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- Title
Association Between State-Level Access to Reproductive Care and Suicide Rates Among Women of Reproductive Age in the United States.
- Authors
Zandberg, Jonathan; Waller, Rebecca; Visoki, Elina; Barzilay, Ran
- Abstract
This cohort study analyzes suicide rates among reproductive-aged women from 1974 to 2016 to determine their association with state-level legislative policies surrounding abortion and restricted access to reproductive care. Key Points: Question: Are state-level legislative policies surrounding abortion or restricted access to reproductive care related to women's suicide rates in the United States? Findings: In this longitudinal ecologic study with a difference-in-differences analysis, the enforcement of laws restricting access to abortion and reproductive care from 1974 to 2016 was associated with suicide rates among reproductive-aged women but not women of postreproductive age. Meaning: Restrictions to reproductive care represent a macro-level risk factor for suicide among reproductive-aged women, which may have implications for suicide prevention strategies in this population, particularly as the issue remains at the center of divisive debate in the United States. Importance: Many states in the United States enforce restrictions to reproductive care, with access to abortion remaining a highly divisive issue. Denial of abortion is linked with heightened stress and anxiety among reproductive-aged women. However, no studies have tested whether access to reproductive care is linked to suicide. Objective: To evaluate whether state-level restrictions in access to reproductive care in the United States were associated with suicide rates among reproductive-aged women from 1974 to 2016. Design, Setting, and Participants: A longitudinal ecologic study with a difference-in-differences analysis assessed whether annual changes in the enforcement of state-level restrictions to reproductive care were related to annual state-level suicide rates vs rates of death due to motor vehicle crashes. Duration of follow-up varied between different states (range, 4-40 years), contingent on the first year that restrictions were implemented. Models controlled for year and state fixed effects and other relevant demographic and economic factors. Analyses were conducted between December 2021 and January 2022. Exposures: Targeted Regulation of Abortion Providers (TRAP) laws index measuring state-year–level restrictions to reproductive care. Main Outcomes and Measures: Annual state-level suicide rates and motor vehicle crash death rates among reproductive-aged women (ages 20-34 years; target group) vs women of postreproductive age (ages 45-64 years; control group). Results: Twenty-one US states enforced at least 1 TRAP law between 1974 and 2016. Annual rates of death by suicide ranged from 1.4 to 25.6 per 100 000 women of reproductive age to 2.7 to 33.2 per 100 000 women of postreproductive age during the study period (1974-2016). Annual motor vehicle crash death rates among women of reproductive age ranged from 2.4 to 42.9 per 100 000. Enforcement of TRAP laws was associated with higher suicide rates among reproductive-aged women (β = 0.17; 95% CI, 0.03 to 0.32; P =.02) but not women of postreproductive age (β = 0.06; 95% CI, –0.11 to 0.24; P =.47) nor to deaths due to motor vehicle crashes (β = 0.03, 95% CI, –0.04 to 0.11; P =.36). Among reproductive-aged women, the weighted average annual-state level suicide death rate when no TRAP laws were enforced was 5.5 per 100 000. Enforcement of a TRAP law was associated with a 5.81% higher annual rate of suicide than in pre-enforcement years. Findings remained significant when using alternative, broader indices of reproductive care access and different age categorizations. Conclusions and Relevance: In this study with a difference-in-differences analysis of US women, restrictions on access to reproductive care from 1974 to 2016 were associated with suicide rates among reproductive-aged women. Given the limitations of the ecologic design of this study, further research is needed to assess whether current factors affecting access to reproductive care services are related to suicide risk among women of reproductive age and to inform suicide prevention strategies.
- Subjects
UNITED States; CHILDBEARING age; SUICIDE statistics; ABORTION statistics; TRAFFIC accidents; SUICIDE prevention; SUICIDE risk factors; DEATH rate
- Publication
JAMA Psychiatry, 2023, Vol 80, Issue 2, p127
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2022.4394