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Littell JH, Abel KM, Biggs MA, Blum RW, Foster DG, Haddad LB, Major B, Munk-Olsen T, Polis CB, Robinson GE, Rocca CH, Russo NF, Steinberg JR, Stewart DE, Stotland NL, Upadhyay UD, van Ditzhuijzen J. Correcting the scientific record on abortion and mental health outcomes. BMJ 2024; 384:e076518. [PMID: 38413135 DOI: 10.1136/bmj-2023-076518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Julia H Littell
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Robert W Blum
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - Brenda Major
- Department of Psychological and Brain Sciences, University of California Santa Barbara, USA
| | - Trine Munk-Olsen
- Department of Clinical Research (Research Unit for Child and Adolescent Psychiatry), University of Southern Denmark, Odense, Denmark
- The National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Chelsea B Polis
- Center for Biomedical Research, Population Council, New York, NY, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Corinne H Rocca
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | | | - Julia R Steinberg
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Donna E Stewart
- Departments of Psychiatry, Obstetrics and Gynecology, Medicine, Surgery, Anesthesiology, Family and Community Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Nada Logan Stotland
- Department of Psychiatry and Behavioral Sciences, Rush Medical Center, Rush University, Chicago, IL, USA
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Jenneke van Ditzhuijzen
- Interdisciplinary Social Science: Social Policy and Public Health, Utrecht University, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, Netherlands
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Hooberman L, Ozoguz S. Abortion, mental health and epistemologies of psychological knowledge and ignorance. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2022. [DOI: 10.1111/spc3.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Hooberman
- Department of Psychology The CUNY Graduate Center New York New York USA
| | - Sedef Ozoguz
- Department of Psychology The CUNY Graduate Center New York New York USA
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Affective and Substance Abuse Disorders Following Abortion by Pregnancy Intention in the United States: A Longitudinal Cohort Study. ACTA ACUST UNITED AC 2019; 55:medicina55110741. [PMID: 31731786 PMCID: PMC6915619 DOI: 10.3390/medicina55110741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Psychological outcomes following termination of wanted pregnancies have not previously been studied. Does excluding such abortions affect estimates of psychological distress following abortion? To address this question this study examines long-term psychological outcomes by pregnancy intention (wanted or unwanted) following induced abortion relative to childbirth in the United States. Materials and Methods: Panel data on a nationally-representative cohort of 3935 ever-pregnant women assessed at mean age of 15, 22, and 28 years were examined from the National Longitudinal Survey of Adolescent to Adult Health (Add Health). Relative risk (RR) and incident rate ratios (IRR) for time-dynamic mental health outcomes, conditioned by pregnancy intention and abortion exposure, were estimated from population-averaged longitudinal logistic and Poisson regression models, with extensive adjustment for sociodemographic differences, pregnancy and mental health history, and other confounding factors. Outcomes were assessed using the Diagnostic and Statistical Manual, Version 4, American Psychiatric Association (DSM-IV) diagnostic criteria or another validated index for suicidal ideation, depression, and anxiety (affective problems); drug abuse, opioid abuse, alcohol abuse, and cannabis abuse (substance abuse problems); and summary total disorders. Results: Women who terminated one or more wanted pregnancies experienced a 43% higher risk of affective problems (RR 1.69, 95% CI 1.3–2.2) relative to childbirth, compared to women terminating only unwanted pregnancies (RR 1.18, 95% CI 1.0–1.4). Risks of depression (RR 2.22, 95% CI 1.3–3.8) and suicidality (RR 3.44 95% CI 1.5–7.7) were especially elevated with wanted pregnancy abortion. Relative risk of substance abuse disorders with any abortion was high, at about 2.0, but unaffected by pregnancy intention. Excluding wanted pregnancies artifactually reduced estimates of affective disorders by 72% from unity, substance abuse disorders by 11% from unity, and total disorders by 21% from unity. Conclusions: Excluding wanted pregnancies moderately understates overall risk and strongly understates affective risk of mental health difficulties for women following abortion. Compared to corresponding births, abortions of wanted pregnancies are associated with a greater risk of negative psychological affect, particularly depression and suicide ideation, but not greater risk of substance abuse, than are abortions of unwanted pregnancies. Clinical, research, and policy implications are discussed briefly.
