Restrictive abortion policy climate is associated with increased depression symptoms among women in the United States: Findings from a 25-year longitudinal study

To examine associations between state-level abortion restrictiveness and depression among female participants in a large, US sample surveyed from 1990-2015. Eligible participants were female respondents in the Monitoring the Future panel study followed from adolescence into adulthood (N=19,881 female respondents with 50,995 unique observations). Depression symptoms were assessed using a four-item index. State-level restrictive abortion policy climate was quantified using an annual index of 18 policies, standardized across states and years. We modeled associations using log-binomial multilevel models, adjusting for individual (e.g., race/ethnicity, age, urbanicity) and state-level (e.g., unemployment, income inequality, political and legislative composition, demographic composition, gender wage gap) confounders. We conducted tests to assess robustness of findings, including using a negative control outcome (motor vehicle crashes), alternative populations (male respondents), and subgroup tests by religiosity. A one-standard deviation increase in state abortion restrictiveness (equivalent to approximately 4 more restrictive laws) was associated with a 7% increase in depression symptoms among females (adjusted risk ratio [RR]=1.07, 95% confidence interval [CI]: 1.02-1.11). As hypothesized, associations among our alternative sample were not statistically significant (males, RR=1.03, 95% CI 0.99-1.08, though estimates did not statistically differ by sex) as were associations with our negative control outcome (motor vehicle crashes). As hypothesized, associations were most pronounced among female respondents reporting low religiosity (RR=1.08, 95% CI: 1.01-1.15), and not significant among those reporting high religiosity. Restrictive abortion policies are associated with higher depression symptoms among women. Legal protections for reproductive health care may benefit mental health. • This large national study examined the impact of abortion legislation on depression • Women in states with more abortion restrictions had more depression symptoms • Multiple robustness tests confirmed these associations