Affected Others of Problem Gambling: Prevalence and Health Associations Across Relationship Types - A Population-Representative Swedish Study.

Gambling-related harm extends beyond the individual who gambles and affects others in their social environment, referred to as affected others (AO). This study examined the prevalence of AO by relationship type and socio-demographic characteristics, and assessed health outcomes across different AO categories in the general Swedish population. Data were drawn from the national survey Gambling and Health 2021, conducted by the Public Health Agency of Sweden. The sample comprised 7,343 respondents aged 16-84 years. Past year AO status was assessed for family members or close relatives, friends, and colleagues or fellow students. Health outcomes included indicators of mental, behavioural, and relational health. Associations were examined using adjusted logistic regression analyses. Overall, 11.1% of respondents reported that someone in their close social environment had experienced gambling problems at any point during the past 12 months, most commonly a friend (5.4%). AOs reported a higher prevalence of adverse mental, behavioural, and relational health outcomes than non-AOs. After adjustment, AO status remained associated with moderate mental distress across all relationship types, with additional associations observed for serious mental distress among family AOs. Behavioural outcomes remained elevated among family and friend AOs, including at-risk gambling and hazardous alcohol use. Relational outcomes showed the most consistent associations, including increased arguments across all AO categories, experiences of violence among friend AOs, and work-related conflicts, particularly among work/school AOs. The findings indicate that AOs constitute a substantial and heterogeneous group in the population and underscore the relevance of considering relationship type when addressing gambling-related harm.