Understanding the temporal relationship between bipolar disorder and problem gambling, and the mechanisms underlying the links between these disorders, requires longitudinal studies. For example, in our study the association between lifetime rapid cycling and gambling problems in the preceding 12 months can be explained by the presence of hypomanic or manic episodes during this period; however, the cross-sectional design makes this hard to assess. Future research would also benefit from assessing motivations for gambling in bipolar disorder. These findings require replication in large, independent samples of people with bipolar disorder. All participants in this study were of UK White ethnicity, and thus future studies should explore problem gambling in other ethnic groups with bipolar disorder.
