- Design
- Quasi-experimental staggered difference-in-differences study
- Population
- 61,951,305 enrollee-years, US adults 18–64 with employer insurance, 2016–2023
- Primary outcome
- Mental health and substance use prescriptions and diagnoses
- Effect
- Antidepressant use +0.57 pp (men) and +1.08 pp (women)
This study used US insurance claims covering about 62 million enrollee-years and compared states that legalised online sports betting between 2018 and 2022 with those that had not, using a staggered difference-in-differences design.
Legalisation was associated with small rises in the probability of antidepressant use (0.57 percentage points in men, 1.08 in women) and anti-anxiety medication use (0.32 and 0.64 points), and in outpatient diagnoses of depression and anxiety. There was no detectable change in substance use disorder treatment or in emergency and inpatient mental health visits.
The design is stronger than a simple before-and-after comparison, but it is still observational and cannot attribute individual cases to gambling. It is a reason to ask about betting — including online and app-based betting, which is widespread in India — when someone presents with new low mood or anxiety.
- Ask about gambling, including online and app-based betting, when assessing new depression or anxiety.
- Screen with a brief tool such as the Problem Gambling Severity Index when betting is reported.
- Ask about debts and financial strain, which often drive distress and suicide risk in problem gambling.
- Effects were seen in outpatient care, not in emergency or inpatient settings.
Why it matters
Gambling is rarely asked about in mental health assessments, yet population-level access appears to show up in prescribing.
Don't overread it
This is an association at state level; it does not show that betting caused any individual's depression.
The statistics, in plain English
A rise of 0.57 percentage points means about 6 more people per 1,000 using an antidepressant — small per person, large across a population. Difference-in-differences compares changes over time between states that did and did not legalise, which removes some but not all confounding.
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