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A study published in JAMA Network Open suggests that the implementation of state-level total abortion bans is associated with an increase in suicidal thoughts among female high school students. The findings indicate that severe legal restrictions on abortion care may negatively influence adolescent mental health in affected regions. This research highlights a potential link between major reproductive healthcare policy changes and youth psychological well-being across the United States.
Suicide represents one of the leading causes of death among young people aged 10 to 24 in the United States. In recent years, public health experts have increasingly examined how broad societal conditions and legal policies shape emotional health. Policy decisions that restrict access to basic healthcare services tend to increase personal uncertainty and reduce an individual’s sense of control over their future life events.
In June 2022, the United States Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization, which overturned national constitutional protections for abortion access. Following this landmark ruling, multiple states swiftly passed total abortion bans that outlawed nearly all abortion services within their borders. Prior to this decision, public discussions rarely examined potential links between reproductive restrictions and suicide risk among adolescents.
“Right before the Dobbs decision, there was a lot of speculation about the effects of overturning Roe v. Wade, but almost no attention to suicide risk,” said Wendy R. Sheldon, founder and director of Verge Research. She noted that international observations helped inform the research team’s focus on youth mental health.
“Having worked in other countries where abortion was illegal, I knew that some women facing unwanted pregnancies would go to extraordinary lengths to end them, including risking their own lives,” Sheldon explained. “I also knew that young people are hit hardest by abortion restrictions and that an unwanted pregnancy at a young age can be especially devastating. So I wanted to explore whether there might be a connection between abortion restrictions and suicidality among young people.”
Female adolescents are often uniquely vulnerable to changes in reproductive healthcare law. Young women face significant financial, logistical, and social barriers when seeking healthcare services compared to older adults. Additionally, experiencing an unintended pregnancy during teenage years can dramatically alter a young person’s educational, financial, and social trajectory.
“Adolescents have largely been left out of the research and public discussion about the consequences of abortion bans,” Sheldon pointed out. “Young people face particular barriers to obtaining abortion care, including financial limitations, travel difficulties, and parental involvement requirements. Yet we still know very little about how and to what extent these barriers affect their mental health.”
Adolescence is a critical developmental stage characterized by heightened emotional reactivity and sensitivity to environmental stressors. Public awareness of legal restrictions can generate feelings of distress, anxiety, or helplessness among teenagers. Even for adolescents who are not currently pregnant, perceived loss of reproductive autonomy can act as a chronic psychological stressor that influences mental health outcomes.
To examine how these legal changes might influence youth mental health, the researchers analyzed data from the Youth Risk Behavior Survey. Managed by the Centers for Disease Control and Prevention, this survey gathers national data on health behaviors among high school students using standardized, anonymous questionnaires. The scientists examined survey data collected across four different time points: 2017, 2019, 2021, and 2023.
The final dataset included 338,324 public high school students in grades 9 through 12 across 15 states. Exactly 169,967 of these participants were female, and the overall median age was 16 years old. About 10 percent of the total sample resided in states that implemented total abortion bans following the 2022 Supreme Court ruling.
The researchers classified states into two distinct groups based on their legal environment. Five states in the dataset, including Arkansas, Missouri, Oklahoma, Tennessee, and Texas, enacted total abortion bans during the 12 months preceding the 2023 survey. Ten other states in the dataset did not enact total bans during the study period and served as a baseline control group, including states such as Maryland, Michigan, Nevada, and Pennsylvania.
To evaluate changes in mental health, the authors measured two specific outcomes: suicidal ideation and suicide attempts. Suicidal ideation was defined as a student reporting that they had seriously considered or made a detailed plan to attempt suicide within the past 12 months. Suicide attempts were defined as reporting one or more actual attempts, or reporting an attempt that resulted in an injury or overdose requiring medical care.
The authors employed a statistical technique known as a difference-in-differences analysis. This method compares the change in outcomes over time among a group affected by a policy change to the change over time among an unaffected comparison group. By using this approach, scientists can separate the specific effect of a policy implementation from broader, national shifts in adolescent mental health trends.
The statistical models adjusted for individual student characteristics, including race, ethnicity, and grade level in school. The researchers also controlled for state-level COVID-19 death rates during each survey year to account for potential differences in pandemic severity that might have influenced mental well-being. Additionally, the authors analyzed data from male high school students as a secondary control group, as male teenagers were not directly subject to the legal limits placed on personal pregnancy options.