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Akdag Topal C, Terzioglu F. Assessment of depression, anxiety, and social support in the context of therapeutic abortion. Perspect Psychiatr Care 2019; 55:618-623. [PMID: 31004351 DOI: 10.1111/ppc.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The purpose of this study is to determine the levels of anxiety, depression, social support, and nursing care needed by women undergoing therapeutic abortion. DESIGNS AND METHODS Sixty women were administered a sociodemographic form, the Hospital Anxiety Depression Scale and the Multidimensional Perceived Social Support Scale. RESULTS More than half of the women experienced anxiety (61.7%). Anxiety scores were high (10.8 ± 3.7), and most of the women had depression (85.0%). Social support from family and friends of the women decreased the women's anxiety and depression levels significantly; social support from their partners also decreased the women's anxiety levels (P < 0.05). PRACTICE IMPLICATIONS Support from family and friends after therapeutic abortion is a fundamental affective variable on anxiety scores.
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Affiliation(s)
- Cansu Akdag Topal
- Department of Obstetrics and Gynecologic Nursing, Faculty of Nursing, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Fusun Terzioglu
- Department of Nursing, Faculty of Health Sciences, Atilim University, Golbasi, Ankara, Turkey
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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Lindberg L, Scott RH. Effect of ACASI on Reporting of Abortion and Other Pregnancy Outcomes in the US National Survey of Family Growth. Stud Fam Plann 2018; 49:259-278. [PMID: 30040126 PMCID: PMC6166437 DOI: 10.1111/sifp.12068] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abortion is a behavior that is stigmatized and difficult to measure. To improve reporting of abortion and other sensitive behaviors in the United States, the National Survey of Family Growth (NSFG) supplements the interviewer administered face-to-face (FTF) interview with audio computer-assisted self-interviewing (ACASI). This paper estimates differential reporting of abortion and other pregnancy outcomes (miscarriage, live birth) in the NSFG (2002, 2006-2010, 2011-2015) between women's ACASI and FTF interviews. Examining reporting of less stigmatized pregnancy outcomes can help understand the relative contributions of stigma and survey-level factors in reporting of abortions. More women reported abortions, miscarriages and births in the ACASI than the FTF interview. Differences in reporting were moderated by the length of recall. The ACASI elicited relatively more reporting of abortions and miscarriages among non-white and low-income women. Reporting ratios increased over time. ACASI is a tool that may work differently across time, for different measures, and with varying survey contexts.
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McNamara B, Russo J, Chaiken S, Jacobson J, Kerns J. A qualitative study of digoxin injection before dilation and evacuation. Contraception 2018; 97:515-519. [PMID: 29477630 DOI: 10.1016/j.contraception.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to qualitatively understand patients' experiences with digoxin as a step before dilation and evacuation (D&E). STUDY DESIGN We recruited English-speaking women from one abortion health center where digoxin is routinely used before D&E. We interviewed participants one to three weeks after the D&E about physical and emotional experiences with digoxin and understanding of its purpose. Using grounded theory, we analyzed transcripts iteratively, identifying themes from interviews; we stopped recruitment when we reached thematic saturation. RESULTS We conducted 20 interviews and participants described mixed experiences. Three overarching themes from the qualitative interviews were: (1) physical and emotional discomfort; (2) varied understanding of digoxin's purpose and effects; and (3) reassurance. Most participants described significantly negative experiences with digoxin; however, many participants also described positive aspects of the injection intermingled with those negative experiences. CONCLUSIONS Participants' experiences with digoxin before D&E were both polarized and nuanced. While participants were largely clear about digoxin's action, they were much less clear about the reason for its use. IMPLICATIONS Both the clinical purpose for and patients' experiences with digoxin before D&E are complicated. Providers who continue to use digoxin should consider patient preferences in how they offer digoxin, and consider tools to ensure patient understanding.
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Affiliation(s)
- Blair McNamara
- Yale University School of Medicine, New Haven, CT 06520, USA.
| | - Jennefer Russo
- Planned Parenthood of Orange and San Bernardino Counties, Orange, CA 92866, USA
| | | | - Janet Jacobson
- Planned Parenthood of Orange and San Bernardino Counties, Orange, CA 92866, USA
| | - Jennifer Kerns
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94110, USA
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Abstract
SummaryA recent Royal College of Psychiatrists' statement concluded that current evidence on abortion and mental health is inconclusive. This contribution examines the background to the Royal College of Psychiatrists' statement and the issues it raises. It is concluded that the best route to resolving such issues is through further and better research.
