Anxiety, Depression Symptoms Increase Post-Dobbs Abortion Decision

Benjamin Thornburg, BS

Credit: Johns Hopkins University

Anxiety and depression symptoms increased in trigger states following the Dobbs abortion decision overturning Roe vs. Wade and Planned Parenthood v. Casey, according to a new study.¹

“Using a nationally representative dataset and variation in trigger law status across states, this study demonstrated that living in states with trigger abortion bans, compared with living in states without such bans, was associated with a small but significantly greater increase in [Patient Health Questionnaire-4] scores after the Dobbs opinion,” investigators wrote. “The study also demonstrated an increased probability of surpassing the [Patient Health Questionnaire-4’s] threshold for clinically relevant symptoms in states with trigger abortion bans relative to states without such bans after the Dobbs opinion and its leak.”

Since the constitution had previously protected abortion and women’s rights, the Dobbs decision caused an immediate shockwave: instantly banning abortion in 13 states with trigger laws. These states had already passed laws banning abortion that would go into effect as soon as the Supreme Court overturned Roe vs. Wade. States with trigger laws include Arkansas, Idaho, Kentucky, Louisiana, Missouri, Mississippi, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming.

“The Supreme Court has eliminated an established right that has been an essential component of women’s liberty for half a century – a right that has safeguarded women’s ability to participate fully and equally in society,” said Attorney General Merrick B. Garland on the day of Dobbs decision.²

Because of the sudden abortion ban in 13 states, investigators wanted to assess how the Dobbs abortion decision impacted mental health, specifically anxiety and depression symptoms, among individuals residing in trigger states relative to those in non-trigger states.¹ Led by Benjamin Thornburg, BS, from the department of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, the investigators obtained data from a nationally representative cross-sectional Household Pulse Survey from December 2022 and assessed changes in anxiety and depressive symptoms from before May 2, 2022 (baseline) to after the Dobbs decision on June 24, 2022, or the leaked draft of Dobbs on May 2, 2022.

The team compared changes in symptoms in the 13 trigger states (159, 854 respondents) and the 37 non-trigger states (558,899 respondents). Investigators measure anxiety and depressive symptomoms using the Patient Health Questionnaire-4 (PHQ-4). Of note, PHQ-4 scores range from 0 to 12 with a score of 5 or greater signifying the presence of anxiety or depressive symptoms.

The survey had a response rate of 6.04%, and 87% of respondents completed the Patient Health Questionnaire-4. The mean age of respondents was 48 years, and 51% were female.

At baseline, respondents in trigger states had a mean PHQ-4 of 3.51 (95% CI, 3.44 to 3.59) which increased to a score of 3.81 post-Dobbs decision (95% CI, 3.45 to 3.53). Moreover, the team observed a significantly greater increase in the mean Patient Health Questionnaire-4 by 0.11 (95% CI, 0.06 to 0.16; P < .001) in trigger states versus non-trigger states.

The change in anxiety and depression symptoms was not significantly different for those in trigger states versus non-trigger states (difference-in-differences estimate, 0.09; 95% CI, − 0.03 to 0.21; P = .15).

A significantly greater increase in mean PHQ-4 scores was observed among females aged 18 to 45 years in trigger versus non-trigger states (difference-in-differences estimate, 0.23; 95% CI, 0.08 to 0.37; P = .002) but not for males in the same age range (0.14; 95% CI, −0.08 to 0.36; P = .23). The differences in estimates for females and females aged 18 – 45 were statistically significant (P = .02), which investigators note demonstrates how the Dobbs decision increased females’ anxiety and depression symptoms more than males.

Limitations the investigators highlighted included using a new dataset developed for COVID-19, pooling data from various individuals over time rather than using the same sample, only having approximately a 6% response rate, and not reporting political ideology which could have affected how the Dobbs decision affected mental health.

“This finding could be related to many factors, 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,” concluded investigators.

^References

1. ^{Thornburg, B, Kennedy-Hendricks, A, Rosen, J, et al. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA. 2024;331(4):294-301. doi:10.1001/jama.2023.25599}
2. ^{Attorney General Merrick B. Garland Statement on Supreme Court Ruling in Dobbs v. Jackson Women’s Health Organization. Office of Public Affairs. June 24, 2022. https://www.justice.gov/opa/pr/attorney-general-merrick-b-garland-statement-supreme-court-ruling-dobbs-v-jackson-women-s. Accessed January 23, 2024.}