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Sports betting laws tied to anxiety care use
Researchers found higher antidepressant and antianxiety prescription use and more outpatient visits for depression and anxiety following legalization, with more robust associations among men.
Assess whether legalization of online sports betting was associated with changes in behavioral health care use among adults with employer-sponsored insurance.
Approach:
Design and data: Quasi-experimental staggered difference-in-differences analysis of MarketScan claims from January 2016 through December 2023.
Population: Included 61,951,305 enrollee-years among adults aged 18–64 in 22 states that legalized online sports betting and 13 states that had not legalized it by the end of 2023.
Outcomes: Compared medication fills and outpatient, emergency department, and inpatient care for depression, anxiety, and substance use disorders; also assessed gambling disorder diagnoses and naltrexone fills.
Key Findings:
Legalization was associated with increased antidepressant and antianxiety medication use and outpatient visits for depression and anxiety. Relative increases were generally about 5% to 7%.
Associations were more robust among men, although estimated increases were often numerically larger among women.
Differences in mental health care use generally widened over time, with larger associations 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.
There were no significant changes in the probability of filling a substance use disorder medication prescription or receiving an outpatient substance use disorder diagnosis. Among men, visit counts involving gambling disorder diagnoses increased 33% and naltre…
Interpretation:
The authors reported that legalization was associated with increased outpatient and prescription mental health service use, but the mechanisms were uncertain. Increased use could reflect worsening mental health or greater access to care among people with previously unmet needs.
Limitations:
The study included only adults with employer-sponsored insurance, limiting generalizability to uninsured people, Medicaid beneficiaries, and those with less stable employment.
Claims data did not identify gambling participation, so effects of direct betting involvement could not be distinguished from exposure through family members.
People who lost employer-sponsored coverage were not observed after coverage loss.
Some outpatient mental health outcomes showed upward trends before legalization, complicating interpretation.
Conclusion:
The authors stated that further research is needed to understand the mechanisms underlying these associations.
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