Gambling disorder is a pattern of persistent, recurrent gambling that continues despite serious personal, family, or financial harm.1 We previously reported a growing rate of people newly diagnosed with gambling disorders in the U.S.2 Interest in its health consequences has grown as sports betting has been legalized across much of the United States and as prediction-market platforms such as Polymarket and Kalshi have expanded access to real-money wagering. Gambling disorder has long been known to occur alongside other mental health conditions, but the order in which these conditions arise has been difficult to establish.
We studied 13,533 U.S. patients newly diagnosed with a gambling disorder during an outpatient visit between January 2017 and May 2026 and matched each of them to four patients who had an outpatient visit on the same date but no gambling diagnosis (54,132 comparison patients). Matching was done on age, sex, rurality and social vulnerability based on latest address, and date of the outpatient visit. We measured the share of patients with another mental health diagnosis in three time windows relative to the gambling diagnosis or matched encounter: more than 18 months before, within the 18 months before, and within the 18 months after.
Among women, a gambling disorder diagnosis was associated with substantially higher diagnosis rates of nearly every mental health condition studied, both before and after the gambling disorder diagnosis, compared with women without a gambling disorder diagnosis, as seen in Figure 1. The gap was large well before the gambling disorder diagnosis: more than 18 months prior, 61.9% of women who would go on to have a diagnosed gambling disorder had a depression diagnosis versus 30.8% of comparison women, 60.0% had an anxiety diagnosis versus 35.7%, and 24.0% had a PTSD diagnosis versus 10.3%. In the 18 months after the gambling disorder diagnosis, personality disorders were diagnosed in 3.0% of women with a gambling disorder versus 0.3% of comparison women, and suicidal ideation was diagnosed in 4.9% versus 0.6%.
The same bidirectional pattern held among men, though their pre-diagnosis rates were lower in absolute terms and their post-diagnosis increases were larger, as seen in Figure 2. In the 18 months after a gambling disorder diagnosis, men were newly diagnosed with other mental health conditions at substantially higher rates than comparison men, including depression (14.6% vs. 3.5% of comparison men), anxiety (12.6% vs. 5.0%), substance use disorder (11.3% vs. 4.1%), and suicidal ideation (6.0% vs. 0.9%). As among women, ADHD and OCD showed more modest gaps.
Because elevated rates appeared on both sides of the index date in both sexes, the data are consistent with a bidirectional relationship rather than other mental illness simply following gambling or gambling simply following other mental illness. One contributor to the observed gap might be that patients already engaged in mental health care within a health system may be more likely to have a gambling disorder recognized and documented than patients not receiving such care. Similarly, patients seeking care for gambling issues might be more likely to be evaluated for other mental health conditions than other patients. The differences persisted across strata of age, rurality, and social vulnerability, indicating the association is not confined to any one subgroup.
