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Abstract
A phenomenological approach was used to examine the responses of women to elective abortion. Sixteen women who terminated a pregnancy for nonmedical reasons at least 15 years previously participated. These women were caught up in the moment, they made a decision, had an abortion, and life continued—for some as before, for others, forever altered. Women encountered a sense of disruption. The abortion and reflections about the experience existed as an unspoken story, confided to few. Thoughts of this past experience reached into present events and generated new awareness, producing insights. The terminated pregnancy for some became embodied. These women were compelled to make sense of their abortion experiences as they sought to integrate these experiences into their sense of self. These women’s relationships affected the abortion experience and were affected by the abortion experience. This research expands our understanding of the long-term responses of women after abortion.
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Thorp JM. Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later. SCIENTIFICA 2012; 2012:980812. [PMID: 24278765 PMCID: PMC3820464 DOI: 10.6064/2012/980812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/15/2012] [Indexed: 06/02/2023]
Abstract
During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one or more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadequate for this important task.
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Affiliation(s)
- John M. Thorp
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
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Coleman PK, Maxey CD, Spence M, Nixon CL. Predictors and Correlates of Abortion in the Fragile Families and Well-Being Study: Paternal Behavior, Substance Use, and Partner Violence. Int J Ment Health Addict 2008. [DOI: 10.1007/s11469-008-9188-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rowlands S. The decision to opt for abortion. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008; 34:175-80. [DOI: 10.1783/147118908784734765] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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5
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Abstract
The aim of the present review was to explore the role of the psychiatrist in late terminations of pregnancy. A literature review was conducted using MEDLINE and psycINFO databases, focussing on articles that explored (i) existing decision-making processes in late terminations; (ii) psychological sequelae of both early and late termination of pregnancy; (iii) the role of psychiatry in both early and late termination of pregnancy; and (iv) the involvement of psychiatry in complex medical decisions. The decision to perform a late termination of pregnancy is complex. Contributing to its complexity is an array of political, legal, societal, and ethical factors. The literature regarding psychological sequelae is frequently confusing and weakened by methodological problems. Methods of assisting in this decision-making process include the involvement of committees and psychiatrists. There are precedents for the involvement of psychiatrists in such a setting. Historically, psychiatrists played a role in screening women who requested an early termination. Psychiatrists are often involved in ethically challenging and complex clinical decisions in the general hospital setting. The involvement of psychiatry in this complex decision-making process has potential advantages and disadvantages. It is timely for psychiatrists to consider their position on their discipline's involvement.
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Affiliation(s)
- Kirsty Morris
- Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Coleman PK. Resolution of Unwanted Pregnancy During Adolescence Through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences. J Youth Adolesc 2006. [DOI: 10.1007/s10964-006-9094-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Broen AN, Moum T, Bødtker AS, Ekeberg Ø. The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Med 2005; 3:18. [PMID: 16343341 PMCID: PMC1343574 DOI: 10.1186/1741-7015-3-18] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Accepted: 12/12/2005] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Miscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was to determine whether there are differences in the patterns of normalization of mental health scores after these two pregnancy termination events. METHODS Forty women who experienced miscarriages and 80 women who underwent abortions at the main hospital of Buskerud County in Norway were interviewed. All subjects completed the following questionnaires 10 days (T1), six months (T2), two years (T3) and five years (T4) after the pregnancy termination: Impact of Event Scale (IES), Quality of Life, Hospital Anxiety and Depression Scale (HADS), and another addressing their feelings about the pregnancy termination. Differential changes in mean scores were determined by analysis of covariance (ANCOVA) and inter-group differences were assessed by ordinary least squares methods. RESULTS Women who had experienced a miscarriage had more mental distress at 10 days and six months after the pregnancy termination than women who had undergone an abortion. However, women who had had a miscarriage exhibited significantly quicker improvement on IES scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group at two and five years after the pregnancy termination (IES avoidance means: 3.2 vs 9.3 at T3, respectively, p < 0.001; 1.5 vs 8.3 at T4, respectively, p < 0.001). Compared with the general population, women who had undergone induced abortion had significantly higher HADS anxiety scores at all four interviews (p < 0.01 to p < 0.001), while women who had had a miscarriage had significantly higher anxiety scores only at T1 (p < 0.01). CONCLUSION The course of psychological responses to miscarriage and abortion differed during the five-year period after the event. Women who had undergone an abortion exhibited higher scores during the follow-up period for some outcomes. The difference in the courses of responses may partly result from the different characteristics of the two pregnancy termination events.
