Caution should be taken with these estimates as we expect overlap with individuals being affected by multiple gamblers and/or affected others being gamblers themselves

To illustrate harms more clearly, we applied the prevalence of 6% of affected others to the distribution of prevalence across the levels of harm above:

• 2.4% of adults suffer problem-gambler harm as affected others (1, 290, 000 individuals)

• 1.8% of adults suffer moderate-risk harm as affected others (965, 000 individuals)

• 1.8% of adults suffer low-risk harm as affected others (965, 000 individuals)

• A total of 3.2m adult affected others who suffer significant gambling--harm due to another person's gambling in the past 12 months

Loss of healthy life in 3.2m adult affected others (YLD)

• 0.47 million years (DW of 0.36 and 1.29m adults)

• 0.32 million years (DW of 0.27 and 0.97m adults)

• 0.15 million years (DW of 0.15 and 0.97m adults)

• A total of 0.94 million years of healthy life are lost due to gambling-related disability in adult affected others

Context around DALYs in England 2013

• Dietary risks: 1.47m (10.8%)

• Tobacco smoke: 1.46m (10.7%)

• Gambling-harm in adult affected others: 0.77m (5.6%)

(Estimated from gambling-harm in Great Britain 2020: 0.94m, England 2013 population: 53.9m, Great Britain 2020 population: 66.1m)

• Alcohol use: 0.55m (4.0%)

• Drug use: 0.27m (2.0%)

Limitations

Harms that are not measured in this estimate

YLD = years of healthy life lost due to disability

YLL = year of healthy life lost due to mortality

• YLD & YLL in young people who are affected others

• YLD & YLL in affected others who are not aware the cause of harm is gambling

• YLL in affected others

Other limitations

• 0.94m results from a conservative estimate of prevalence and the lowest possible DW of 0.36 in PG-harm affected others

• YouGov studies reported significantly higher prevalence rates of own gambling-harm (13% and 12%) than as in affected others (7% and 6%) contrary to Gambling Commission guidance

Conclusions

• To our knowledge, there have been only two attempts to measure prevalence of affected others in Great Britain, which were of adults at 7% and 6%, in 2019 and 2020, respectively

• At a prevalence of 6%, a total of 3.2m adult affected others suffered significant gambling--harm due to another person's gambling in the past 12 months

• Harms in affected others are likely to be shifted towards the more harmful levels of gambling-harm

• Our analysis found that gambling-harm in 3.2m adult affected others caused the loss of 0.94m DALYs (or 5.6% of all DALYs) or years of healthy life lost per year in Great Britain

Appendix

Gambling-harm in Affected Others

A study from 2016 reported a taxonomy of gambling-harms in affected others in the same categories as the taxonomy of gambling-harm in gamblers:

• Financial harm

• Relationship Disruption

• Conflict or Breakdown

• Emotional or Psychological Distress

• Decrements to Health

• Cultural Harm

• Reduced Performance at Work or Study

• Criminal Activity

• Lifecourse and Intergenerational

A systematic review published in 2018 explored harms in affected others in themes of:

• Impact on Concerned Significant Other's (CSOs) (partners)

• Impact on the martial/couple dyad

• CSOs other than partners

• CSOs help-seeking behaviour