In a study published in JAMA, researchers have uncovered that the Supreme Court’s decision to overturn Roe v. Wade, known as the Dobbs decision, was linked to a noticeable increase in anxiety and depression symptoms across the United States. This effect was particularly pronounced among women of reproductive age in states that had preemptively passed laws to ban abortions upon the decision’s announcement.
The Dobbs v. Jackson Women’s Health Organization decision marked a pivotal moment in U.S. legal history, overturning nearly 50 years of federal abortion rights established by Roe v. Wade and Planned Parenthood v. Casey. This monumental ruling shifted the power to regulate abortions back to individual states, many of which had already enacted “trigger laws” designed to immediately ban abortions if Roe was overturned.
Thirteen states had trigger laws in place at the time the Dobbs decision was announced, including Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming.
In light of these dramatic legal shifts and the potential for widespread effects on public health, researchers embarked on a study to assess the mental health impacts of the Dobbs decision. Prior studies had shown that being denied an abortion could lead to increased depression and anxiety, but the broader implications of such a significant policy change on the general population’s mental health were not well understood.
“I had pursued a paper employing a similar methodology to assess the impacts of North Carolina’s controversial ‘Bathroom Bill.’ This research made it clear to me that noteworthy policy shifts like this could have an impact on factors that are not directly related to what they were designed to target,” said study author Benjamin Thornburg, a PhD candidate in the Bloomberg School’s Department of Health Policy and Management.
The new study utilized data from the Household Pulse Survey, an online survey initiated by the U.S. Census Bureau in April 2020, amid the COVID-19 pandemic. This survey aimed to collect real-time data on how U.S. households were faring in terms of health and socioeconomic status. With responses from 718,753 individuals, the survey provided a rich dataset for analysis.
The researchers focused on the Patient Health Questionnaire-4 (PHQ-4), a brief screening tool included in the survey to measure anxiety and depression symptoms. The PHQ-4 scores range from 0 to 12, with higher scores indicating more severe symptoms of anxiety and depression.
The analysis covered survey waves from December 29, 2021, to January 19, 2023, a period that included the leak and official announcement of the Dobbs decision, allowing the researchers to compare mental health outcomes before and after these events.
In the six months following the Dobbs decision, anxiety and depression scores increased by 8.5% in states with trigger laws, compared to a 5.4% increase in states without such laws. Notably, women aged 18 to 45 in trigger states saw a 3.03% increase in their PHQ-4 scores, while their counterparts in non-trigger states actually experienced a slight decrease. This suggests that the decision had a more substantial emotional and psychological toll on women of reproductive age in states poised to restrict abortion access.
“We found that adverse mental health impacts were driven primarily by females of reproductive age, which is surprising insofar as it indicates that the underlying mechanism was not necessarily salient for similarly aged males,” Thornburg told PsyPost.
Moreover, the researchers explored the probability of individuals exceeding the clinical threshold for anxiety and depression, as indicated by their PHQ-4 scores. It found a significant increase in the likelihood of surpassing this threshold in trigger states relative to non-trigger states, further highlighting the mental health risks posed by the Dobbs decision.
“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 said. “Ultimately, this study indicates that population mental health can be impacted distally by non-mental health policies.”
The findings offer valuable insights into the immediate and significant mental health impacts of major policy changes, particularly those affecting personal rights and freedoms such as the Dobbs decision. However, the study was not without its limitations.
The researchers noted the challenges inherent in using a relatively new dataset like the Household Pulse Survey, which, while beneficial for its timeliness and breadth, has not been as extensively validated as other long-standing data sources. Additionally, the survey’s design as a cross-sectional study — capturing different individuals’ responses over time rather than tracking the same individuals — complicates the task of attributing changes directly to the Dobbs decision.
“Our data were comprised of different groups of adults surveyed over time, which hampered our ability to adjust for individual level characteristics,” Thornburg explained. “However, our sample size was large and weighted to be representative of the population, which makes this limitation less concerning.”
Looking ahead, the study’s authors call for further research to explore the mental health impacts of policy changes more deeply. Specifically, they suggest future studies could benefit from longitudinal designs, providing clearer insights into how specific policy changes directly affect mental health. Moreover, understanding the role of political ideology and other individual-level factors in shaping responses to such policy shifts could offer a more nuanced view of their psychological impacts.
“We are currently working on a project assessing the impacts of the Dobbs decision on the National Residency Match,” Thornburg said. “Medical graduates are a geographically flexible group, often moving long distances for their preferred residency program, and their preferences are known to be greatly informed by a program’s geographic location. As such, we hypothesize that programs in states with abortion bans might have a harder time attracting applicants relative to those without, especially among medical specialties where the education would be affected explicitly (Ob/Gyn), or are comprised of a large proportion of residents who are women (family medicine, pediatrics, psychiatry, etc.).”
The study, “Anxiety and Depression Symptoms After the Dobbs Abortion Rights Decision,” was authored by Benjamin Thornburg, Alene Kennedy-Hendricks, Joanne Rosen, and Matthew Eisenberg.
