Adolescent Suicidality After State-Level Total Abortion Bans.

Importance: Suicide is a leading cause of death among US adolescents, and restrictive abortion policies may influence suicide risk by increasing uncertainty and reducing perceived control over life trajectories, particularly among female adolescents who face disproportionate barriers to abortion access. Following the 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization, multiple states implemented total abortion bans. Their association with adolescent suicidality has not been quantitatively assessed. Objective: To evaluate whether implementation of total abortion bans was associated with suicidal ideation and suicide attempts among female high school students. Design, Setting, and Participants: This cross-sectional study used difference-in-differences and event-study analyses of data from the Centers for Disease Control and Prevention Youth Risk Behavior Surveys (2017, 2019, 2021, and 2023) conducted among female and male students in grades 9 to 12 at public high schools in 15 participating states. Analyses were conducted between January 2025 and February 2026 and stratified by sex. Exposure: State-level implementation of a total abortion ban during the 12 months preceding survey administration. Main Outcomes and Measures: Outcomes of interest were self-reported suicidal ideation (serious consideration or planning) and suicide attempts (≥1) in the past 12 months, measured using Youth Risk Behavior Survey items. Results: The analytic sample included 338 324 students (median [IQR] age, 16 [15-17] years), of whom 169 967 (50%) were female. Among female students, increases in suicidal ideation were greater in states that implemented abortion bans than in states that did not (adjusted difference-in-differences estimate, 4.3 [95% CI, 1.6 to 6.5] percentage points). For suicide attempts, the corresponding estimate was similar but less precise and did not reach statistical significance (adjusted difference-in-differences estimate, 3.2 [95% CI, -0.4 to 6.1] percentage points). Among male students, estimates were smaller and not statistically significant (adjusted difference-in-differences estimate: ideation, 1.1 [95% CI, -0.9 to 4.4] percentage points; attempts, -0.3 [95% CI, -3.2 to 6.6] percentage points). For both sexes, event-study estimates reinforced the difference-in-differences findings and showed no evidence of differential prepolicy trends. Conclusions and Relevance: In this cross-sectional study of high school students, implementation of total abortion bans was associated with increased suicidal ideation among female students, with similar but less precise estimates observed for suicide attempts. These findings suggest that the policies in these states may adversely influence female adolescents' mental health and underscore the importance of accessible suicide prevention and mental health services in affected states.