State-level abortion access associated with suicide risk during reproductive years

Restrictions on reproductive care access were associated with higher state-level rates of suicide among reproductive-aged women, according to a study published in JAMA Psychiatry.

“Stress is a key contributor to mental health burden and a major driver of increased suicide risk,” Ran Barzilay, MD, PhD, an assistant professor of psychiatry at the University of Pennsylvania Perelman School of Medicine in Philadelphia, said in a press release. “We found that this particular stressor — restriction to abortion — affects women of a specific age in a specific cause of death, which is suicide. That’s the 10,000-foot view.”

Barzilay and colleagues conducted a difference-in-differences analysis of deidentified, state-level CDC data on abortion access and suicide rates from 1974 to 2016. They measured reproductive care access using the Targeted Regulation of Abortion Providers (TRAP) laws index, which indicated state-level enforcement of ASC laws, admitting privileges and transfer agreements. The TRAP law index score was 0 if no laws were in place and 3 if all three laws were enforced.

The researchers used the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) database to determine suicide rates among the target population — reproductive-aged women aged 20 to 34 years — and a control group of post-reproductive-aged women (aged 45-64 years). Suicide rates were compared with the rates of motor vehicle crash-related deaths, another leading cause of death, among reproductive-aged women.

At least one TRAP law was enforced in 21 states between 1974 and 2016. Among reproductive-aged women, the annual rate of suicide ranged from 1.4 to 25.6 per 100,000 women and the annual rate of motor vehicle crash deaths ranged from 2.4 to 42.9 per 100,000 women. Among women older than reproductive age, suicide rates ranged from 2.7 to 33.2 per 100,000 women.

When no TRAP laws were in place, the weighted average annual state-level rate of suicide was 5.5 per 100,000 deaths.

Enforcement of TRAP laws was associated with higher suicide rates among reproductive-aged women (beta = 0.17; 95% CI, 0.03-0.32) but not among post-reproductive-aged women.

In states where TRAP laws were enforced, the rate of suicide was 5.81% higher among reproductive-aged women during vs. before enforcement.

Additionally, TRAP laws were not associated with the rate of motor vehicle crash-related deaths among reproductive-aged women.

Although the study design does not allow a causal relationship between abortion access and suicide rates to be identified, Barzilay and colleagues said the findings may have implications for clinicians and policymakers.

“Further research is needed to assess whether current factors affecting access to reproductive care services are related to suicide risk among women of reproductive age and to inform suicide prevention strategies,” they wrote.

References:

• Berger MW. Restricted abortion access linked to increased suicide risk in young women. Penn Today. penntoday.upenn.edu/news/restricted-abortion-access-linked-increased-suicide-risk-young-women. Accessed Jan. 3, 2023.
• Zandberg J, et al. JAMA Psych. 2022;doi:10.1001/jamapsychiatry.2022.4394.