Problem gambling among young women and men in Sweden

Sammanfattning: Gambling among young people is a significant public health concern. While an understanding of the aetiology of gambling problems is crucial for prevention, there is limited knowledge about the onset of and the risk factors for problem gambling among youth. This thesis aims to estimate the incidence of a first episode of problem gambling and to examine some potential risk factors for problem gambling among Swedish young women and men. In Study I, we analysed data among the 16 to 24 year-old study participants (n=19,016) in the cross-sectional Swedish National Public Health Survey in 2004 to 2007. In Study II and III, we used the first two waves of the Swedish Longitudinal Gambling Study (Swelogs), with the study participants being the 16 to 44 year-olds (n=4,364; Study II), and the 17 to 25 year-olds (n=2,241; Study III). In Study IV, we used a case-control study in 2011 nested in the Swelogs cohort, and analysed data among the 16 to 24 year-old cases and controls (n=1,116). The incidence of first episode problem gambling was higher among Swedish youth, aged 16 to 24 years, than among 25 to 44 year-olds, and three times higher among young men (3.3; 2.2-5.0%) than young women (1.1; 0.4-3.1%). Individual transitions in problem gambling in one year, from problem gambling to recovery, and from recovery to recurrent problem gambling, were common. Our findings suggest that the higher prevalence of problem gambling among Swedish youth compared to 25 to 44 year-olds is explained by a higher incidence of first episode problem gambling, and a lower proportion of recovery, among youth compared to 25 to 44 year-olds. It has been hypothesized that life stressors may lead to deviant behaviours among youth, and that affective disorders and adverse life events predispose people to problem gambling. We found that poor mental health was strongly associated with problem gambling for women, while high alcohol use and violence victimisation were associated with gambling and/or problem gambling for young men, in cross-sectional analyses. Further, lower compulsory school grades were associated with a higher risk of gambling problems up to eight years later for both sexes. However, an onset of affective disorders and child/youth maltreatment seemed to be risk factors for problem gambling only for females (in particular: anxiety disorders and emotional neglect). For males, these exposures seemed to occur simultaneously or after the gambling problem (in particular: depression and physical abuse). Our findings extend previous research about the aetiology of gambling problems. The incidence of a first episode of problem gambling among young people has not been estimated in a nationally representative sample before. Moreover, while research has established large sex differences in the prevalence of problem gambling among youth, very few studies of risk factors for youth problem gambling have examined the sexes separately. Our findings show that Swedish young men have an increased risk of problem gambling compared to Swedish young women overall, but that several of the examined risk factors were only associated with problem gambling among young women. It is possible that the path to problem gambling is, at least in part, different for young women and men.