{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:00:41Z","timestamp":1783443641098,"version":"3.54.6"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Understanding whether abortion restrictions are associated with poor mental health is crucial for mitigating policy, public health, or clinical interventions.<\/jats:p><\/jats:sec>Objective<\/jats:title>To quantify changes in frequent mental distress among females in Texas, following implementation of the 2021 Texas Heartbeat Act Senate Bill 8 (SB8), which banned abortions upon detection of embryonic cardiac activity.<\/jats:p><\/jats:sec>Design, Setting, Participants<\/jats:title>This cross-sectional study was conducted using 2012 to 2022 data from the Behavioral Risk Factor Surveillance System (BRFSS), a population-based representative survey. Participants were aged 18 to 44 years and included females in Texas, males in Texas, and females in other states. Data were analyzed from May 2024 to February 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Implementation of SB8 in Texas in September 2021.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was frequent mental distress, defined as 14 days or more of poor mental health during the past 30 days. Difference-in-differences models were used to examine the association between SB8 implementation and changes in frequent mental distress among females aged 18 to 44 years in Texas compared with males in Texas and females from other states.<\/jats:p><\/jats:sec>Results<\/jats:title>This study included 79\u202f609 individuals (age proportion, 18 to 29 years [43.9%], 30 to 39 years [38.3%], 40 to 44 years [17.8%]; 15\u202f614 females in Texas [25.5%]; 14\u202f500 males in Texas [26.1%]; 49\u202f495 females in other states [48.4%]). Between 2012 and 2022, frequent mental distress increased from 14.2% (95% CI, 13.2%-15.2%) to 21.9% (95% CI, 19.4%-24.4%) in 15\u202f614 females in Texas and increased from 11.1% (95% CI, 10.2%-12.0%) to 15.0% (95% CI, 13.1%-16.9%) in 14\u202f500 males in Texas. SB8 implementation in 2021 was associated with an adjusted increase of 6.8 (95% CI, 3.0-10.6) percentage points among females compared with males. In a stratified analysis by age group, SB8 was associated with larger increases in frequent mental distress among females aged 18 to 29 years (9.8 [95% CI, 3.1-16.7] percentage points) and females aged 30 to 39 years (7.4 [95% CI, 2.0-12.9] percentage points) compared with males. In adjusted models comparing females in Texas with females in other states, SB8 was associated with an increase of 5.3 (95% CI, 1.7-9.0) percentage points compared with females in 5 pooled states (Arkansas, Indiana, Kentucky, Mississippi, Oklahoma) and an increase of 6.1 (95% CI, 2.0-10.2) percentage points compared with females in California in frequent mental distress.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this repeated cross-sectional study, there was a significant association between SB8 implementation and an increase in frequent mental distress. Disproportionately higher increases among younger people could be associated with higher levels of anticipated or actual need for abortion care or less ability to overcome barriers to care, including travel. These findings signal that state abortion policy may negatively affect mental health.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.9576","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T15:00:51Z","timestamp":1747062051000},"page":"e259576","source":"Crossref","is-referenced-by-count":9,"title":["Mental Distress Among Females Following 2021 Abortion Restrictions in Texas"],"prefix":"10.1001","volume":"8","author":[{"given":"Jusung","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"White","sequence":"additional","affiliation":[{"name":"Resound Research for Reproductive Health, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa K.","family":"Dalton","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor"},{"name":"Program on Women\u2019s Healthcare Effectiveness Research, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"issue":"20","key":"zoi250347r2","doi-asserted-by":"publisher","first-page":"2048","DOI":"10.1001\/jama.2022.20423","article-title":"Association of Texas\u2019 2021 ban on abortion in early pregnancy with the number of facility-based abortions in Texas and surrounding states.","volume":"328","author":"White","year":"2022","journal-title":"JAMA"},{"issue":"1","key":"zoi250347r4","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14226","article-title":"Abortion