Clinical Scorecard: Online sports betting legalization tied to increased mental health care use

At a Glance

Key Highlights

• In a quasi-experimental analysis of 61,951,305 enrollee-years, legalization was associated with increased antidepressant and antianxiety medication use and outpatient depression and anxiety care.
• Estimated relative increases in antidepressant and antianxiety medication use were approximately 5% among both men and women; associations were more robust among men.
• Associations generally widened over time, with larger increases reported 4 to 5 years after legalization.
• No statistically significant changes were detected in emergency department or inpatient visits for depression, anxiety, or substance use disorders.
• Among men, secondary analyses found increases in the number of gambling disorder visits and naltrexone prescription fills, but not in the probability of having at least one such visit or fill.

Guideline-Based Recommendations

Diagnosis

Management

Monitoring & Follow-up

Risks

• The study did not establish that legalization caused the observed changes; some outpatient mental health outcomes had upward trends before legalization.
• Claims data did not identify gambling participation, so effects of direct betting involvement could not be separated from exposure through family members.
• Findings may not generalize to uninsured people, Medicaid beneficiaries, or people with less stable employment; people losing employer-sponsored coverage were not observed after coverage loss.

Patient & Prescribing Data

Adults aged 18 to 64 years with employer-sponsored insurance in 22 states that legalized online sports betting between 2018 and 2022 and 13 states that had not legalized it by the end of 2023.

After legalization, the probability of filling an antidepressant prescription increased by 0.57 percentage points among men and 1.08 percentage points among women; antianxiety prescription probability increased by 0.32 and 0.64 percentage points, respectively. These were approximately 5% relative increases in both groups for each medication category.

Clinical Best Practices

• The study reports associations from a quasi-experimental claims analysis and does not establish that legalization caused increased mental health care use.
• The study population was limited to adults with employer-sponsored insurance, and claims did not measure gambling participation.
• The article does not provide individual-level screening, diagnosis, treatment, or monitoring recommendations.

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