Even after controlling for bipolar type diagnoses, we found that rapid cycling and suicidal ideation or attempt were significantly associated with gambling problems. Rapid cycling was over 2.5 times more frequent in individuals at risk of problem gambling compared with individuals at low risk, and similarly those with gambling problems reported having had more lifetime episodes of hypomania or mania. The number of episodes of depression, however, was not significantly elevated. Those at moderate or severe risk of problem gambling were also 3.5 times more likely to have considered or attempted suicide. This is supported by Kennedy et al, who reported that people with gambling problems in a bipolar disorder sample in Canada were more than twice as likely to have been at higher suicide risk in the preceding month compared with those with no gambling problem.10 Suicide risk is known to be elevated in bipolar disorder,17,22–24 and our study demonstrates that comorbid gambling problems elevate this risk further. However, our data do not suggest that gambling problems are simply a marker of illness severity in bipolar disorder, as illustrated
