Collateral Damage: Assessing the Impact of Gambling Problems on the Health and Wellbeing of Concerned Significant Others

The adverse effects of gambling are of current public health concern. Gambling-related harm originates with the person who gambles and extends to those close to them. This thesis seeks to discern how and when gambling problems impact the health and wellbeing of concerned significant others (CSOs) of people who gamble. Although CSOs often report health and wellbeing decrements, these studies tend to be cross-sectional, use a limited range of health and wellbeing measures, and are often conducted with small and specific groups of CSOs. Consequently, our understanding of this issue includes considerable gaps that justify further exploration. 

This thesis conducted five studies to address these issues and examine the health and wellbeing of CSOs from distinct perspectives. The first two studies use large population- representative datasets to understand aspects of CSO health and wellbeing (adults, N=22,968; children, N=3,695). The third study explores health and wellbeing in CSOs exposed to different levels of gambling problem severity (N=13,698). Using longitudinal data spanning 18 years, the fourth research study examines CSO health and wellbeing prior to exposure to the gambling problem (N=13,661). The final study employs a novel measure of closeness (Significant Other Closeness Scale) to identify which CSOs are likely to be harmed. It examines the connection between gambling-related harm and CSO health and wellbeing outcomes based on the nature of the relationship with the person who gambles (N=1,131). 

The main findings in these studies reveal that financial wellbeing is impacted in virtually all CSOs, while other health and wellbeing decrements are more likely to be present when the gambling problem is severe. These impacts occur most commonly where there is a close familial or partner connection, sharing responsibilities and finances. The body of work as a whole identifies some factors that are more strongly or directly impacted by another person’s i gambling problems, such as CSOs experiencing psychological distress, negative emotions, and low financial and social wellbeing. Furthermore, this thesis identifies health and wellbeing decrements commonly experienced by CSOs, but found that some decrements are not necessarily a direct consequence of exposure to gambling problems. These include lower health-related quality of life, lower satisfaction with health and lower mental health functioning amongst CSOs. Although not directly caused by exposure to another person’s gambling problem, these conditions appear to be exacerbated by such exposure. The number of CSOs impacted by another’s gambling is estimated to range between one and six, depending on the severity of the gambling problems. Therefore, in terms of health and wellbeing, while the impact may not be as severe for CSOs, their numbers substantially exceed that of people with first-order gambling problems, suggesting that the overall societal burden may be more substantial. 

The results of these studies have implications for policymaking by bringing attention to and providing new and rigorous evidence for gambling harm to CSOs. This information can be used in designing and implementing public health policies to reduce the burden of gambling harm in the community. This thesis includes recommendations for support providers, including areas of focus and CSO groups to target. The proposals include providing CSOs with holistic support addressing their feelings of distress, bespoke financial assistance, increasing social support and providing guidance on supporting the person who gambles. Finally, the thesis describes several topics as valuable areas for future research focus. These include longitudinal research, continued use of the closeness scale, the need to focus on financial wellbeing, and a greater understanding of the relationship between social support and health and wellbeing in CSOs. Overall, the thesis sheds light on the significant impact of gambling problems on the health and wellbeing of CSOs, and areas that need addressing, to reduce the overall societal burden and increase the quality of life for this vulnerable group.