Problem gambling among young women and men in Sweden

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

Gender and Responsible Gambling in Spain. The Social Gambling Questionnaire for Women (SGQW-47), a new screening instrument

Objective: The aim of this study is to develop a questionnaire to assess responsible gambling habits in females of the general population, to explore its psychometric properties and to compare the results between a community sample and a clinical sample of patients with gambling disorder. We also aim at providing empirical evidence of the gambling habits among Spanish females. Method: Two samples were selected to develop the questionnaire and to explore gambling habits in female Spanish population. The clinical sample was recruited from the Pathological Gambling Unit at the University Hospital of Bellvitge (Barcelona, Spain), comprising 30 patients. The community sample was recruited from individuals visiting the hospital for the Dentistry and Chiropody Departments, placed at the same university hospital and it comprised 316 females. Results: The questionnaire showed high values for sensitivity and specificity, discriminating between patients with gambling disorder and healthy controls. More than a 3% of the females from the community sample presented a problematic gambling behavior. In relation to predictors of gambling behavior, low socioeconomic status emerged as the unique socio-demographic factor for problematic gambling. Moreover, the illusion of winning money through gambling or feeling better by gambling were powerful stimulators of gambling behavior. Conclusions: Despite being male is strongly associated with the development of problem gambling, females can also be considered "at risk gamblers" themselves. To explore gambling habits of this population, identifying potentially harmful behaviors, in order to maintain responsible gambling habits, may contribute to the development of prevention and education programs promoting the general health of the community

Typologies of young pathological gamblers based on sociodemographic and clinical characteristics

Objective: the aim of this study is to explore empirical clusters within the population of young Spanish individuals attending outpatient pathological gambling treatment. Method: the South Oaks Gambling Screen (SOGS), the Symptom Checklist (SCL-90-R), the Temperament and Character Inventory-R (TCI-R) and other clinical and psychopathological measures were administered to 154 patients (between 17 and 25 years old). The two-step cluster analysis explored the presence of empirical heterogeneous groups based on clinical and socio-demographic characteristics. Results: three clusters of young pathological gambling patients emerged. Type I showed less psychopathology and more functional personality traits. Type II showed a profile characterized by major emotional distress, shame, immaturity, hostility and negative feelings. Type III showed the most severe psychopathological profile and most psychopathological disturbances and schizotypal traits. Conclusions: these results suggest that three distinct endophenotypes exist, and that environmental factors have a stronger influence in the first, while in the second and third, individual factors related to deficits of emotional regulation stand out

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences

Background: studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder. Method: a total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses. Results: there were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small. Conclusions: it is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences

Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder. A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses. There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small. It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed

The Lisbon Treaty, the EU committee and the Swedes : A study on the EU-committee’s work regarding the provisions on democratic principles of the Lisbon Treaty and the swedes’ perceived level of impact on the EU

This paper presents a study on how the Swedish EU committee has processed and implemented the Lisbon Treaty. More specifically, the eight article; provision on democratic principles. The eight article intends to increase the level of political participation among the citizens of EU. Therefore, the study also provides the perspective of the citizens of Sweden regarding whether they think they can affect the decisions made by the EU and also, whether they actually do participate in the democratic life provided by the EU. Through combining the work of the EU committee and the perspective of the Swedish people, the study contributes with a wide perspective that can understand how the implementation of the Lisbon Treaty has turned out. What this study has presented is that the work of the EU committee has been limited, which also reflects the Swedes’ engagement in participatory democracy. In addition to this, there are also split opinions whether they think they can affect the political decisions made by the EU

Erfarenheter av pedagogiska utmaningar vid genomförandet av examensmålet våld mot barn på landets lärosäten

Artikelns syftar till att undersöka hur examensmålet fokus på barns våldsutsatthet tolkas och implementeras i professionsutbildningar. Det empiriska materialet utgår från en högskolepedagogisk kurs som Barnafrid, Linköpings universitet har genomfört på uppdrag av JÄMY samt två fallbeskrivningar.Resultat visar på pedagogiska och didaktiska utmaningar som dels handlar om hur ett nytt examensmål ska kunna integreras i fulltecknade utbildningsplaner, dels om hur examensmålet innehåll ska tolkas. I examensmålet finns en hierarkisk ordning där olika våldsformer exempelvis våld mot barn är underordnat mäns våld mot kvinnor. Det krävs därför prioriteringar av vilket våld och målgrupp som ska ingå i undervisningen. Om blivande professioner redan i sin utbildning får uppfattningen att olika former av våld kan särskiljas och vägas mot varandra kan det ge en endimensionell och förenklad syn på våldsutsatthet.

Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority – A National population-based study in Sweden

BACKGROUND: To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers. METHODS: The study included 168,952 individuals (aged 16–84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level. FINDINGS: Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44–4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49–2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94–38·40) and exposure to physical violence (7·46, 2·97–18·70). INTERPRETATION: In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities. FUNDING: We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit

A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries

The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0–18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied  risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.Funding: Open access funding provided by Linköping University. FORTE (Dnr 2019–12-01).</p

"Long journey to shelter" : a study protocol: a prospective longitudinal analysis of mental health and its determinants, exposure to violence and subjective experiences of the migration process among adolescent and young adult migrants in Sweden

Introduction According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail. Methods and analysis Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden. Ethics and dissemination The Regional Ethics Board of Linkoping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.Funding Agencies|FORTE-the Swedish Research Council for Health, Working Life and Welfare [2019-01660]; Queen Silvias foundation</p