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Restrepo D, Duque M, Montoya L, Hoyos C. [A 38-year-old Woman with a Legal and Voluntary Interruption of Pregnancy due to Mental Health Risk. An Unexpected Outcome]. ACTA ACUST UNITED AC 2017; 46:116-120. [PMID: 28483171 DOI: 10.1016/j.rcp.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/08/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe a case of legal and voluntary interruption of pregnancy due to a mental health risk in the mother. However, the foetus survived and the mother decided to care for the child. METHODS Description of the case and a non-systematic review of the relevant literature. RESULTS A multiparous woman of 38 years with unknown gestational age who requests legal and voluntary interruption of pregnancy. After abortion a male child born of 1050 grams was born, intubated and admitted to intensive care. Subsequently, the mother, without the mental problems that led to abortion, gradually assumed the care of the child. DISCUSSION To address this complex case, several aspects are analysed: first, the change of mind of a woman in her desire to be a mother. Second, the disappearance of mental symptoms in the immediate postpartum. Third, the need to review the clinical, ethical and legal foundations of the legal ruling that allows therapeutic abortion in Colombia.
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Affiliation(s)
- Diana Restrepo
- Medicina, Psiquiatría, CES University, Medelllín, Colombia.
| | - Marle Duque
- Medicina, Psiquiatría, CES University, Medelllín, Colombia
| | - Laura Montoya
- Medicina, Psiquiatría, CES University, Medelllín, Colombia
| | - Catalina Hoyos
- Medicina, Psiquiatría, CES University, Medelllín, Colombia
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Huang Z, Hao J, Su P, Huang K, Xing X, Cheng D, Xiao L, Xu Y, Zhu X, Tao F. The Impact of Prior Abortion on Anxiety and Depression Symptoms During a Subsequent Pregnancy: Data From a Population-Based Cohort Study in China. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20111102040509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Zhaohui Huang
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
- Shaoxing Center for Disease Control and Prevention, Shaoxing 312071, Zhejiang Province, China
| | - Jiahu Hao
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
- Shaoxing Center for Disease Control and Prevention, Shaoxing 312071, Zhejiang Province, China
| | - Puyu Su
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Kun Huang
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiuya Xing
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Daijuan Cheng
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Limin Xiao
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Yuanyuan Xu
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiaoming Zhu
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Fangbiao Tao
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
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Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Med 2016; 4:2050312116665997. [PMID: 27781096 PMCID: PMC5066584 DOI: 10.1177/2050312116665997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/22/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for US women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion. METHOD Panel data on pregnancy history and mental health history for a nationally representative cohort of 8005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, and involuntary pregnancy loss). Risk ratios were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and Poisson regression models. RESULTS After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (risk ratio, 1.45; 95% confidence interval, 1.30-1.62; p < 0.0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (risk ratio, 1.24; 95% confidence interval, 1.13-1.37; p < 0.0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%; 95% confidence interval, 6.0-11.3) of the prevalence of mental disorders examined over the period were attributable to abortion. CONCLUSION Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.
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Waqas A, Raza N, Lodhi HW, Muhammad Z, Jamal M, Rehman A. Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator? PLoS One 2015; 10:e0116510. [PMID: 25629925 PMCID: PMC4309576 DOI: 10.1371/journal.pone.0116510] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/10/2014] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Pregnancy is generally viewed as a time of fulfillment and joy; however, for many women it can be a stressful event. In South Asia it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. METHODOLOGY This cross-sectional study was done at four teaching hospitals in Lahore from February, 2014 to June, 2014. A total of 500 pregnant women seen at hospital obstetrics and gynecology departments were interviewed with a questionnaire consisting of three sections: demographics, the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). Pearson's chi-squared test, bivariate correlations and multiple linear regression were used to analyze associations between the independent variables and scores on the HADS and SPS. RESULTS Mean age among the 500 respondents was 27.41 years (5.65). Anxiety levels in participants were categorized as normal (145 women, 29%), borderline (110, 22%) or anxious (245, 49%). Depression levels were categorized as normal (218 women, 43.6%), borderline (123, 24.6%) or depressed (159, 31.8%). Inferential analysis revealed that higher HADS scores were significantly associated with lower scores on the SPS, rural background, history of harassment, abortion, cesarean delivery and unplanned pregnancies (P < .05). Social support (SPS score) mediated the relationship between the total number of children, gender of previous children and HADS score. Women with more daughters were significantly more likely to score higher on the HADS and lower on the SPS, whereas higher numbers of sons were associated with the opposite trends in the scores (P < .05). CONCLUSION Because of the predominantly patriarchal sociocultural context in Pakistan, the predictors of antenatal anxiety and depression may differ from those in developed countries. We therefore suggest that interventions designed and implemented to reduce antenatal anxiety and depression should take into account these unique factors.
