Frameworks of gambling harms: a comparative review and synthesis

Abstract Background A public health approach to gambling has been accompanied by a wide understanding of gambling harms. This has led to the creation of conceptual frameworks to understand and itemize different gambling-related harms, dimensions of harms, and subjects of harms. The current paper presents a comparative review and synthesis of existing harm frameworks. Method Following the PRISMA guidelines, we conducted a systematic literature review on existing harm frameworks in five scientific databases across the years 2000–2021. We included studies that aimed at creating a conceptual framework or synthesis of different level gambling harms at a population level. The final sample consists of seven papers that present four different models. Results Gambling-related harms span health, psychological, relationship, financial, cultural, work, and crime-related issues. Harms accrue to individuals (heavy gamblers, non-problem gamblers and nongamblers), but also to families, communities, and societies. Harms form a spectrum in terms of severity and temporality. Risk factors or determinants of gambling are often similar to the harmful consequences of gambling. Conclusions The results are discussed in terms of gaps in current understanding of gambling harms, including increased communication between models, increased focus on severity levels and issues of causality, and a better incorporation of harms that stem from gambling provision rather than harmful gambling consumption. We conclude that framing harms as consequences of individual behavior remains predominant, and a shift of focus to the social and commercial determinants of gambling harms is needed. This also includes the development of societal level harm screening.