Data Show Gambling Disorder Tied to Much Higher Mental Illness Rates

Patients diagnosed with a gambling disorder are far more likely than other patients to carry a concurrent diagnosis of depression, anxiety, post-traumatic stress disorder or a substance use disorder, according to an Epic Research analysis of 13,533 patients published Oct. 2 — and in many cases those diagnoses appear years before anyone flagged the gambling.

The analysis drew on Cosmos, a de-identified dataset drawn from more than 310 million patient records across roughly 2,200 hospitals and 50,000 clinics in all 50 states. Researchers identified every patient newly diagnosed with a gambling disorder during an outpatient visit between January 2017 and May 2026 and matched each to four patients seen on the same date without a gambling diagnosis, producing a comparison group of 54,132. The groups were matched on age, sex, rurality, social vulnerability and visit date.

What the numbers show for women

Women with a gambling disorder diagnosis carried the heavier pre-existing burden. In the window more than 18 months before their diagnosis, 61.9 percent already had a diagnosed depression compared with 30.8 percent of matched women without a gambling disorder. Anxiety had been diagnosed in 60.0 percent versus 35.7 percent, PTSD in 24.0 percent versus 10.3 percent, and a substance use disorder in 46.0 percent versus 19.9 percent.

New diagnoses continued to accumulate after the gambling disorder was identified. Within 18 months, personality disorders were diagnosed in 3.0 percent of women with a gambling disorder versus 0.3 percent of comparison patients, and suicidal ideation in 4.9 percent versus 0.6 percent.

Men start lower and rise faster

Men had lower rates of pre-existing conditions, but their diagnoses climbed more sharply after the index date. In the 18 months following a gambling disorder diagnosis, 14.6 percent of men were newly diagnosed with depression compared with 3.5 percent of matched men, 12.6 percent with anxiety compared with 5.0 percent, 11.3 percent with a substance use disorder compared with 4.1 percent, and 6.0 percent with suicidal ideation compared with 0.9 percent. Attention deficit and obsessive-compulsive diagnoses showed smaller gaps in both sexes.

Because elevated rates appeared on both sides of the diagnosis date, the researchers wrote that the data are consistent with a bidirectional relationship rather than a one-directional story in which mental illness simply precedes gambling, or the reverse.

Why researchers are watching gambling more closely

Gambling disorder is defined as persistent, recurrent gambling that continues despite serious personal, family or financial harm, and the DSM-5 reclassified it as an addictive disorder rather than an impulse-control problem. The condition has drawn more attention as sports betting has been legalized across much of the country and as prediction markets such as Polymarket and Kalshi have widened access to real-money wagering.

Epic's own earlier work illustrates the trend. In a report the company published this summer, the rate of people newly diagnosed with a gambling disorder rose from 3.0 per 100,000 patients in the first quarter of 2018 to 4.8 per 100,000 in the first quarter of 2026, a roughly 61 percent increase concentrated in states that legalized sports betting.

What the study cannot say

The Epic teams were careful to list what their method cannot establish. The relationship between gambling and other psychiatric conditions is strongly bidirectional, they wrote, so the directionality windows characterize the pattern without resolving what causes what. The timing of the measurement windows is also asymmetric: the "before" period is open-ended while the "after" period is capped at 18 months, a design that can bias results toward showing that mental health problems come first.

The analysis also rests on diagnosis codes, which introduces a detection problem the authors call Berkson bias. Patients already engaged in mental health care inside a health system are more likely to have a gambling problem recognized and coded than patients who never seek care, and people who come in for gambling are more likely to be evaluated for other conditions. People with milder problems that never reach a clinician do not appear in the data at all. The authors describe their case definition as capturing a small, non-representative slice of true gambling disorder, note that they could not measure social determinants of health in detail, and said the work was completed by two teams that analyzed the data independently and reached similar conclusions.

Where treatment fits

The findings point toward screening rather than any new therapy. No medication is approved by the Food and Drug Administration specifically for gambling disorder; treatment rests on behavioral approaches such as cognitive behavioral therapy, motivational interviewing and, for many patients, medications borrowed from other indications. Because the analysis shows such heavy overlap with depression, anxiety and substance use, clinicians who treat gambling disorder increasingly work from an integrated model that addresses the co-occurring conditions at the same time — the approach dual diagnosis programs are built around.

For families, the practical reading is that a gambling problem showing up in someone already being treated for depression or a substance use disorder is not a separate, unrelated issue. The Substance Abuse and Mental Health Services Administration operates a free national helpline at 1-800-662-4357, and the 988 Suicide and Crisis Lifeline handles calls and texts from people in crisis at any hour.