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

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.