(278) Socioeconomic Vulnerabilities and Postpartum Depression: Assessing the Aftermath of Dobbs v. Jackson in Trigger and Non-Trigger States

Background: : The US Supreme Court's Dobbs v Jackson Women’s Health Organization decision (June 2022) returned abortion regulation to individual states, activating previously enacted trigger laws in several states.

Objective: : To examine the changes in postpartum depression (PPD) diagnoses resulting from abortion restrictions implemented after the Dobbs decision.

Methods: : A retrospective cohort study was conducted using Medicaid data from January 2019 to December 2024. Women aged 12 to 55 years were categorized into high, medium, and low socioeconomic status (SES) groups based on a summary measure derived from 2021 US Census data. Two analytic samples were created for each SES group, representing the periods before and after the Dobbs decision. A Difference-in-Differences (DiD) approach was used to estimate changes in PPD diagnoses among residents of trigger states post-Dobbs relative to pre-Dobbs changes in non-trigger states.

Results: : The pre-Dobbs period included 34,836 (high-SES), 33,854 (medium-SES), and 34,017 (low-SES) individuals. The post-Dobbs period included 20,581 (high-SES), 20,342 (medium-SES), and 20,207 (low-SES) individuals. Residents of trigger states were younger, more often located in the South, had a higher rate of teenage pregnancy, and faced greater socioeconomic challenges, but had lower rates of maternal comorbidities, lifestyle risk factors, and obstetrical complications. Residence in a trigger state was significantly associated with an increased likelihood of PPD diagnosis only for patients residing in low-SES areas (DiD estimate 0.055, 95% CI: 0.045-0.066).

Conclusions: : Analysis of Medicaid data from December 2019 to December 2024 revealed statistically significant differences in PPD diagnosis rates between trigger and non-trigger states following Dobbs among women in lower-SES areas.

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