The statistical analysis demonstrated a distinct divergence in mental health trends after the implementation of total abortion bans. Prior to 2022, female students in states that later enacted bans showed similar mental health trends to female students in non-ban states. Following the policy changes in 2023, suicidal ideation among female students in ban states rose from 33 percent to 34 percent, whereas in non-ban states, ideation dropped from 33 percent to 29 percent.
After applying full statistical controls, the difference-in-differences model showed that total abortion bans were associated with an adjusted 4.3 percentage point increase in suicidal ideation among female high school students. This difference was statistically significant, indicating that the pattern was unlikely to be the result of random chance. The mathematical models confirmed that prepolicy trends were equivalent between the two state groups prior to the policy enactments.
For suicide attempts among female students, unadjusted trends rose from 15 percent in 2021 to 18 percent in 2023 in ban states, while remaining relatively flat in non-ban states at around 11 percent. The adjusted statistical model indicated a 3.2 percentage point increase in suicide attempts among female students in ban states compared to non-ban states, though this estimate was less mathematically precise. In contrast, male students showed no statistically significant changes in either suicidal ideation or suicide attempts following the legal shifts.
“The main takeaway is that abortion bans may have consequences that go well beyond access to abortion itself,” Sheldon said. “We found an increase of about 4 percentage points in suicidal thoughts among female high school students in states with total abortion bans, compared with female students in states without bans. We didn’t find anything comparable among male students. We also saw increases in suicide attempts of a similar magnitude, although those estimates were less precise.”
Sheldon expressed surprise at how rapidly these psychological patterns emerged across the population. “I was surprised by how large the increase in suicidal ideation was among female students in ban states and how quickly it appeared after the bans took effect,” Sheldon told PsyPost. “The contrast with male students in those same states also stood out. We didn’t see comparable changes in ideation or attempts among males, which makes the findings for females even more concerning.”
Some methodological factors should be kept in mind when reading these conclusions. The Youth Risk Behavior Survey gathers cross-sectional data, meaning different groups of students complete the survey during each cycle. Because researchers cannot track individual students over time, the study cannot measure how a specific student’s mental health changed directly before and after the policy shift.
The study design also means that individual motivations behind reported thoughts of suicide cannot be directly identified. “Our study wasn’t designed to tell us why suicidal ideation increased. There are likely multiple factors at play, and these may vary depending on young people’s different lived experiences,” Sheldon explained.
“We also don’t know whether the students reporting suicidal thoughts had personally experienced an unwanted pregnancy or ever sought an abortion,” Sheldon added. “Because we observed an increase at the population level, it’s likely that these policies are affecting young people more broadly, not only those who have personally needed abortion services.”
Data availability presented additional challenges across participating regions. Response rates for the suicide attempt questions were lower than those for suicidal ideation, which reduced statistical precision. Additionally, exposure to the policy was not completely uniform, as some students had lived under total abortion bans for longer periods than others when answering the questionnaire.
The survey sample was restricted to teenagers attending public high schools, meaning these findings may not automatically apply to home-schooled students, private school students, or youth who have left school. States that enacted total abortion bans may also differ from non-ban states in broader political or social climates that were not captured by the study’s demographic controls. Sheldon noted that “our study cannot tell us exactly why this happened, but it suggests we need to take the potential mental health effects of these policies seriously, especially for young people.”
To address these unanswered questions, the authors are pursuing further research to understand the direct experiences of affected youth. “Our next priority is understanding what’s driving this relationship,” Sheldon explained. “As a first step, we’re partnering with Advocates for Youth on workshops with young pregnancy-capable people living in ban states. We want to hear directly from them about how these policies are affecting mental health in their communities, and what kinds of support they think would make the biggest difference.”
The researchers hope to use these community insights to build practical support systems. “Ultimately, we hope to develop and evaluate an intervention designed by and for young people, to help address suicidality in communities with total abortion bans,” Sheldon said. “We’re also looking at whether the mental health effects of total abortion bans differ by race, age, or other characteristics. We’re continuing our analyses using CDC Youth Risk Behavior Survey data and exploring collaborations that would allow us to explore these questions using other data sources.”
Sheldon emphasized the importance of including adolescent voices in broader policy evaluations moving forward. “I hope these findings encourage researchers, policymakers, clinicians, educators, and families to listen more closely to young people, and to consider their mental health when shaping abortion policies and assessing their consequences,” Sheldon remarked.
The study, “Adolescent Suicidality After State-Level Total Abortion Bans,” was authored by Wendy R. Sheldon, Rayan Ouaddi, Nicole Chen, and Jason M. Lindo.