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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.25599

摘要内容如下：

重要性

2022年，美国最高法院在多尔蒂诉杰克逊妇女健康组织案的裁决中废除了联邦堕胎权。在13个州，通过先前通过的立法，即触发法，立即禁止堕胎。

目的

评估多尔蒂判决后，居住在有触发法的州的人与居住在没有触发法的州的人相比，焦虑和抑郁症状的变化。

设计、设置和参与者

使用具有全国代表性的重复横断面家庭脉搏调查（2021年12月-2023年1月），通过比较13个触发状态和37个非触发状态，估计差异中的差异模型，以检查Dobbs（2022年6月24日的Dobbs决定，或2022年5月2日的泄露草案，以2022年5月2日之前的基线期为基准）后抑郁和焦虑症状的变化。对全部人群（N=718753）进行了模型估计，并分别对18至45岁的153108名女性和102581名男性进行了模型估计。

曝光

在多尔蒂裁决或其泄露的草案之后，居住在有触发法律的州。

主要成果和措施

通过患者健康问卷-4（[PHQ-4]）测量焦虑和抑郁症状；范围，0-12；得分超过5分表明抑郁或焦虑症状升高；最小重要差异未知）。

结果

总体调查回复率为6.04%，87%的受访者完成了PHQ-4。人口加权平均年龄为48岁（标准差为17岁），其中51%为女性。在触发状态下，基线期和多尔蒂决定后的平均PHQ-4评分分别为3.51（95%CI，3.44-3.59）和3.81（95%CI，3.75-3.87），在非触发状态下分别为3.31（95%CI，3.27-3.34）和3.49（95%CI，3.45-3.53）。平均PHQ-4评分显著增加0.11（95%CI，0.06至0.16；P<.001）在触发状态与非触发状态下。从基线到草案泄露后，PHQ-4的变化在触发状态与非触发状态之间没有显著差异（双重差分估计，0.09；95%可信区间为-0.03~0.21；P=.15）。从基线到多尔蒂意见后，在18至45岁的女性中，与非触发状态相比，触发状态的平均PHQ-4得分显著增加（双重差分估计，0.23；95%可信区间为0.08~0.37；P=.002）。在18岁至45岁的男性中，双重差分估计值无统计学意义（0.14；95%可信区间为-0.08~0.36；P=.23）。18岁至45岁的男性和女性的估计值差异具有统计学意义（P=.02）。

结论和相关性

在这项对2021年12月至2023年1月的美国调查数据的研究中，与居住在没有堕胎触发法的州相比，居住在有堕胎触发法的州与多尔蒂案判决后焦虑和抑郁症状的小幅但显著增加有关。

英文原文如下：

Abstracts

Importance  In 2022, the US Supreme Court abolished the federal right to abortion in the Dobbs v Jackson Women's Health Organization decision. In 13 states, abortions were immediately banned via previously passed legislation, known as trigger laws.

Objective  To estimate changes in anxiety and depression symptoms following the Dobbs decision among people residing in states with trigger laws compared with those without them.

Design, Setting, and Participants  Using the nationally representative repeated cross-sectional Household Pulse Survey (December 2021-January 2023), difference-in-differences models were estimated to examine the change in symptoms of depression and anxiety after Dobbs (either the June 24, 2022, Dobbs decision, or its May 2, 2022, leaked draft benchmarked to the baseline period, prior to May 2, 2022) by comparing the 13 trigger states with the 37 nontrigger states. Models were estimated for the full population (N = 718 753), and separately for 153 108 females and 102 581 males aged 18 through 45 years.

Exposure  Residing in states with trigger laws following the Dobbs decision or its leaked draft.

Main Outcomes and Measures  Anxiety and depression symptoms were measured via the Patient Health Questionnaire-4 ([PHQ-4]; range, 0-12; scores of more than 5 indicate elevated depression or anxiety symptoms; minimal important difference unknown).

Results  The survey response rate was 6.04% overall, and 87% of respondents completed the PHQ-4. The population-weighted mean age was 48 years (SD, 17 years), and 51% were female. In trigger states, the mean PHQ-4 scores in the baseline period and after the Dobbs decision were 3.51 (95% CI, 3.44 to 3.59) and 3.81 (95% CI, 3.75 to 3.87), respectively, and in nontrigger states were 3.31 (95% CI, 3.27 to 3.34) and 3.49 (95% CI, 3.45 to 3.53), respectively. There was a significantly greater increase in the mean PHQ-4 score by 0.11 (95% CI, 0.06 to 0.16; P < .001) in trigger states vs nontrigger states. From baseline to after the draft was leaked, the change in PHQ-4 was not significantly different for those in trigger states vs nontrigger states (difference-in-differences estimate, 0.09; 95% CI, -0.03 to 0.21; P = .15). From baseline to after the Dobbs opinion, there was a significantly greater increase in mean PHQ-4 scores for those in trigger states vs nontrigger states among females aged 18 through 45 years (difference-in-differences estimate, 0.23; 95% CI, 0.08 to 0.37; P = .002). Among males aged 18 through 45 years, the difference-in-differences estimate was not statistically significant (0.14; 95% CI, -0.08 to 0.36; P = .23). Differences in estimates for males and females aged 18 through 45 were statistically significant (P = .02).

Conclusions and Relevance  In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

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