New research indicates that the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health opinion is not just unpopular, but potentially linked to increased suicide risks.
In June, the decision overturned decades of reproductive healthcare protections established by the landmark 1973 Roe v. Wade ruling. Approximately one year before Dobbs, an interdisciplinary team from the University of Pennsylvania and Children’s Hospital of Philadelphia initiated research into abortion restrictions and suicide risk.
Their findings were recently published in the JAMA Psychiatry journal.
“Stress is a key contributor to mental health burden and a major driver of increased suicide risk,” said Ran Barzilay of the Perelman School of Medicine and CHOP, a child-adolescent psychiatrist, neuroscientist and co-author of the study. “We found that this particular stressor – restriction to abortion – affects women of a specific age in a specific cause of death, which is suicide. That’s the 10,000-foot view.”
Barzilay, Jonathan Zandberg of the Wharton School and Rebecca Waller of Penn’s Department of Psychology decided to work on the study after realizing overlaps in their research. They looked at the mental health implications of enforcing strict reproductive rights and risk of suicide, the third leading cause of death for 25- to 44-year-olds in the U.S.
To do this, they “conducted what’s called a difference-in-differences analysis, using state-level data from 1974 through 2016 and covering the entire population of adult women during that time,” said a press release. Even before the Dobbs, each state had its own laws around abortion access. These are tracked by the Guttmacher Institute.
“We constructed three indices that measure access to reproductive care by looking at the enforcement of state-level legislation,” Zandberg explained. “Every time a state enforced a law that was related to reproductive care, we incorporated it into the index.”
With this index, they analyzed suicide rates among women of reproductive age before and after the laws took effect. They compared those numbers to broad suicide trends and rates in places without similar restrictions.
“Comparatively, women who experienced the shock of this type of restrictive legislation had a significant increase in suicide rate,” Zandberg said.
For further perspective, they ran the same analysis for all 45- to 64-year-old women between 1974 and 2016. They did not find any effect in that age group. Additionally, they examined another common cause of death – motor vehicle death rates – and saw no effect.
These findings do not prove that restricting abortion access caused suicide rates to increase. However, researchers said that their “analytic approach is one of the most rigorous methods to enable causal inference.”
Barzilay said the “association is robust – and it has nothing to do with politics,” since it is backed by data.
“We’re looking at the connection between summary data about causes of death at the state level and policy and politics over many decades.
Yet, every death represents an individual moment of tragedy,” Waller said. “So, there’s clearly an awful lot more that we need to understand about what these findings mean for individual suicide risk.”
At this point, the research could help physicians and other health care providers approach suicide risk classification in reproductive-age women. It also “adds hard data to the ethical debate around abortion access,” and highlights the need for better suicide prevention access.
“Whatever your view is on all of this, it’s all over the news. It’s everywhere,” Waller explained. “The women internalizing the stories they hear are the ones who these restrictions will affect the most.”
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