Suicide is the second leading cause of death among individuals aged 10 to 24 years in the US, and adolescent suicidality has been identified as a major psychiatric and public health concern.1,2 In response, considerable attention has been devoted to identifying modifiable risk factors associated with suicidal thoughts and behaviors.3 Recent research has emphasized the role of structural and policy-related determinants that influence access to resources and opportunities, exposure to stressors, and perceived control over major life events.4,5
In this study, we examine whether state-level changes in abortion access represent a potential structural contributor to suicidality among female adolescents. Specifically, we focus on total abortion bans implemented in multiple states following the 2022 US Supreme Court decision in Dobbs v Jackson Women’s Health Organization (hereafter, Dobbs). Total abortion bans effectively eliminate abortion access, since the few legal exceptions that exist are narrowly defined and infrequently applied.6,7
Female adolescents may be particularly vulnerable to these laws because they are directly affected by pregnancy and often face disproportionate financial and logistical barriers to accessing abortion care.8,9 In addition, loss of abortion access may affect adolescent mental health by increasing uncertainty and reducing perceived control over future life trajectories, consistent with evidence linking abortion denial to adverse mental health and socioeconomic outcomes.10 Adolescence is a critical period in psychological development, marked by heightened emotional reactivity and increased sensitivity to environmental stressors.11,12 As a result, the potential influence of reproductive health policies may be amplified during this developmental stage.
In this cross-sectional study using difference-in-differences analysis of high school students, implementation of state total abortion bans was significantly associated with suicidal ideation among female students, with a 4.3– to 4.4–percentage point increase compared with changes in states without bans. Estimates for suicide attempts among female students were similar in direction and magnitude, ranging from 3.2 to 3.9 percentage points, although they were less precisely estimated. There were no corresponding changes among male students, and event-study analyses showed no evidence of differential prepolicy trends for either sex. These findings are consistent with prior evidence linking restrictive abortion policies to adverse mental health outcomes among adult females, while providing new evidence regarding adolescent suicidality, a clinically urgent and understudied outcome in the post-Dobbs policy landscape.
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