Associations between adverse childhood experiences and gambling: a nationwide population study

Adverse childhood experiences (ACEs) have long-term effects on health and behavior, and problem gambling is increasingly viewed as a maladaptive coping strategy linked to stress and emotional dysregulation. Building on prior research and the Pathways Model, this study examines the association between childhood adversity and adult problem gambling. The study uses nationally representative data from the Healthy Finland Survey 2022–23, including 28,154 adults aged 20 + (response rate 46%). Of the 5,749 participants in the health examination component, 4,785 completed a follow-up questionnaire that included measures of childhood adversity. Problem gambling severity was assessed using the Problem Gambling Severity Index (PGSI). Childhood adversity was measured using the ACE-THL questionnaire, with 12 ACE items covering abuse, sexual harassment, neglect, household dysfunction, economic hardship, parental mental health or substance use problems, and parental loss, with a 5-point frequency response scale. Analyses were adjusted for sociodemographic factors. Cumulative adversity was constructed using a provisional percentile-based cut-off for each item. Among those with at-risk or problem gambling, 16% reported four or more ACEs, compared with 11% in non-problem gambling and 5% in non-gambling. After adjustment, problem gambling remained significantly associated with higher childhood adversity. The findings highlight the role of early-life adversity in gambling-related harm. To conclude, the findings provide insights into the developmental origins of gambling problems and highlight the need for preventive strategies addressing childhood adversity within public health frameworks.

Key messages

• The findings support integrating childhood adversity prevention into public health frameworks as a strategy to reduce the developmental risk factors that contribute to problem gambling.

• Higher ACE scores independently predict gambling harm and lifetime problem gambling, with bullying, violence, sexual abuse, and family dysfunction most strongly linked.