Mental Distress Among Females Following 2021 Abortion Restrictions in Texas.

Importance: Understanding whether abortion restrictions are associated with poor mental health is crucial for mitigating policy, public health, or clinical interventions. Objective: 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. Design, Setting, Participants: 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. Exposure: Implementation of SB8 in Texas in September 2021. Main Outcomes and Measures: 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. Results: This study included 79 609 individuals (age proportion, 18 to 29 years [43.9%], 30 to 39 years [38.3%], 40 to 44 years [17.8%]; 15 614 females in Texas [25.5%]; 14 500 males in Texas [26.1%]; 49 495 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 15 614 females in Texas and increased from 11.1% (95% CI, 10.2%-12.0%) to 15.0% (95% CI, 13.1%-16.9%) in 14 500 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. Conclusions and Relevance: 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.