States in the U.S. that legalized online sports betting saw increases in the use of depression and anxiety medications as well as outpatient diagnoses for depression and anxiety, according to a study from researchers at the Johns Hopkins Bloomberg School of Public Health.
The researchers used a large national dataset of employer-sponsored health insurance claims from January 2016 to December 2023, a period in which online sports betting became legal in many states, for their analysis. The team compared insurance claims of individuals in the 22 states that legalized online sports betting between 2018 and 2022 and those in 13 “control” states that had not legalized online sports betting by the end of 2023. The researchers excluded states that legalized online sports betting in 2023 or prior to 2018.
The study found that states saw significant increases in filled prescriptions for antidepressants and anti-anxiety medications, as well as outpatient diagnoses of depression and anxiety, after legalizing online sports betting.
The study was published online October 14 in JAMA Psychiatry .
“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, ” says study senior author Mark Meiselbach , PhD, an assistant professor in the Bloomberg School’s Department of Health Policy and Management.
The study’s first author was Ben Westermeyer, a PhD candidate in Meiselbach’s research group.
The past several decades have seen a loosening of gambling restrictions. Online sports betting, following a 2018 U.S. Supreme Court ruling, is now legal in most U.S. states, and is dominated by “sportsbook” apps such as DraftKings and FanDuel. Today, tens of millions of Americans participate in online sports betting, though estimates vary.
Gambling is increasingly framed as a public health issue. Researchers have linked gambling to anxiety, depression, substance use, and other mental health problems—including “gambling disorder,” an addiction disorder.
To better understand potential impacts of online sports betting, the researchers looked for changes at the state level, before and after legalization, in the percentage of insurance enrollees with one or more prescription fills for antidepressant, anti-anxiety, or substance use disorder medications; or one or more outpatient, emergency department, or inpatient visits with a diagnosis of depression, anxiety, or substance use disorder.
The analysis found that legalization was associated with increased probabilities of an outpatient diagnosis of depression—a 6.73% increase for men and 5.47% increase for women, relative to the sample averages—and with increased probabilities of using antidepressant medications (+5.44% for men, +5.00% for women).
The findings were similar for anxiety: +7.20% and +6.50% increases in the probability of an anxiety disorder outpatient diagnosis, and +4.99% and +5.17% increases in the probability of using anti-anxiety drugs, for men and women respectively.
The analysis found no significant increase in the probabilities of substance use disorder diagnoses or medication use. The researchers also found no evidence for increased probabilities of emergency department or inpatient visits resulting in depression or anxiety diagnoses.
“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,” Westermeyer says.
The authors note that the study was limited to people with employer-sponsored health insurance and does not measure the effects of legalization on other groups. Additionally, the researchers could not link individual-level sports betting to changes in healthcare use because insurance claims data do not capture whether people bet on sports.
The researchers now hope to conduct more targeted studies of the issue, using datasets that allow them to more directly measure online sports betting alongside mental health measures.
“I think there’s room for us to zero in on this a bit more,” Westermeyer says.
“ Online Sports Betting Legalization and Behavioral Health Care Use ” was co-authored by Benjamin Westermeyer, Matthew Eisenberg, and Mark Meiselbach.
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JAMA Psychiatry