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Affiliation(s)
- Ahmed Waqas
- CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan
| | - Nahal Raza
- CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan
| | - Haneen Wajid Lodhi
- CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan
| | - Zerwah Muhammad
- CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan
| | - Mehak Jamal
- CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan
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13
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Curley M, Johnston C. Exploring treatment preferences for psychological services after abortion among college students. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2013.879566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Maureen Curley
- University of Florida College of Nursing, Gainesville, Florida, USA
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Fergusson DM, Horwood LJ, Boden JM. Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence. Aust N Z J Psychiatry 2013; 47:819-27. [PMID: 23553240 DOI: 10.1177/0004867413484597] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There have been debates about the linkages between abortion and mental health. Few reviews have considered the extent to which abortion has therapeutic benefits that mitigate the mental health risks of abortion. The aim of this review was to conduct a re-appraisal of the evidence to examine the research hypothesis that abortion reduces rates of mental health problems in women having unwanted or unintended pregnancy. METHODS Analysis of recent reviews (Coleman, 2011; National Collaborating Centre for Mental Health, 2011) identified eight publications reporting 14 adjusted odds ratios (AORs) spanning five outcome domains: anxiety; depression; alcohol misuse; illicit drug use/misuse; and suicidal behaviour. For each outcome, pooled AORs were estimated using a random-effects model. RESULTS There was consistent evidence to show that abortion was not associated with a reduction in rates of mental health problems (p>0.75). Abortion was associated with small to moderate increases in risks of anxiety (AOR 1.28, 95% CI 0.97-1.70; p<0.08), alcohol misuse (AOR 2.34, 95% CI 1.05-5.21; p<0.05), illicit drug use/misuse (AOR 3.91, 95% CI 1.13-13.55; p<0.05), and suicidal behaviour (AOR 1.69, 95% CI 1.12-2.54; p<0.01). CONCLUSIONS There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems.
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Affiliation(s)
- David M Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
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Affiliation(s)
- Julia R Steinberg
- Department of Psychiatry, University of California, San Francisco, San Francisco, USA
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Bellieni CV, Buonocore G. Abortion and subsequent mental health: Review of the literature. Psychiatry Clin Neurosci 2013; 67:301-10. [PMID: 23859662 DOI: 10.1111/pcn.12067] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 03/28/2013] [Accepted: 05/26/2013] [Indexed: 02/03/2023]
Abstract
The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of 36 studies were retrieved, and six of them were excluded for methodological bias. Depression, anxiety disorders (e.g. post-traumatic stress disorder) and substance abuse disorders were the most studied outcome. Abortion versus childbirth: 13 studies showed a clear risk for at least one of the reported mental problems in the abortion group versus childbirth, five papers showed no difference, in particular if women do not consider their experience of fetal loss to be difficult, or if after a fetal reduction the desired fetus survives. Only one paper reported a worse mental outcome for childbearing. Abortion versus unplanned pregnancies ending with childbirth: four studies found a higher risk in the abortion groups and three, no difference. Abortion versus miscarriage: three studies showed a greater risk of mental disorders due to abortion, four found no difference and two found that short-term anxiety and depression were higher in the miscarriage group, while long-term anxiety and depression were present only in the abortion group. In conclusion, fetal loss seems to expose women to a higher risk for mental disorders than childbirth; some studies show that abortion can be considered a more relevant risk factor than miscarriage; more research is needed in this field.
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Affiliation(s)
- Carlo V Bellieni
- Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.
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Brondino N, Colombini G, Morandotti N, Podavini F, De Vidovich G, Formica M, Arossa A, De Silvestri A, Montanari L, Caverzasi E. Psychological correlates of decision-making during prenatal diagnosis: a prospective study. J Psychosom Obstet Gynaecol 2013; 34:68-74. [PMID: 23706024 DOI: 10.3109/0167482x.2013.797404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Decision-making during prenatal diagnosis has not been extensively studied. We aimed to determine psychological correlates and level of decisional conflict following prenatal diagnosis. METHOD A total of 159 pregnant women were consecutively enrolled. All participants completed three questionnaires (the Hospital Anxiety and Depression scale, the Berlin Social Support scales and the Decisional Conflict scale) at three time points (T1 - waiting period between prenatal testing and disclosure of the results; T2 - decision phase within 3 days from test result disclosure; T3 - digestion period within 3 weeks from disclosure). RESULTS Women with fetal anomaly who terminate pregnancy were significantly more anxious and depressed than controls at each time point. Additionally, women with a normal fetus who terminate pregnancy presented higher level of anxiety and depression compared with controls at T2. Women who terminated pregnancy showed increased uncertainty scores at T2 and T3. Anxious and depressed individuals at T2 (decision period) were more uncertain about their choice at T3 compared to women with normal levels of anxiety and depression. CONCLUSION The decision to terminate pregnancy, irrespective of test results, may determine emotional distress and psychiatric morbidity. Women who were anxious and depressed at decision appeared to be more uncertain about their choices as time passed by. A careful assessment of women during prenatal diagnosis should be useful to identify women who may benefit from psychological support.
