Sociocultural Context and Suicidal Ideation Around an Unintended Pregnancy

This project examines suicidal ideation and behaviors and other psychological health outcomes (depression and post-traumatic stress disorder) from before to after an abortion in the U.S. and whether and how the sociocultural context is associated with these outcomes around an abortion. This research is important for effectively and efficiently preventing suicidal ideation and behaviors in people having abortions. Almost ¼ of women in the U.S. will have an abortion over their reproductive life span and research finds elevated rates of suicide and suicidal ideation and behaviors among those who have an abortion compared to those who do not. No U.S. study has prospectively examined individuals’ suicidal ideation and behaviors from before to after an abortion or what malleable contextual and individual factors are associated with suicidal ideation around such an experience. However, one recent study conducted at the state level found that states that enacted more restrictive abortion policies between 1974 and 2016—indicative of an unsupportive sociocultural context—subsequently had increases in completed suicides among reproductive aged women but not among post-menopausal women. These findings are provocative and warrant an investigation of the influence of the sociocultural context on individuals’ suicidal ideation and behaviors around an abortion in the U.S. While the sociocultural context surrounding abortion has varied by geography within the U.S. for some time, currently there is significant variation in the sociocultural context by state. The primary objective of this AFSP proposal is to capitalize on the very unique opportunity to expand a recently started (9/1/2023) R21 which, in November, will begin recruiting patients from Maryland (legal and supportive context) and Florida (legal and unsupportive context), two very different sociocultural contexts. This AFSP grant would fund a third and different sociocultural context (illegal and unsupportive context): those living in states where abortion is illegal and having medication abortions via Aid Access, a Dutch-run organization providing medications to women for $150. We will use a novel methodology to examine suicidal ideation and behaviors from before to after an abortion and whether and how the sociocultural context influences these outcomes around an abortion. To do this, we will recruit 280 people having abortions in states where it is banned and follow them for a year. Informed by stress and coping theory, empirical research, and a previously conducted pilot study, we have the following aims: 1) To detail changes in suicidal ideation and behaviors from 1 week before to 1 year after an abortion in the current context, 2) To examine the extent to which the sociocultural context influences suicidal ideation and behaviors around an abortion, 3) To investigate whether stigma, logistical experiences, cognitive appraisals and coping expectations mediate the association, and 4) To explore whether social support buffers the effects of a negative sociocultural context on suicidal ideation and behaviors around an abortion. Knowledge gained from the proposed research will be used for an R01 application and inform interventions and clinical practice aimed at preventing suicidal ideation and behaviors around an abortion.