Online Sports Betting Legalization Tied to More Depression Care

States that legalized online sports betting saw measurable increases in the treatment of depression and anxiety afterward, according to a Johns Hopkins Bloomberg School of Public Health study published online October 14 in JAMA Psychiatry. The analysis of employer-sponsored insurance claims found the probability of an outpatient depression diagnosis rose 6.73 percent for men and 5.47 percent for women relative to sample averages, with similar gains for anxiety and for prescriptions of the medications used to treat both.

The paper, "Online Sports Betting Legalization and Behavioral Health Care Use," was written by Benjamin Westermeyer, Matthew Eisenberg and Mark Meiselbach, all of the Bloomberg School's Department of Health Policy and Management. It compared claims in 22 states that legalized online sports betting between 2018 and 2022 against 13 states that had not legalized by the end of 2023, excluding states that moved in 2023 or before 2018.

What the claims data showed

The researchers drew on a national dataset of employer-sponsored health insurance claims running from January 2016 to December 2023, a window that begins two years before the Supreme Court struck down the federal ban on sports wagering and extends five years past it. They tracked two things at the state level: the share of enrollees filling prescriptions for antidepressants and anti-anxiety drugs, and the share with an outpatient, emergency department or inpatient visit carrying a diagnosis of depression, anxiety or a substance use disorder.

After legalization, the share of enrollees filling antidepressant prescriptions rose 5.44 percent for men and 5.00 percent for women. Anxiety diagnoses rose 7.20 percent for men and 6.50 percent for women. The probability of using anti-anxiety medication rose 4.99 percent for men and 5.17 percent for women — the single category in which the increase was larger for women than men, a pattern that follows from the fact that those drugs are prescribed more often to women overall.

Gambling has been linked in earlier research to anxiety, depression and substance use disorder, and gambling disorder is classified as an addiction. The new findings extend that association from individuals to populations: the change appears in a state's claims data after the state legalizes, not only among people who have been diagnosed with a gambling problem.

Men absorbed most of the increase

The gender split tracks behavior. Men make up the majority of sports bettors, and in nearly every category the analysis measured, the increase in mental health treatment was larger for men — in depression diagnoses, antidepressants, and anxiety diagnoses. Only anti-anxiety prescriptions moved slightly more for women.

"I hope these results will increase awareness among psychiatrists and primary care doctors who treat mental health, as well as online sports bettors themselves, that these online apps can lead to harms beyond financial risks," Meiselbach, the senior author and an assistant professor at Johns Hopkins, said in a statement released by the school.

Westermeyer, the first author and a PhD candidate in Meiselbach's research group, framed the result as a warning about attribution as much as about harm. "Overall, these findings support the concern that there are broad mental health effects of online gambling legalization, though those who are experiencing those effects, and their clinicians, don't necessarily attribute it to gambling," he said. A patient who has never mentioned betting to a mental health provider is exactly the case the study suggests is easiest to miss.

What the study did not find

Two null results matter as much as the positive ones. The analysis found no significant increase in the probability of a substance use disorder diagnosis or in the use of medications prescribed for addiction, and no evidence that emergency department or inpatient visits producing a depression or anxiety diagnosis became more common.

That pattern points to a particular kind of harm: the increases showed up in outpatient diagnoses and routine prescriptions, the settings where months of low-grade distress surface, rather than in crises severe enough to send someone to a hospital. When The Independent reported on the findings, it noted separate research showing that diagnoses of gambling disorder itself have risen more than 60 percent nationally since 2018 — a figure that describes the addiction, while the Johns Hopkins paper describes the broader mental health care that follows legalization.

The limits the authors name

The study was confined to people with employer-sponsored insurance and cannot speak to Medicaid enrollees, the uninsured or people who buy coverage on the individual market, groups that make up a large share of the population in the states that legalized. The researchers also could not connect any particular person's betting to their care, because insurance claims do not record whether a patient wagers. That gap means the analysis measures a state-level shift around legalization, not a causal chain running from an app to a prescription.

Westermeyer said the team wants to close that distance. "I think there's room for us to zero in on this a bit more," he said, describing plans for studies built on datasets that capture betting directly alongside mental health measures. Until then, the value of the paper is the size and direction of the signal it detects in data that already exists — a population-level change in treatment use that appeared after states opened the market and that no clinician was looking for.