Rise in anxiety, depression symptoms for residents in states with strict abortion laws

Key takeaways:

• Anxiety and depression symptoms were higher for those in trigger states vs. non-trigger states after Dobbs.
• Women aged 18 to 45 years in trigger states vs. non-trigger states had greater mental health symptoms.

Living in states with abortion trigger laws was associated with small but significantly greater increases in anxiety and depression symptoms after Dobbs compared with states without such laws, according to survey data published in JAMA.

“Research conducted prior to Dobbs established that individual abortion denial was significantly associated with adverse outcomes, including symptoms of depression and anxiety,” Benjamin Thornburg, BS, a PhD student in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health at Johns Hopkins University, and colleagues wrote. “Whether policies inhibiting abortion access have population-level effects on mental health is unclear.”

Thornburg and colleagues utilized data from the nationally representative repeated cross-sectional Household Pulse Survey from 2021 to 2023 to evaluate change in anxiety and depression symptoms after the May 2022 leaked Dobbs draft or the June 2022 Dobbs decision. The survey was administered through an internet-based platform to 718,753 individuals living in the U.S. Researchers compared responses from residents living in 13 abortion trigger states with those from the 37 non-trigger states.

The primary outcome was anxiety and depression symptoms measured through the Patient Health Questionnaire-4 (PHQ-4), with scores greater than 5 indicating elevated symptoms.

Overall, 6.04% of individuals (mean age, 48 years; 51% women) responded to the survey and 87% of respondents completed the PHQ-4.

For those living in states with abortion trigger bans, mean PHQ-4 scores increased from 3.51 at baseline to 3.81 after Dobbs. For those living in non-trigger states, mean PHQ-4 scores increased from 3.31 at baseline to 3.49 after Dobbs. Researchers observed a significantly greater increase in mean PHQ-4 score by 0.11 in states with abortion trigger bans compared with non-trigger states (P < .001).

From baseline to after the Dobbs draft leaked, PHQ-4 changes were not significantly different for residents living in states with or without abortion trigger bans. However, from baseline to after the Dobbs decision, researchers noted a significantly greater increase in PHQ-4 scores among women aged 18 to 45 years living in states with abortion trigger bans compared with those in non-trigger states (P = .002). For men aged 18 to 45 years living in states with abortion trigger bans, there was no statistically significant change in PHQ-4 score.

In addition, researchers observed statistically significant differences in estimates between men and women aged 18 to 45 years (P = .02).

Limitations of this study include the use of Household Pulse Survey data, which was developed for COVID-19 research, using pooled cross sections of different individuals over time and not a panel of the same sample, having a low population-weighted response rate and the inability to capture individual-level political ideology in survey data, which likely has a role in how Dobbs impacted individual mental health, according to the researchers.

“The findings provide new evidence about the relationship between the changing abortion policy landscape and mental health following the Dobbs opinion,” the researchers wrote. “Although there were increases in symptoms of anxiety and depression for the general population after the opinion, changes in symptoms of anxiety and depression were greater among those living in states with trigger abortion bans and, in particular, among females within the age range generally used to compute lifetime abortion incidence.”