It is well known that many problem gamblers also suffer from other psychiatric conditions. However, knowledge regarding the temporal sequencing of the conditions is lacking, as well as insight in possible gender specific patterns. The aim of this study was to examine the risk for psychiatric comorbidity among problem gamblers compared to non-problem gamblers in the general Swedish population, as well as the age of onset and the temporal sequencing of problem gambling and the comorbid psychiatric conditions among lifetime problem gamblers. A case–control study nested in the Swelogs cohort was used. For both the female and the male problem gamblers, the risk for having had a lifetime psychiatric condition was double or more than double compared to the controls. Having experienced anxiety or depression before gambling onset, constituted a risk for developing problem gambling for the women but not for the men. Further, the female cases initiated gambling after their first period of anxiety, depression and problems with substances, and problem gambling was the last condition to evolve. Opposite this, the male cases initiated gambling before any condition evolved, and depression and suicidal events emerged after problem gambling onset. There were large differences in mean age of onset between the female cases and their controls, this was not the case for the males. Gender specific patterns in the association between problem gambling and psychiatric comorbidity, as well as in the development of problem gambling needs to be considered in treatment planning as well as by the industry in their advertising.

The association between problem gambling and suicidal behaviours is well established in treatment seeking populations, but less explored among sub-clinical problem gamblers in the general population. The aim of this study was to examine the association between problem gambling (including moderate risk gambling) and suicidal ideations/suicide attempts, in the general Swedish population. Another aim was to compare problem gamblers with and without suicide ideation/attempts. A case-control study nested in the Swelogs cohort was used. Both ideations and attempts were about twice as frequent among the cases compared to the controls. After controlling for socio-economic status and life-time mental health problems, suicidal ideation, but not attempts, remained significantly higher among the cases compared to the controls. The largest difference between attempters and non-attempters were on payment defaults and illicit drug abuse, whereas depression yielded the largest difference between ideators and non-ideators. Problem gambling severity (PGSI 8+) resulted in the smallest difference, compared to the other variables, between attempters and non-attempters. Even though no conclusion regarding the casual relationship can be drawn in this type of study, it seems like sub-clinical levels of problem gambling might have an impact on suicidal ideations whereas for suicide attempts to occur, other factors need to be present. In addition to mental health issues, financial difficulties may be such factors.

Background: Research on the identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. However, a single instrument measuring gambling behavior, severity, and specific deleterious effects is lacking. Objective: This protocol describes the development of the Gambling Disorder Identification Test (G-DIT), which is a 9- to 12-item multiple-choice scale with three domains: gambling consumption, symptom severity, and negative consequences. The scale is analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Methods: The G-DIT is developed in four steps: (1) identification of items eligible for the G-DIT from a pool of existing gambling measures; (2) presentation of items proposed for evaluation by invited expert researchers through an online Delphi process and subsequent consensus meetings; (3) pilot testing of a draft of the 9- to 12-item version in a small group of participants with problem gambling behavior (n=12); and (4) evaluation of the psychometric properties of the final G-DIT measure in relation to the existing instruments and self-reported criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), among individuals with problem gambling and nonproblematic recreational gambling behaviors (n=600). This protocol article summarizes step 1 and describes steps 2 and 3 in detail. Results: As of October 2018, steps 1-3 are complete, and step 4 is underway. Conclusions: Implementation of this online Delphi study early in the psychometric development process will contribute to the face and construct validity of the G-DIT. We believe the G-DIT will be useful as a standard outcome measure in the field of problem gambling research and serve as a problem-identification tool in clinical settings. International Registered Report Identifier (IRRID): RR1-10.2196/12006

Background: Gambling is not uncommon among adolescents, and a non-trivial minority has serious problems with gambling. Therefore, enhanced knowledge about factors that may prevent against problematic gambling among youth is needed. Prior research has shown that a strong school ethos, which can be defined as a set of attitudes and values pervading at a school, is associated with a lower inclination among students to engage in various risk behaviours. Knowledge about the link between school ethos and adolescent gambling is however scarce. The aim of the study was to investigate the association between teacher-rated school ethos and student-reported gambling and risk gambling, when controlling also for sociodemographic characteristics at the student- and the school-level. Methods: Data from two separate cross-sectional surveys were combined. The Stockholm School Survey (SSS) was performed among 5123 students (aged 17–18 years) in 46 upper secondary schools, and the Stockholm Teacher Survey (STS) was carried out among 1061 teachers in the same schools. School ethos was measured by an index based on teachers’ ratings of 12 items in the STS. Adolescent gambling and risk gambling were based on a set of single items in the SSS. Sociodemographic characteristics at the student-level were measured by student-reported information from the SSS. Information on sociodemographic characteristics at the school-level was retrieved from administrative registers. The statistical method was multilevel regression analysis. Two-level binary logistic regression models were performed. Results: The analyses showed that higher teacher ratings of the school’s ethos were associated with a lower likelihood of gambling and risk gambling among students, when adjusting also for student- and school-level sociodemographic characteristics. Conclusions: This study showed that school ethos was inversely associated with students’ inclination to engage in gambling and in risk gambling. In more general terms, the study provides evidence that schools’ values and norms as reflected by the teachers’ ratings of their school’s ethos have the potential to counteract unwanted behaviours among the students.