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Affiliation(s)
- Anne Nordal Broen
- Department of Behavioral Sciences, Institute of Basic Sciences in Medicine, University of Oslo, P.O. Box 1111 Blindern, 0317 Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioral Sciences, Institute of Basic Sciences in Medicine, University of Oslo, P.O. Box 1111 Blindern, 0317 Oslo, Norway
| | | | - Øivind Ekeberg
- Department of Behavioral Sciences, Institute of Basic Sciences in Medicine, University of Oslo, P.O. Box 1111 Blindern, 0317 Oslo, Norway
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Cougle JR, Reardon DC, Coleman PK. Generalized anxiety following unintended pregnancies resolved through childbirth and abortion: a cohort study of the 1995 National Survey of Family Growth. J Anxiety Disord 2005; 19:137-42. [PMID: 15488373 DOI: 10.1016/j.janxdis.2003.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Revised: 11/25/2003] [Accepted: 12/12/2003] [Indexed: 11/19/2022]
Abstract
The psychological consequences of induced abortion are complex and subject to both considerable controversy and methodological criticisms. While many women report feelings of relief immediately after the procedure, others report feelings of anxiety, which they attribute to their abortions. The purpose of the present study was to examine risk of generalized anxiety following unintended pregnancies ending in abortion or childbirth using a large representative sample of American women. Among all women, those who aborted were found to have significantly higher rates of subsequent generalized anxiety when controlling for race and age at interview. Implications of the findings are discussed. In particular, findings highlight the clinical relevance of exploring reproductive history in therapeutic efforts to assist women seeking relief from anxiety.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, University of Texas, 1 University Station A8000, Austin, TX 78712-0187, USA.
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10
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Coleman PK, Reardon DC, Strahan † T, Cougle JR. The psychology of abortion: A review and suggestions for future research. Psychol Health 2005. [DOI: 10.1080/0887044042000272921] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Bernazzani O, Bifulco A. Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences. Soc Sci Med 2003; 56:1249-60. [PMID: 12600362 DOI: 10.1016/s0277-9536(02)00123-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Adverse pregnancy experiences were examined retrospectively in relation to adult lifetime experience of clinical depression to see whether such experience conferred long-term risk for women. The sample consisted of just under 200 community-based women, half of whom were selected for high depressive-risk on the basis of adverse childhood experience. Over two-thirds of these women had experienced pregnancy. Adverse pregnancies were classified either in terms of loss (adverse non-live pregnancy/births) or in terms of live births in difficult circumstances (adverse live pregnancy/births). Intensive life history interviews collected details of all pregnancies, childhood neglect/abuse, marital adversity and a history of episodes of clinical depression. Both adverse non-live and live pregnancy experiences were significantly related to lifetime depression. The relationship remained for depression in different time periods and for those episodes unrelated to maternity experience. Both types of adverse pregnancy/birth experiences were associated with increased rates of marital problems. While adverse live pregnancy/births related to prior childhood neglect/abuse, this did not hold for those non-live. Logistic regression showed that only adverse non-live pregnancy/births together with marital adversity and childhood neglect/abuse provided the best model for lifetime depression. The findings are discussed in terms of lifetime trajectories linking difficult environments, close relationships and issues of loss.
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Affiliation(s)
- Odette Bernazzani
- Department of Psychiatry, University of Montréal, Pavillon Rosemont, 5689 Boulevard Rosemont, Qué, Canada H1T 2H1.
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Coleman PK, Reardon DC, Rue VM, Cougle J. State-funded abortions versus deliveries: a comparison of outpatient mental health claims over 4 years. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2002; 72:141-152. [PMID: 14964603 DOI: 10.1037/0002-9432.72.1.1410155] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this record-based study, rates of 1st-time outpatient mental health treatment for 4 years following an abortion or a birth among women receiving medical assistance through the state of California were compared. After controlling for preexisting psychological difficulties, age, months of eligibility, and the number of pregnancies, the rate of care was 17% higher for the abortion group (n = 14,297) in comparison with the birth group (n = 40,122). Within 90 days after the pregnancy, the abortion group had 63% more claims than the birth group, with the percentages equaling 42%, 30%, and 16% for 180 days, 1 year, and 2 years, respectively. Additional comparisons between the abortion and birth groups were conducted on the basis of claims for specific types of disorders and age.