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Affiliation(s)
- Natascia Brondino
- Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Psychiatry, University of Pavia, Pavia, Italy.
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The Characteristics and Severity of Psychological Distress After Abortion Among University Students. J Behav Health Serv Res 2013; 40:279-93. [DOI: 10.1007/s11414-013-9328-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Steinberg JR, Trussell J, Hall KS, Guthrie K. Fatal flaws in a recent meta-analysis on abortion and mental health. Contraception 2012; 86:430-7. [PMID: 22579105 DOI: 10.1016/j.contraception.2012.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 03/21/2012] [Accepted: 03/28/2012] [Indexed: 01/19/2023]
Abstract
Similar to other reviews within the last 4 years, a thorough review by the Royal College of Psychiatrists, published in December 2011, found that compared to delivery of an unintended pregnancy, abortion does not increase women's risk of mental health problems. In contrast, a meta-analysis published in September 2011 concluded that abortion increases women's risk of mental health problems by 81% and that 10% of mental health problems are attributable to abortions. Like others, we strongly question the quality of this meta-analysis and its conclusions. Here we detail seven errors of this meta-analysis and three significant shortcomings of the included studies because policy, practice and the public have been misinformed. These errors and shortcomings render the meta-analysis' conclusions invalid.
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Affiliation(s)
- Julia R Steinberg
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
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Kendall T, Bird V, Cantwell R, Taylor C. To meta-analyse or not to meta-analyse: abortion, birth and mental health. Br J Psychiatry 2012; 200:12-4. [PMID: 22215864 DOI: 10.1192/bjp.bp.111.106112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.
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Affiliation(s)
- Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
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22
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Coleman PK. Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009. Br J Psychiatry 2011; 199:180-6. [PMID: 21881096 DOI: 10.1192/bjp.bp.110.077230] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians. AIMS To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome. METHOD After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios. RESULTS Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour. CONCLUSIONS This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.
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Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, 16 D FCS Building, Bowling Green State University, Bowling Green, Ohio 43402, USA.
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Steinberg JR, Becker D, Henderson JT. Does the outcome of a first pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the National Comorbidity Survey. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2011; 81:193-201. [PMID: 21486261 PMCID: PMC3076612 DOI: 10.1111/j.1939-0025.2011.01088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examines the risk of depression, suicidal ideation, and lower self-esteem following an abortion versus a delivery, with and without adjusting for important correlates. Using the National Comorbidity Survey, we tested how first pregnancy outcome (abortion vs. delivery) related to subsequent major depression, suicidal ideation, and self-esteem. Models controlling for risk factors, such as background and economic factors, prepregnancy violence experience, and prepregnancy mental health, as well as a model with all risk factors, were examined. When no risk factors were entered in the model, women who had abortions were more likely to have subsequent depression, OR=1.53, 95% CI [1.05-2.22], and suicidal ideation, OR=2.02, 95% CI [1.40-2.92], but they were not more likely to have lower self-esteem, B=-.02. When all risk factors were entered, pregnancy outcome was not significantly related to later depression, OR=0.87, 95% CI [0.54-1.37], and suicidal ideation, OR=1.19, 95% CI [0.70-2.02]. Predictors of mental health following abortion and delivery included prepregnancy depression, suicidal ideation, and sexual violence. Policies and practices implemented in response to the claim that abortion hurts women are not supported by our findings. Efforts to support women's mental health should focus on known risk factors, such as gender-based violence and prior mental health problems, rather than abortion history.
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Affiliation(s)
- Julia R Steinberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143-0744, USA.
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Warren JT, Harvey SM, Henderson JT. Do depression and low self-esteem follow abortion among adolescents? Evidence from a national study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2010; 42:230-5. [PMID: 21126298 PMCID: PMC5234489 DOI: 10.1363/4223010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT A 2008 report by the American Psychological Association found no evidence that an induced abortion causes mental health problems in adult women. No conclusions were drawn with respect to adolescents because of a scarcity of evidence. METHODS Data from the National Longitudinal Study of Adolescent Health were used to examine whether abortion in adolescence was associated with subsequent depression and low self-esteem. In all, 289 female respondents reported at least one pregnancy between Wave 1 (1994-1995) and Wave 2 (1996) of the survey. Of these, 69 reported an induced abortion. Population-averaged lagged logistic regression models were used to assess associations between abortion and depression and low self-esteem within a year of the pregnancy and approximately five years later, at Wave 3 (2001-2002). RESULTS Abortion was not associated with depression or low self-esteem at either time point. Socioeconomic and demographic characteristics did not substantially modify the relationships between abortion and the outcomes. CONCLUSIONS Adolescents who have an abortion do not appear to be at elevated risk for depression or low self-esteem in the short term or up to five years after the abortion.