patients\u2019 decision making about where to obtain out-of-state care following Texas\u2019 2021 abortion ban.","volume":"59","author":"White","year":"2024","journal-title":"Health Serv Res"},{"issue":"5","key":"zoi250347r5","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1097\/AOG.0000000000005153","article-title":"Abortion access and medically complex pregnancies before and after Texas Senate Bill 8.","volume":"141","author":"Arey","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"8","key":"zoi250347r6","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1001\/jamapediatrics.2024.0885","article-title":"Infant deaths after Texas\u2019 2021 ban on abortion in early pregnancy.","volume":"178","author":"Gemmill","year":"2024","journal-title":"JAMA Pediatr"},{"issue":"4","key":"zoi250347r7","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.ajog.2022.06.060","article-title":"Maternal morbidity and fetal outcomes among pregnant women at 22 weeks\u2019 gestation or less with complications in 2 Texas hospitals after legislation on abortion.","volume":"227","author":"Nambiar","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"zoi250347r8","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1001\/jamapsychiatry.2022.4394","article-title":"Association between state-level access to reproductive care and suicide rates among women of reproductive age in the United States.","volume":"80","author":"Zandberg","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"4","key":"zoi250347r9","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1001\/jama.2023.25599","article-title":"Anxiety and depression symptoms after the Dobbs abortion decision.","volume":"331","author":"Thornburg","year":"2024","journal-title":"JAMA"},{"issue":"27","key":"zoi250347r10","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.adl5743","article-title":"The impact of abortion restrictions on American mental health.","volume":"10","author":"Anderson","year":"2024","journal-title":"Sci Adv"},{"issue":"3","key":"zoi250347r11","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.4509","article-title":"Mental Distress among female individuals of reproductive age and reported barriers to legal abortion following the US supreme court decision to overturn Roe v Wade.","volume":"6","author":"Dave","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"16","key":"zoi250347r12","article-title":"Self-reported frequent mental distress among adults\u2014United States, 1993-1996.","volume":"47","author":"Centers for Disease Control and Prevention","year":"1998","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"zoi250347r13","doi-asserted-by":"publisher","DOI":"10.5888\/pcd10.130090","article-title":"Adult caregivers in the United States: characteristics and differences in well-being, by caregiver age and caregiving status.","volume":"10","author":"Anderson","year":"2013","journal-title":"Prev Chronic Dis"},{"issue":"1","key":"zoi250347r14","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1089\/pop.2015.0162","article-title":"Leveraging health-related quality of life in population health management: the case for healthy days.","volume":"20","author":"Slabaugh","year":"2017","journal-title":"Popul Health Manag"},{"issue":"10","key":"zoi250347r18","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.2105\/AJPH.2013.301339","article-title":"Disparities in abortion rates: a public health approach.","volume":"103","author":"Dehlendorf","year":"2013","journal-title":"Am J Public Health"},{"issue":"7","key":"zoi250347r19","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1001\/archpsyc.63.7.824","article-title":"Association between obesity and psychiatric disorders in the US adult population.","volume":"63","author":"Simon","year":"2006","journal-title":"Arch Gen Psychiatry"},{"key":"zoi250347r20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02646838.2024.2353091","article-title":"Delayed care during pregnancy and postpartum linked to poor maternal mental health: evidence in the United States.","volume":"9","author":"Lee","year":"2024","journal-title":"J Reprod Infant Psychol"},{"key":"zoi250347r21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1093\/eurpub\/ckx008","article-title":"The relationship between self-reported health status and signs of psychological distress within European urban contexts.","volume":"27","author":"Williams","year":"2017","journal-title":"Eur J Public