From Rights to Risks: Mental Health Implications for Pregnant Patients Following the Reversal of Roe v. Wade

Introduction The overturn of Roe v. Wade threatened reproductive rights, leading to bans, delayed access to care, and potentially increased psychological stress surrounding abortion care. We aim to assess the incidence and prevalence of acute stress episodes (ASE) and depressive episode diagnoses in patients after a non-spontaneous abortion. Methods We used a medical record database, TriNetX (TriNetX, LLC, Cambridge, MA), to assess the incidence and prevalence of depressive episodes (International Classification of Diseases, Tenth Revision, Clinical Modification {ICD-10-CM}=F32) and acute stress episodes (ICD-10-CM=F43.0, F43.9, and F43.11) in patients who received non-spontaneous abortions across 66 US healthcare organizations. We used relative risk with 95% confidence intervals to compare outcomes across three periods: pre-COVID (July 2017-2019), COVID (July 2020-2022), and post-Roe v. Wade (pRvW, July 2022-2024). Chi-squared (χ²) tests assessed differences within racial groups from 2017 to 2024. Results The prevalence of acute psychiatric episodes increased over time (depressive episodes: pre-COVID/COVID=0.779 {0.766-0.791} and COVID/pRvW=0.794 {0.783-0.806}; acute stress episode: pre-COVID/COVID=0.745 {0.713-0.779} and COVID/pRvW=0.739 {0.710-0.770}). The incidence of depressive episodes dipped during COVID and was highest during pRvW (pre-COVID/COVID, 1.062 {1.010-1.117}; COVID/pRvW, 0.845 {0.802-0.890}; pre-COVID/pRvW, 0.897 {0.850-0.947}). The incidence of acute stress episodes increased in the COVID and pRvW periods, but these periods were not statistically different from each other (pre-COVID/COVID, 0.838 {0.741-0.947}; pre-COVID/pRvW, 0.759 {0.667-0.863}). The prevalence of depressive episodes increased significantly for African American patients (χ²=15.845, degrees of freedom {dF}=6, and p=0.0146). Discussion Overall, there has been an increase in the incidence and prevalence of acute stress episode and depressive episode diagnoses since the overturn of Roe v. Wade, with certain racial groups being disproportionately impacted. This illustrates the need for improved psychological resources, specifically for marginalized communities. Conclusion The overturn of Roe v. Wade seems to be associated with an increased incidence and prevalence of acute psychiatric diagnoses after a non-spontaneous abortion. Further studies should be conducted to establish such an association.