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Affiliation(s)
- Jocelyn T Warren
- Department of Public Health, Oregon State University, Corvallis, USA.
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Late-term elective abortion and susceptibility to posttraumatic stress symptoms. J Pregnancy 2010; 2010:130519. [PMID: 21490737 PMCID: PMC3066627 DOI: 10.1155/2010/130519] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/26/2010] [Accepted: 06/28/2010] [Indexed: 11/25/2022] Open
Abstract
The primary aim of this study was to compare the experience of an early abortion (1st trimester) to a late abortion (2nd and 3rd trimester) relative to Posttraumatic Stress Disorder (PTSD) symptoms after controlling for socio-demographic and personal history variables. Online surveys were completed by 374 women who experienced either a 1st trimester abortion (up to 12 weeks gestation) or a 2nd or 3rd trimester abortion (13 weeks gestation or beyond). Most respondents (81%) were U.S. citizens. Later abortions were associated with higher Intrusion subscale scores and with a greater likelihood of reporting disturbing dreams, reliving of the abortion, and trouble falling asleep. Reporting the pregnancy was desired by one's partner, experiencing pressure to abort, having left the partner prior to the abortion, not disclosing the abortion to the partner, and physical health concerns were more common among women who received later abortions. Social reasons for the abortion were linked with significantly higher PTSD total and subscale scores for the full sample. Women who postpone their abortions may need more active professional intervention before securing an abortion based on the increased risks identified herein. More research with diverse samples employing additional measures of mental illness is needed.
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Gissler M, Artama M, Ritvanen A, Wahlbeck K. Use of psychotropic drugs before pregnancy and the risk for induced abortion: population-based register-data from Finland 1996-2006. BMC Public Health 2010; 10:383. [PMID: 20591182 PMCID: PMC2914778 DOI: 10.1186/1471-2458-10-383] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 06/30/2010] [Indexed: 11/10/2022] Open
Abstract
Background Some, though not all studies have reported an increased risk for mental health problems after an induced abortion. Problems with design and data have compromised these studies and the generalisation of their results. Methods The Finnish Medication and Pregnancy database (N = 622 671 births and 114 518 induced abortions for other than fetal reasons) in 1996-2006 was utilised to study the use of psychotropic drugs in the three months before a pregnancy ending in a birth or an induced abortion. Results In total 2.1% of women with a birth and 5.1% of women with an induced abortion had used a psychotropic medicine 0-3 months before pregnancy. Psychotropic drug users terminated their pregnancies (30.9%) more often than other pregnant women (15.5%). Adjustment for background characteristics explained one third of this elevated risk, but the risk remained significantly increased among users of psychotropic medicine (OR 1.94, 95% confidence intervals 1.87-2.02). A similar risk was found for first pregnancies (30.1% vs. 18.9%; adjusted OR 1.53, 95% confidence intervals 1.42-1.65). The rate for terminating pregnancy was the highest for women using hypnotics and sedatives (35.6% for all pregnancies and 29.1% for first pregnancies), followed by antipsychotics (33.9% and 36.0%) and antidepressants (32.0% and 32.1%). Conclusions The observed increased risk for induced abortion among women with psychotropic medication highlighs the importance to acknowledge the mental health needs of women seeking an induced abortion. Further studies are needed to establish the impact of pre-existing differences in mental health on mental health outcomes of induced abortions compared to outcomes of pregnancies ending in a birth.
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Affiliation(s)
- Mika Gissler
- THL National Institute for Health and Welfare, Helsinki, Finland.
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28
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Mota NP, Burnett M, Sareen J. Associations between abortion, mental disorders, and suicidal behaviour in a nationally representative sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:239-47. [PMID: 20416147 DOI: 10.1177/070674371005500407] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Most previous studies that have investigated the relation between abortion and mental illness have presented mixed findings. We examined the relation between abortion, mental disorders, and suicidality using a US nationally representative sample. METHODS Data came from the National Comorbidity Survey Replication (n = 3310 women, aged 18 years and older). The World Health Organization-Composite International Diagnostic Interview was used to assess mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and lifetime abortion in women. Multiple logistic regression analyses were employed to examine associations between abortion and lifetime mood, anxiety, substance use, eating, and disruptive behaviour disorders, as well as suicidal ideation and suicide attempts. We calculated the percentage of respondents whose mental disorder came after the first abortion. The role of violence was also explored. Population attributable fractions were calculated for significant associations between abortion and mental disorders. RESULTS After adjusting for sociodemographics, abortion was associated with an increased likelihood of several mental disorders--mood disorders (adjusted odds ratio [AOR] ranging from 1.75 to 1.91), anxiety disorders (AOR ranging from 1.87 to 1.91), substance use disorders (AOR ranging from 3.14 to 4.99), as well as suicidal ideation and suicide attempts (AOR ranging from 1.97 to 2.18). Adjusting for violence weakened some of these associations. For all disorders examined, less than one-half of women reported that their mental disorder had begun after the first abortion. Population attributable fractions ranged from 5.8% (suicidal ideation) to 24.7% (drug abuse). CONCLUSIONS Our study confirms a strong association between abortion and mental disorders. Possible mechanisms of this relation are discussed.
