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States that legalized online sports betting saw measurable increases in depression and anxiety treatment, according to a large insurance claims study. Analyzing nearly 62 million enrollee-years, researchers found higher rates of antidepressant and antianxiety prescriptions and more outpatient mental health visits after legalization — with effects growing stronger over time. Clinicians are now being urged to routinely ask patients about online betting as a potential mental health trigger.
A new study published in JAMA Psychiatry suggests that legalizing online sports betting comes with a hidden cost: more people seeking treatment for depression and anxiety. Researchers analyzed commercial insurance claims from nearly 62 million enrollee-years of adults aged 18–64 across 22 states that legalized online sports betting between 2018 and 2022, comparing them to 13 states that hadn't. Using a difference-in-differences approach, they found statistically significant increases in antidepressant and antianxiety prescriptions, as well as outpatient mental health visits, following legalization — with no corresponding rise in ER visits, hospitalizations, or substance use disorder treatment.
The effects were seen in both men and women but were more consistent among men. Notably, the gap between legalized and non-legalized states widened over time, suggesting that gambling-related mental health harms often take years to surface — consistent with the slow progression from casual betting to problem gambling.
Why it matters: Online sports betting apps offer near-unlimited, barrier-free access to gambling — and this study suggests the mental health fallout is real and growing. Experts are calling it a "hidden epidemic," urging clinicians to proactively ask patients about sports betting habits, even without formal screening tools, as a potential contributor to depression and anxiety.