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Quinton WJ, Major B, Richards C. Adolescents and adjustment to abortion: are minors at greater risk? PSYCHOLOGY PUBLIC POLICY AND LAW 2001; 7:491-514. [PMID: 12953681 DOI: 10.1037/1076-8971.7.3.491] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors tested the Supreme Court's assumption that minors are particularly susceptible to psychological distress following abortion. The responses of 38 minors (age < 18 years) were compared with those of 402 adults, 1 month and 2 years after an elective, 1st-trimester abortion. Minors were relatively less satisfied with their abortion decision and felt less benefit from the abortion than did adults 1 month postabortion, but they did not differ from adults in adjustment 2 years postabortion. Minors were not more depressed than adults at either time period, and their decision satisfaction and perceived benefit at both time periods did not suggest a population at risk. Age group differences in adjustment 1 month postabortion were explained by minors' reduced self-efficacy appraisals for coping, greater use of avoidant coping strategies, and greater perceived parental conflict. These findings challenge the Court's assumption that minors are particularly vulnerable to psychological harm following abortion.
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Affiliation(s)
- W J Quinton
- Department of Psychology, University of California, Santa Barbara, California 93106, USA.
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Bianchi-Demicheli F, Perrin E, Lüdicke F, Bianchi PG, Fert D, Bonvallat F, Chatton D, Campana A. Sexuality, partner relations and contraceptive practice after termination of pregnancy. J Psychosom Obstet Gynaecol 2001; 22:83-90. [PMID: 11446158 DOI: 10.3109/01674820109049958] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to determine the impact of termination of pregnancy (TOP) on women's sexual well-being, the couple and contraceptive practice. In a prospective qualitative and quantitative study, 103 women undergoing induced abortion by vacuum aspiration were interviewed before the abortion and 6 months later. The interview was performed by means of a questionnaire including open and closed questions, and two psychological tests (Locke-Wallace and Horowitz). After TOP, the majority of women did not report changes in their sexual behavior and satisfaction. Eighteen per cent of women reported a decrease in sexual desire and 17% reported orgasmic disorders. About one-third of women described psychosomatic symptoms, but a minority were traumatized by the event. Ninety-eight per cent of the women were informed about, and had practiced, contraception in the past; 69% had actually used some kind of contraception during the menstrual cycle that had resulted in pregnancy (31% had had unprotected intercourse). Six months later, 83% practiced contraception, and only 17% did not. Fourteen out of 84 couples separated after TOP (one in six). Six months after TOP, the large majority of women interviewed seemed able to cope with TOP. A minority presented some persisting sexual dysfunction and/or some psychosomatic symptoms.
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Affiliation(s)
- F Bianchi-Demicheli
- Department of Obstetrics and Gynecology, Geneva University Hospital, Switzerland
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15
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Thomas T, Tori CD. Sequelae of abortion and relinquishment of child custody among women with major psychiatric disorders. Psychol Rep 1999; 84:773-90. [PMID: 10408200 DOI: 10.2466/pr0.1999.84.3.773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A growing number of women with major psychiatric disorders frequently consider the choice of abortion or relinquishment of the custody of children. Psychological reactions to abortion and relinquishment of custody were assessed and contrasted among 119 hospitalized women of M age 40 yr. and psychiatric patients. An original questionnaire was developed to assess emotional symptoms, psychiatric signs, attitudes, and satisfaction with the decision regarding the loss of a fetus or child. As hypothesized, reported sequelae of relinquishments of custody were rated as significantly more severe than sequelae of abortion. Dissatisfaction with choice, negative attitudes, religious affiliation, and involuntary removal of a child from custody were predictive of distress following abortion or relinquishment. The findings show that increased efforts are needed to help women with psychiatric difficulties cope with reproductive planning and losses.
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Affiliation(s)
- T Thomas
- California School of Professional Psychology, Alameda, USA.
