Online Sports Betting Legalization Associated With Increased Outpatient Mental Health Care Use

A JAMA Psychiatry study examined whether online sports betting legalization was associated with mental health and substance use disorder (SUD) treatment use. Researchers used a staggered difference-in-differences design and employer-sponsored insurance claims from January 2016 through December 2023, comparing states that legalized online betting during 2018–2022 with states that had not legalized it by study end. The analysis included 61,951,305 enrollee-years among adults aged 18–64; 52% were women, and mean age was 41.9 years.

Legalization was associated with increases in antidepressant prescription fills of 0.57 percentage points in men (95% CI, 0.26–0.89) and 1.08 points in women (95% CI, 0.23–1.94). Antianxiety medication use increased by 0.32 and 0.64 percentage points, respectively. Outpatient depression diagnoses increased by 0.34 percentage points in men and 0.57 in women; corresponding increases for anxiety were 0.67 and 1.15 points. There were no detectable changes in SUD medication use or outpatient SUD diagnoses, or in behavioral health diagnoses in emergency department and inpatient settings.

The findings suggest increased outpatient mental health care use following legalization, rather than a demonstrated increase in acute care use. The study establishes associations, not individual-level causation or whether affected enrollees gambled. Its convenience sample of employer-insured adults limits generalizability, and treatment claims do not directly measure symptom burden. Only the abstract was available for assessment.