- Design
- Staggered difference-in-differences analysis of claims data, 2016 to 2023
- Population
- About 62 million enrollee-years of US adults aged 18 to 64 with employer insurance
- Primary outcome
- Mental health and substance use treatment, prescriptions and diagnoses
- Effect
- Antidepressant use, women +1.08 percentage points (95% CI 0.23 to 1.94); anxiety diagnoses, women +1.15 (0.50 to 1.81)
A quasi-experimental study compared US states that legalised online sports betting between 2018 and 2022 with those that had not, using insurance claims for adults aged 18 to 64 (about 62 million enrollee-years). Published in JAMA Psychiatry on 14 October 2026.
Legalisation was associated with small increases in antidepressant use (men +0.57 percentage points, women +1.08) and anxiolytic use (men +0.32, women +0.64), and in outpatient diagnoses of depression (men +0.34, women +0.57) and anxiety (men +0.67, women +1.15). There was no detectable change in substance use disorder treatment, or in emergency or inpatient mental health diagnoses.
The design is stronger than a simple before-and-after comparison, but it remains observational and covers only people with employer insurance. It does not identify who in a household was gambling. Still, it adds to the case for asking about gambling when a patient presents with new low mood or anxiety, including partners and family members affected by someone else's betting. Online betting is widely accessible in India, so the question is relevant here too.
- Ask about gambling, including online and app-based betting, when assessing new depression or anxiety
- Ask whether someone else's gambling is affecting the patient, since harm falls on families too
- Use a brief screen such as the Problem Gambling Severity Index when the answer is yes
- Check for debt and suicidal thinking in people with gambling-related distress
Why it matters
Gambling harm reaches clinics as low mood and anxiety, not as a gambling complaint, and it goes unrecorded unless someone asks.
Don't overread it
This is a population association; it does not show that betting caused any individual's depression.
The statistics, in plain English
A rise of 1.08 percentage points means about one more woman in every hundred insured was filling an antidepressant prescription after legalisation than would have been expected. Small at the individual level, it is large across a population of millions.
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