Background: This study aimed to explore the association between psychosocial health, gambling and gambling problems in a nationally representative sample of Swedish youth aged 16–24 years. Another aim was to examine whether these associations were different between young men and women.

Methods: Data were from the cross-sectional Swedish National Public Health Survey in 2004–07. With a response rate of 60.1%, the sample consisted of 19 016 youth. Using a sex-stratified multinomial logistic regression, we estimated associations between psychosocial health variables and gambling and gambling problems.

Results: Among males, we found that the higher the alcohol consumption, the higher the likelihood of gambling and gambling problems. Men with high alcohol consumption had an almost four times higher likelihood of gambling problems than men with no or low alcohol consumption (OR 3.94, 95% CI: 2.17–7.14). Moreover, young male victims of violence were more than twice as likely to have gambling problems than non-victims (OR 2.35, 95% CI: 1.39–3.99). Among young women, we found an inverse association between high alcohol consumption and gambling problems (OR 0.15, 95% CI: 0.05–0.44), opposite that of the young men. Furthermore, psychological distress (OR 6.15, 95% CI: 2.15–17.60) and suicidality (OR 2.88, 95% CI: 1.16–7.17) were associated with higher probabilities of gambling problems among young women.

Conclusion: Alcohol use, violence victimization and poor mental health are associated with gambling problems among Swedish youth, however, with important sex differences. Prevention of youth gambling should consider sex differences and psychosocial health in addition to gambling.