Legalizing sports betting linked to increased demand for mental health services, study shows

Karl Hille, Baltimore Sun on Oct 20, 2026

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Legalizing sports betting is associated with an increase in the number of workers in a state receiving treatment for anxiety or depression, according to a recent Johns Hopkins study.

Johns Hopkins researchers looked at anonymized insurance claims from 30 states that legalized online sports betting between 2016 and 2023. They analyzed the equivalent of 62 million years of individual data to conclude that “legalization was associated with an increase in the probability of people with employer-sponsored health insurance having a prescription or outpatient visit related to depression or anxiety.”

Diagnoses for depression increased 6.7% for men and 5.5% for women, while anxiety diagnoses increased 7.2% for men and 6.5% for women.

Mark Meiselbach, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, said the study doesn’t show sports betting harms most people.

“Even if the majority of people are enjoying sports betting with limited issues, when something becomes so available so rapidly with limited guardrails,” Meiselbach said, “even if only one in 100 people become impacted, that turns into a lot of people” across a state the size of Maryland.

“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,” he said.

The association was “more precise and robust” for men than for women. The researchers also found no significant increase in treatment for substance use disorders or in emergency or inpatient visits for depression or anxiety after legalization.

“Results suggest that state legalization of online sports betting was associated with measurable increases in mental health care use and may increase strain on the behavioral health system,” the authors concluded.

They published their work Oct. 14 in JAMA Psychiatry.

Gambling is increasingly framed as a public health issue. Researchers have linked gambling to anxiety, depression and substance use, in addition to gambling disorder, which is classified as an addiction.

The connection between these issues and sports betting may not be obvious to the doctors treating them, or even to the patient, said the study’s first author, Ben Westermeyer, a doctoral candidate in Meiselbach’s research group.

“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 said in a statement.

The Baltimore Sun reached out to gambling industry organizations including the International Betting Integrity Association and the Fantasy Sports and Gaming Association for comment on these findings. The FSGA declined to comment, and the IBIA had not responded by publication time.

In a 2023 survey, the Fantasy Sports and Gaming Association found that 23% of Americans aged 18 and older participate in sports betting, up from 19% in 2019. Participants were 60% male, with 38% aged 18 to 34.

The International Betting Integrity Association reports that online sports betting is a $300 billion global industry, benefiting from 1.5 million sporting events held worldwide each year.

The Hopkins researchers now hope to conduct more targeted studies that directly measure online sports betting alongside mental health measures.

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