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After the U.S. Supreme Court decision to overturn Roe v. Wade, women living in states with trigger laws criminalizing abortion experienced an increase in anxiety and depression symptoms, according to a retrospective analysis of survey data.

From baseline to after the Dobbs v. Jackson Women's Health Organization opinion in June 2022, there was a significantly greater increase in mean Patient Health Questionnaire-4 (PHQ-4) scores for women ages 18 to 45 in trigger states compared with those in non-trigger states (difference-in-differences estimate 0.23, 95% CI 0.08-0.37, P=0.002), reported Benjamin Thornburg, BS, of Johns Hopkins Bloomberg School of Public Health in Baltimore, and co-authors.

There was also an increase of 0.11 in mean PHQ-4 scores among all survey respondents living in states with trigger laws versus non-trigger states (95% CI 0.06-0.16. P<0.001), they noted in .

However, differences in estimates for men and women ages 18 to 45 were statistically significant (P=0.02).

"Our findings revealed that the overturning of Roe led to a non-trivial increase in the probability of testing positively for anxiety or depression using a screening tool often used in primary care settings," Thornburg told 番茄社区 in an email. "Ultimately, this study revealed that population mental health can be impacted distally by non-mental health policies."

While the study showed increases in symptoms of anxiety and depression for the general population after the opinion, the authors emphasized that most of the increases were driven by women of reproductive age.

This could be related to several factors, they wrote, "including fear about the imminent risk of abortion denial; uncertainty around future limitations on abortion and other related rights, such as contraception; worry over the ability to receive lifesaving medical care during pregnancy; and a general sense of violation and powerlessness related to loss of the right to reproductive autonomy."

, Julia Steinberg, PhD, of the University of Maryland in College Park, noted that the study's results are supported by other studies that have shown negative mental health trends after the Dobbs decision, especially .

"These results provide emerging evidence that at an individual level taking away reproductive autonomy (by not having legal access to an abortion) may increase symptoms of anxiety and depression in all people and particularly females of reproductive age," she wrote.

Steinberg said that while the effects of the study were small from a clinical perspective, they confirm an important contradiction in the argument that abortion may lead to negative mental health effects for women, which she said is often used to justify laws and policies restricting access.

"Scientific evidence consistently finds that abortion does not cause mental health problems," she wrote. "In fact those seeking abortions who are turned away experience mental health effects not observed in those who had received an abortion."

The need for clear and robust evidence about the effects of restricting access to reproductive care is critical, Steinberg added, especially as the U.S. Supreme Court plans to hear the case of FDA v. Alliance for Hippocratic Medicine, which will challenge a recent ruling banning use of mifepristone (Mifeprex).

For this study, Thornburg and co-authors used survey data from the nationally representative cross-sectional Household Pulse Survey from December 2021 to January 2023. Overall, there were 159,854 respondents from 13 states with abortion restriction trigger laws and 558,899 respondents from 37 states without those laws. The population-weighted mean age was 48 years, and just over half of respondents were women (51%).

The survey response rate was 6.04%, and 87% of respondents completed the PHQ-4.

Using difference-in-differences models, the authors examined the change in symptoms of depression and anxiety for respondents before the Dobbs decision, after the initial leaked draft on May 2, 2022, and after the official decision was released on June 24, 2022.

Mean PHQ-4 scores (scores of more than 5 indicate elevated depression or anxiety symptoms) in states with trigger laws increased from 3.51 (95% CI 3.44-3.59) before the decision to 3.81 (95% CI 3.75-3.87) after the official decision was released. Those living in states without trigger laws saw an increase in mean scores from 3.31 (95% CI 3.27-3.34) to 3.49 (95% CI 3.45-3.53).

Among men ages 18 to 45, the difference-in-differences estimate of 0.14 was not statistically significant (95% CI -0.08 to 0.36).

The study was limited by the dataset, which was a pooled cross section of different individuals over time and not a panel of the same sample measured repeatedly.

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