Objective: This study analyzes the impact of the 2022 Dobbs decision on the mental health of pregnant individuals across the United States (US), focusing on rates of depression and anxiety diagnoses before and after the ruling Study Design: A retrospective analysis was conducted using the Epic Cosmos database. Over 8.5 million pregnant patients accessing pregnancy care between 2018 to 2024 were included. As a control population, legal sex males aged 18–45 across the US during the same time periods were assessed. Rates of anxiety and depression were compared between two time periods: pre-Dobbs (January 2018 - February 2020) and post-Dobbs (September 2022 - July 2024), excluding the COVID-19 period (March 2020 - August 2022). The rates of depression and anxiety diagnoses were identified in the Cosmos database, using specific International Classification of Diseases-10 (ICD-10) diagnosis codes for depression and anxiety, as shown in the billing code and problem list. For depression, the codes included were F32.A (Depression, unspecified), F32.* (Major Depression), and F53.0 (Postpartum Depression). For anxiety, the codes utilized were F41.9 (Anxiety disorder, unspecified), F41.* (Generalized anxiety disorder and other anxiety-related conditions), and F43.22 (Adjustment disorder with anxiety). States were categorized based on their abortion policies using Guttmacher Institute criteria: restrictive, protective/restrictive (states with both protective and restrictive policies), or protective. Results: Among 8,881,574 pregnant patients, significant increases in depression and anxiety rates were observed post-Dobbs. Depression diagnoses increased from 8.0% to 11.3% in restrictive states (p<0.001), from 8.2% to 10.8% in protective/restrictive-policy states (p<0.001), and from 8.6% to 11.1% in protective states (p<0.001). Anxiety rates rose from 8.7% to 14.2% in restrictive states (p<0.001), from 10.0% to 13.89% in protective/restrictive-policy states (p<0.001), and from 9.6% to 14.2% in protective states (p<0.001). Comparatively, for males aged 18-45, overall depression rates increased from 5.0% to 5.7% and overall anxiety rates increased from 7.2% to 8.7% (p<0.001). Restrictive states demonstrated the largest increased rates of both conditions. Restrictive states Kentucky and Ohio showed the most pronounced rise in depression rates (Kentucky: 8.1% to 13.9%, p<0.001; Ohio: 11.3% to 16.6%, p<0.001). Similarly, anxiety rates increased sharply in restrictive state West Virginia (12.1% to 20.7%, p<0.001). Protective states exhibited more modest changes. For example, Rhode Island showed a non-significant decrease in anxiety diagnoses (9.2% to 8.2%, p=0.137). Conclusions: Following the Dobbs decision, depression and anxiety rates among pregnant individuals significantly increased, with the largest impact observed in states with restrictive abortion policies. These findings highlight the differential impact of state-level abortion policies on mental health outcomes during pregnancy.

Impact of the Dobbs Decision on Depression & Anxiety Rates During Pregnancy: An Epic Cosmos Analysis