Health"},{"issue":"2","key":"zoi250347r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.1122","article-title":"Association of Texas Senate Bill 8 with requests for self-managed medication abortion.","volume":"5","author":"Aiken","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi250347r23","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1001\/jama.2023.12034","article-title":"Texas\u2019 2021 ban on abortion in early pregnancy and changes in live births.","volume":"330","author":"Bell","year":"2023","journal-title":"JAMA"},{"key":"zoi250347r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2024.110731","article-title":"The impact of the SB 8 Texas abortion ban on pregnancy duration at time of abortion in a large volume Colorado clinic.","volume":"143","author":"Dindinger","year":"2025","journal-title":"Contraception"},{"issue":"4","key":"zoi250347r25","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.contraception.2015.12.017","article-title":"Women\u2019s experiences seeking abortion care shortly after the closure of clinics due to a restrictive law in Texas.","volume":"93","author":"Fuentes","year":"2016","journal-title":"Contraception"},{"issue":"3","key":"zoi250347r27","article-title":"Texas\u2019 2021 ban on abortion in early pregnancy was associated with a decrease in abortion in Texas, an increase in abortions out of state, and a decrease in overall abortions.","volume":"8","author":"White","year":"2023","journal-title":"PRC Research Brief"},{"issue":"8","key":"zoi250347r28","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1001\/jamapediatrics.2024.0885","article-title":"Infant deaths after Texas\u2019 2021 ban on abortion in early pregnancy.","volume":"178","author":"Gemmill","year":"2024","journal-title":"JAMA Pediatr"},{"issue":"2","key":"zoi250347r29","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.jadohealth.2021.11.010","article-title":"Call to action: healthcare providers must speak up for adolescent abortion access.","volume":"70","author":"Bryson","year":"2022","journal-title":"J Adolesc Health"},{"issue":"9","key":"zoi250347r30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7209a1","article-title":"Abortion surveillance\u2014United States, 2021.","volume":"72","author":"Kortsmit","year":"2023","journal-title":"MMWR Surveill Summ"},{"key":"zoi250347r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2023.110128","article-title":"\u201cTime and money and support\u201d: adolescents and young adults\u2019 perceived social and logistical support needs for safe abortion care.","volume":"126","author":"Vear","year":"2023","journal-title":"Contraception"},{"key":"zoi250347r1","unstructured":"The Heartbeat Act, S 8, 2021-2022, 87th Leg (TX 2021). Accessed June 22, 2024. https:\/\/legiscan.com\/TX\/bill\/SB8\/2021."},{"key":"zoi250347r3","unstructured":"Abortion in the United States dashboard. Kaiser Family Foundation. Accessed July 25, 2024. https:\/\/www.kff.org\/womens-health-policy\/dashboard\/abortion-in-the-u-s-dashboard\/."},{"key":"zoi250347r15","unstructured":"State Actions to Mitigate the Spread of COVID-19. Kaiser Family Foundation. Accessed January 16, 2025. https:\/\/www.kff.org\/other\/state-indicator\/state-actions-to-mitigate-the-spread-of-covid."},{"key":"zoi250347r16","unstructured":"QuickFacts: California. United States Census. Accessed February 5, 2025. https:\/\/www.census.gov\/quickfacts\/fact\/table\/CA\/PST045223?"},{"key":"zoi250347r17","unstructured":"QuickFacts: Texas. United States Census. Accessed February 5, 2025. https:\/\/www.census.gov\/quickfacts\/fact\/table\/TX\/RHI225223."},{"key":"zoi250347r26","unstructured":"White? K, Dane\u2019el? A, Vizcarra? E, . Out-of-state travel for abortion following implementation of Texas Senate Bill 8. Texas Policy Evaluation Project. 2022. Accessed April 28, 2024. http:\/\/sites.utexas.edu\/txpep\/files\/2022\/03\/TxPEP-out-of-state-SB8.pdf."},{"key":"zoi250347r31","unstructured":"Rossen? LM, Hamilton? BE, Abma? JC, . Updated methodology to estimate overall and unintended pregnancy rates in the United States. National Center for Health Statistics. Accessed April 6, 2025. https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02-201.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833846\/lee_2025_oi_250347_1746462718.41026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T15:00:54Z","timestamp":1747062054000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.9576","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]}}}