Project Summary This project examines mental health from before to after an elective termination of pregnancy and whether and how the sociocultural context is associated with mental health around an elective termination. This research is important for effectively and efficiently promoting mental health in women and their families and for the well- being of future generations. Only one U.S. study conducted 30 years ago has examined depressive symptoms from before to after an elective termination, and no research has directly examined whether or how the sociocultural context influences mental health around an elective termination. Much has changed in the past 30 years regarding the sociocultural context and who has elective terminations. Patients who have elective terminations are more racially and ethnically diverse, more likely to be low income, and more likely to be mothers already. With respect to the sociocultural context, there has been an overall increase in the volume of enacted policies around elective terminations (with 2021 having the most since 1973), a decrease in the number of clinics providing elective terminations, and an increase in the percentage of U.S. adults believing elective terminations should be legal in all or most cases. Furthermore, within the U.S. these sociocultural indicators vary by geographical location. The long-term goal of this research is to understand whether and how the sociocultural context influences mental health around an elective termination so that brief interventions to promote mental health among those having elective terminations may be implemented most effectively and efficiently. The primary objectives of this proposal are to test the feasibility of a novel methodology that assesses mental health (including depressive, anxiety, stress, and post-traumatic stress symptoms, and suicidal ideation) from before to after an elective termination and examines whether and how the sociocultural context influences mental health around an elective termination. To do this, we propose to recruit and follow for a year 560 women having elective terminations in two very different sociocultural contexts (280 in each context). Informed by stress and coping theory, empirical research, and our recently conducted pilot cohort study, we have the following aims: 1) To detail mental health changes from 1 week before to 1 year after an elective termination, 2) To examine the extent to which the sociocultural context influences mental health around an elective termination, 3) To investigate whether stigma, logistical experiences, cognitive appraisals and coping expectations mediate the association between sociocultural context and mental health around an elective termination, and 4) To explore whether social support buffers the effects of a negative sociocultural context on mental health around an elective termination. Knowledge gained from the proposed research will guide next steps in research and inform brief interventions ...