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      Giving room to subjectivity in understanding and assessing problem gambling: A patient-centered approach focused on quality of life

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          Background and aims

          Problem gambling is characterized by high stigma and self-stigma, making relevant measurement of the burden of the disorder complex. The aim of our qualitative study was to describe health-related quality of life (HRQOL) impacted by problem gambling from the patients’ perspective.


          We conducted 6 focus groups with 25 current or lifetime at-risk problem gamblers to identify key domains of quality of life impacted by problem gambling. A content analysis from the focus groups data was conducted using Alceste © software, using descendant hierarchical classification analysis, to obtain stable classes and the significant presences of reduced forms. The class of interest, detailing the core of impacted quality of life, was described using a cluster analysis.


          Thematic content analysis identified three stable classes. Class 1 contained the interviewers’ speech. Class 3 was composed of the vocabulary related to gambling practice, games and gambling venues (casino, horse betting, etc.). Class 2 described the core of impact of gambling on quality of life and corresponded to 43% of the analyzed elementary context units. This analysis revealed seven key domains of impact of problem gambling: loneliness, financial pressure, relationships deterioration, feeling of incomprehension, preoccupation with gambling, negative emotions, and avoidance of helping relationships.


          We identified, beyond objective damage, the subjective distress felt by problem gamblers over the course of the disorder and in the helping process, marked in particular by stigma and self-stigma. Four impacted HRQOL areas were new and gambling-specific: loneliness, feeling of incomprehension, avoidance of helping relationships, and preoccupation with gambling. These results support the relevance of developing, in a next step, a specific HRQOL scale in the context of gambling.

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          Most cited references 41

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            Deriving a preference-based single index from the UK SF-36 Health Survey.

            This article presents the results of a study to derive a preference-based single index from the SF-36. The study was an attempt to reconcile a profile health status measure, the SF-36, with the "quality adjusted life years" approach. The study undertook a parsimonious restructuring of the SF-36 using explicit criteria to form the SF-6D health state classification. A sample of multidimensional health states defined by this classification were valued by a convenience sample of health professionals, managers, and patients, who responded to a set of visual analogue scale ratings and standard gamble questions, with highly complete and consistent answers. Statistical models were estimated to predict single index scores for all 9000 health states defined by the new classification. The resultant algorithms can be applied to existing SF-36 data sets and used in the assessment of the cost-effectiveness of health technologies. This preliminary work forms the basis of a larger study currently being undertaken in the UK.
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              Recommendations for evaluating the validity of quality of life claims for labeling and promotion.

              The pharmaceutical industry, the medical device industry, and national regulatory agencies such as the United States Food and Drug Administration (FDA) are faced with a number of difficult issues related to the development and evaluation of health-related quality of life (HRQL) claims for product labeling and promotion. This paper outlines some of the unique challenges of HRQL research and makes recommendations for assuring that claims are based on the results of rigorous studies designed and conducted according to accepted scientific principles and practices. Standards of evidence for HRQL are discussed in terms of research design and methodology, instrumentation, statistical analysis, and interpretation. Examples are provided to highlight important points. The paper concludes with a brief discussion of future trends in HRQL outcomes evaluation.

                Author and article information

                J Behav Addict
                J Behav Addict
                Journal of Behavioral Addictions
                Akadémiai Kiadó (Budapest )
                20 January 2019
                March 2019
                : 8
                : 1
                : 103-113
                [1 ]CESP, UVSQ, INSERM, University Paris-Sud, Université Paris-Saclay , Villejuif, France
                [2 ]Inserm U894, Centre Psychiatrie et Neurosciences , Paris, France
                [3 ]AP-HP, Department of Psychiatry and Addictology, Hôpitaux Universitaires Paris Ouest , Paris, France
                [4 ]Sorbonne Paris Cité, Faculté de Médecine, Université Paris Descartes , Paris, France
                [5 ]Addictology and Psychiatry Department, CHU Nantes , Nantes, France
                [6 ]Université de Tours, Inserm U1246, Université de Nantes , Nantes, France
                [7 ]APHP, Hôpitaux Universitaires Paris-Sud , Villejuif, France
                [8 ]Faculté de Médecine Paris Sud, Université Paris XI , Paris, France
                Author notes
                [* ]Corresponding author: Nicolas A. Bonfils; Inserm U894, Centre Psychiatrie et Neurosciences, Issy-Les-Moulineaux, Paris 92130, France; Phone: +33 6 37 29 40 15; Fax: +33 1 71 19 63 72; E-mail: nicolas_bonfils@
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 52, Pages: 11
                Funding sources: None.
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