The median age at onset of illness (defined as the age at first impairment due to affective illness) was significantly younger among participants at moderate or severe risk of problem gambling than among the no or low-risk group (17 years v. 21 years, P<0.001). Significantly more of those at moderate or severe risk had a history of rapid cycling, defined as four or more episodes of mania or hypomania in a 12-month period,14 than those not at risk (56% v. 33%, P = 0.010) and the median number of episodes of hypomania or mania was significantly higher (10 v. 6, P = 0.044). History of suicidal ideation or attempt was significantly more frequent among the moderate or severe risk group (94% v. 79% in the no or low-risk group, P = 0.004), as was history of alcohol misuse defined using DSM-IV criteria (61% v. 47%, P = 0.050) and regular smoking (72% v. 52%, P = 0.006). Finally, those at moderate or severe risk of problem gambling were significantly less impaired during their worst episode of mood elevation than those