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16
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Abstract
Self-in-relation theory and pilot data responses to an Abortion Decision Balance Sheet by 20 women attending an abortion-providing clinic challenge previous formulations of the abortion decision. Pilot data suggest that: women may make an abortion decision based primarily on pragmatics, a belief in their right to choose and knowledge of the safety and simplicity of the procedure. A discrepancy may exist for a significant minority of women between their abstract beliefs/knowledge and the personal meaning for them of the pregnancy, abortion and its safety. Important links may exist between maternal attachment and anxiety about the safety of the abortion procedure. Ramifications for counselling and future research are discussed.
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Affiliation(s)
- S Allanson
- Fertility Control Clinic, East Melbourne, Australia
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17
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Abstract
BACKGROUND We investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy. METHOD This was a prospective cohort study of 13,261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321). RESULTS Rates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3-0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95% CI 1.1-2.6), or who were refused a termination (RR 2.9, 95% CI 1.3-6.3). CONCLUSIONS The findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found.
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Affiliation(s)
- A C Gilchrist
- Department of Child and Adolescent Psychiatry, University of Manchester
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Cozzarelli C, Karrasch A, Sumer N, Major B. The Meaning and Impact of Partner's Accompaniment on Women's Adjustment to Abortion1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1994. [DOI: 10.1111/j.1559-1816.1994.tb00573.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Major B, Cozzarelli C, Testa M, Mueller P. Male Partners' Appraisals of Undesired Pregnancy and Abortion: Implications for Women's Adjustment to Abortion. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1992. [DOI: 10.1111/j.1559-1816.1992.tb00992.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Abstract
The literature is summarized on normative reactions to abortion and factors that increase risk of negative emotional sequelae. Four areas of inquiry for identifying psychotherapeutic issues in regard to abortion are elaborated, including: (a) characteristics of the woman prior to and at the time of the abortion, (b) the nature of social support and the cultural milieu around the abortion, (c) characteristics of the medical environment and abortion procedure, and (d) events subsequent to the abortion which may have aroused post-decisional conflict. The implications of the research literature for psychotherapeutic treatment of women who have had abortions are discussed.
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Abstract
A review of methodologically sound studies of the psychological responses of U.S. women after they obtained legal, nonrestrictive abortions indicates that distress is generally greatest before the abortion and that the incidence of severe negative responses is low. Factors associated with increased risk of negative response are consistent with those reported in research on other stressful life events.
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Affiliation(s)
- N E Adler
- University of California, San Francisco 94143
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Rogers JL, Stoms GB, Phifer JL. Psychological impact of abortion: methodological and outcomes summary of empirical research between 1966 and 1988. Health Care Women Int 1989; 10:347-76. [PMID: 2684950 DOI: 10.1080/07399338909515861] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A systematic "roadmap" through the medical literature that empirically examines the incidence of psychological sequelae of induced abortion is presented. Because outcome incidence rates and methodological profiles vary substantially across studies, selective use of articles from this literature without an accompanying rationale for that selectivity could foster erroneous conclusions. Information compiled here can facilitate a rapid methodological critique of citations in abortion-related materials. Investigations published in English between January 1966 and April 1988 that quantitatively examined psychological sequelae using prospective, retrospective, or comparative methodologies are summarized in tables to produce a synopsis of the demographics, methodological limitations, and gross statistical features of each article. This quantitative guide is designed to facilitate appropriate use of the current literature, provide needed background to assess positions arising from the currently available data, and provide methodological focus for planning better studies in the future.
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Abstract
This article describes a group model of treatment for methadone-maintained pregnant women. Its purpose is to help health care providers alter their own stereotypical attitude toward this population by highlighting the beneficial aspects of group psychotherapy. Special emphasis is placed on developing a comprehensive care program with a biopsychosocial orientation.
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Abstract
The identification of patients at risk for psychologically mediated complications during and after pregnancy should be a part of obstetric care. Psychologic assessment can be incorporated into routine prenatal evaluation. Typically, patients who cope poorly during pregnancy have had previous emotional difficulty. Transient emotional disturbances during the early stages of pregnancy are not unusual. Treatment consists of providing support, education, and opportunity for the patient to ventilate her feelings. These interventions can be provided by the sensitive primary care physician who is willing and able to commit the time, to listen, and to communicate. Drug therapy should usually be avoided. Postpartum blues is common, occurring most often in those who experienced emotional distress during pregnancy and in those with a history of premenstrual tension. Management ideally begins before delivery. Treatment of postpartum depression or psychosis involves use of medication and/or psychotherapy. The effects of medication on breast milk must be considered.
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