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Affiliation(s)
- Natalie P Mota
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba
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Evaluating research on abortion and mental health. Contraception 2009; 80:500-3. [DOI: 10.1016/j.contraception.2009.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 05/15/2009] [Accepted: 06/02/2009] [Indexed: 11/22/2022]
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Robinson GE, Stotland NL, Russo NF, Lang JA, Occhiogrosso M. Is there an "abortion trauma syndrome"? Critiquing the evidence. Harv Rev Psychiatry 2009; 17:268-90. [PMID: 19637075 DOI: 10.1080/10673220903149119] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an "abortion trauma syndrome" or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.
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Affiliation(s)
- Gail Erlick Robinson
- Departments of Psychiatry, University of Toronto, Toronto, Ontario, Canada M M5G2C4.
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31
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Coleman PK, Coyle CT, Shuping M, Rue VM. Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey. J Psychiatr Res 2009; 43:770-6. [PMID: 19046750 DOI: 10.1016/j.jpsychires.2008.10.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 10/19/2008] [Accepted: 10/21/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.
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Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, USA.
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Coleman PK, Rue VM, Coyle CT. Induced abortion and intimate relationship quality in the Chicago Health and Social Life Survey. Public Health 2009; 123:331-8. [PMID: 19324381 DOI: 10.1016/j.puhe.2009.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 09/02/2008] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine associations between abortion and relationship functioning. STUDY DESIGN Independent variables included abortion in a previous relationship and abortion in a current relationship. Perceptions of quality-of-life changes associated with terminating the relationship, conflict, aggressiveness and sexual dysfunction were the outcome measures. METHODS Data were derived from interviews with an ethnically diverse urban sample of men (n=658) and women (n=906). Surveys were conducted in person using computer-assisted personal interview technology by the National Opinion Research Center affiliated with the University of Chicago, USA. RESULTS For men and women, the experience of an abortion in a previous relationship was related to negative outcomes in the current relationship; perceptions of improved quality of life if the current relationship also ended and intimate partner violence. Experience of an abortion within a current relationship was associated with 116% and 196% increased risk of arguing about children for women and men, respectively. Among females, experience of an abortion within a current relationship was associated with increased risk for various forms of sexual dysfunction (122-182%), increased risk of arguments about money (75%), increased risk of conflict about the partner's relatives (80%), and increased risk of arguing about the respondent's relatives (99%). Men whose current partners had experienced an abortion were more likely to report jealousy (96% greater risk) and conflict about drugs (385% greater risk). CONCLUSION Abortion may play a vital role in understanding the aetiology of relationship problems.
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Affiliation(s)
- P K Coleman
- Bowling Green State University, Bowling Green, Ohio 43403, USA.
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Steinberg JR, Jordan B, Wells ES. Science prevails: abortion and mental health. Contraception 2009; 79:81-3. [DOI: 10.1016/j.contraception.2008.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/21/2008] [Indexed: 11/30/2022]
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Beaber TE, Werner PD. The relationship between anxiety and sexual functioning in lesbians and heterosexual women. JOURNAL OF HOMOSEXUALITY 2009; 56:639-654. [PMID: 19591037 DOI: 10.1080/00918360903005303] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The association between anxiety and sexual functioning was studied in relation to women's sexual orientation. Participants in lesbian relationships (n = 42) and heterosexual relationships (n = 78) completed the Multidimensional Anxiety Questionnaire and Female Sexual Function Index. No difference was found between groups on the anxiety measure, but lesbians scored higher than heterosexuals on sexual functioning scales for arousal and orgasm. Intercorrelations among sexual functioning scales were dissimilar for lesbians and heterosexuals. Among heterosexuals, anxiety was negatively correlated with overall sexual functioning, lubrication, orgasm, and pain, but among lesbians anxiety was uncorrelated with all sexual functioning variables.
