{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:46:15Z","timestamp":1791992775781,"version":"4.4.0"},"reference-count":55,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"abstract":"\n Importance<\/jats:title>\n The number of states with legal online sports betting has grown from 1 to 31 since 2018, expanding access to gambling. Despite the known behavioral health burdens associated with gambling, little is understood about legalization\u2019s impact on mental health and substance use treatment use.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between online sports betting legalization and treatment use for mental health conditions and substance use disorders (SUD).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a quasi-experimental staggered difference-in-differences study using claims data from January 2016 to December 2023. The setting was a large, national convenience sample of people with employer-sponsored health insurance. Included in the analysis were men and women aged 18 to 64 years living in states that legalized online sports betting during 2018-2022 or had not by the end of the study period.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n State legalization of online sports betting.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes were measured at the state-year level, weighted by number of enrollees as follows: proportions of enrollees with 1 or more prescription fills for antidepressant, antianxiety, or SUD medications and proportions of enrollees with 1 or more outpatient, emergency department, or inpatient visits with a diagnosis for depression, anxiety, or SUD.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 61\u202f951\u202f305 enrollee-years, 31\u202f914\u202f852 (52%) were women, and the mean (SD) age was 41.9 (13.5) years. Online sports betting legalization was associated with increases in the probability of antidepressant use (men: 0.57 percentage points; 95% CI, 0.26-0.89 percentage points; women: 1.08 percentage points; 95% CI, 0.23-1.94 percentage points) and antianxiety use (men: 0.32 percentage points; 95% CI, 0.14-0.50 percentage points; women: 0.64 percentage points; 95% CI, 0.16-1.12 percentage points), but there was no detectable change in SUD medication use. Legalization was also associated with increases in the probability of an outpatient diagnosis for depression (men: 0.34 percentage points; 95% CI, 0.20-0.49 percentage points; women: 0.57 percentage points; 95% CI, 0.25-0.89 percentage points) and anxiety (men: 0.67 percentage points; 95% CI, 0.32-1.01 percentage points; women: 1.15 percentage points; 95% CI, 0.50-1.81 percentage points) but not SUD. Legalization was not associated with behavioral health diagnoses in the emergency department and inpatient settings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Results of this quasi-experimental difference-in-differences study suggest that online sports betting legalization was associated with an increase in outpatient and prescription mental health care use among people with employer-sponsored health insurance. These findings underscore the importance of prevention and treatment of potential adverse health consequences of legalized online sports betting.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2026.3175","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:00:38Z","timestamp":1791990038000},"source":"Crossref","is-referenced-by-count":0,"title":["Online Sports Betting Legalization and Behavioral Health Care Use"],"prefix":"10.1001","author":[{"given":"Benjamin","family":"Westermeyer","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"},{"name":"Johns Hopkins Center for Mental Health and Addiction Policy, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Eisenberg","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg 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National survey on gambling attitudes and experiences. Accessed May 10, 2026. https:\/\/www.ncpgambling.org\/training\/ngage-survey\/ngage-3\/\"https:\/\/www.ncpgambling.org\/training\/ngage-survey\/ngage-3\/\""},{"key":"yoi260048r28","unstructured":"Nower? L, Stanmyre? JF, Anthony? VWL. The prevalence of online and land-based gambling in New Jersey. Accessed May 10, 2026. https:\/\/www.nj.gov\/oag\/ge\/2023news\/PrevalenceReport2023Final.pdf"},{"key":"yoi260048r29","unstructured":"Brown? JP. Statewide gambling prevalence in Maryland. Accessed May 10, 2026. https:\/\/www.mdproblemgambling.com\/wp-content\/uploads\/2025\/09\/2024-MD-Gambling-Report.pdf"},{"key":"yoi260048r37","doi-asserted-by":"crossref","unstructured":"SportsHandle. States with legal sports betting\u2014US map & updated guide. Accessed May 5, 2026. https:\/\/sportshandle.com\/sports-betting\/","DOI":"10.4324\/9781003479918-2"},{"key":"yoi260048r38","unstructured":"American Gaming Association. Gaming map. 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