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Affiliation(s)
- Tera E Beaber
- California School of Professional Psychology, Alliant International University, San Francisco, CA 94133, USA
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Roomruangwong C, Tangwongchai S, Pittman BP, Epperson CN. Predictors of anxiety symptoms in the gynecological outpatient setting: The Thai experience. Int J Psychiatry Clin Pract 2009; 13:91-9. [PMID: 24916727 DOI: 10.1080/13651500802484026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective. To examine the prevalence and predictors of anxiety in women attending a gynecological outpatient service. Method. A total of 271 women who came to a gynecological outpatient clinic at a large university hospital in Bangkok, Thailand, were asked to complete the state sub-scale of the Spielberger State-Trait Anxiety Index (STAI) and a questionnaire to obtain demographic, medical and gynecological information as well as a questionnaire to assess social support. A cutoff score of ≥ 46 on the STAI was considered to indicate the presence of moderate-severe anxiety. Result. One hundred (36.9%) subjects met criteria for anxiety. Anxious women were more likely to be young and to have had an abortion at an earlier age. They were more likely to reside in rural Thailand, report perception of low social support, present with abnormal vaginal discharge and to have a greater number of gynecological symptoms than non-anxious women. Additionally, anxious women were less likely to have knowledge about their diagnosis compared to non-anxious women. Conclusion. Clinically meaningful levels of anxiety are common among women attending an outpatient gynecological clinic. Awareness of risk factors for anxiety in these women will aid medical personnel in identifying those in need of additional support and/or mental health services.
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Affiliation(s)
- Chutima Roomruangwong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Fergusson DM, Horwood LJ, Boden JM. Abortion and mental health disorders: evidence from a 30-year longitudinal study. Br J Psychiatry 2008; 193:444-51. [PMID: 19043144 DOI: 10.1192/bjp.bp.108.056499] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Research on the links between abortion and mental health has been limited by design problems and relatively weak evidence. AIMS To examine the links between pregnancy outcomes and mental health outcomes. METHOD Data were gathered on the pregnancy and mental health history of a birth cohort of over 500 women studied to the age of 30. RESULTS After adjustment for confounding, abortion was associated with a small increase in the risk of mental disorders; women who had had abortions had rates of mental disorder that were about 30% higher. There were no consistent associations between other pregnancy outcomes and mental health. Estimates of attributable risk indicated that exposure to abortion accounted for 1.5% to 5.5% of the overall rate of mental disorders. CONCLUSIONS The evidence is consistent with the view that abortion may be associated with a small increase in risk of mental disorders. Other pregnancy outcomes were not related to increased risk of mental health problems.
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Affiliation(s)
- David M Fergusson
- Christchurch Healthnd Development Study, University of Otago, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand.
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Charles VE, Polis CB, Sridhara SK, Blum RW. Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception 2008; 78:436-50. [DOI: 10.1016/j.contraception.2008.07.005] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 05/19/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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You say “regret” and I say “relief”: a need to break the polemic about abortion. Contraception 2008; 78:87-9. [DOI: 10.1016/j.contraception.2008.04.116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 04/24/2008] [Indexed: 11/24/2022]
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Steinberg JR, Russo NF. Abortion and anxiety: What's the relationship? Soc Sci Med 2008; 67:238-52. [DOI: 10.1016/j.socscimed.2008.03.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2006] [Indexed: 01/01/2023]
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Jones RK, Kost K. Underreporting of induced and spontaneous abortion in the United States: an analysis of the 2002 National Survey of Family Growth. Stud Fam Plann 2007; 38:187-97. [PMID: 17933292 DOI: 10.1111/j.1728-4465.2007.00130.x] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Underreporting of induced abortions in surveys is widespread, both in countries where the procedure is illegal or highly restricted and in those where it is legal. In this study, we find that fewer than one half of induced abortions performed in the United States in 1997-2001 (47 percent) were reported by women during face-to-face interviews in the 2002 National Survey of Family Growth (NSFG). Hispanic and black women and those with low income were among the least likely to report their experience of abortion. Women were also less likely to report abortions that occurred when they were in their 20s. Second-trimester abortions were more likely to be reported than first-trimester terminations. The levels of recent spontaneous abortion reported in the 2002 NSFG were consistent with the accumulated body of clinical research, although substantially more lifetime pregnancy losses were reported on self-administered surveys than in face-to-face interviews. Subsequent research should explore strategies to improve information collected on abortion, and, in the interim, research involving pregnancy outcomes should be adjusted for unreported induced abortions.
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Affiliation(s)
- Rachel K Jones
- Guttmacher Institute, 125 Maiden Lane, New York, NY 10038, USA.
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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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Abstract
The United Nations has identified gender-based violence against women as a global health and development issue, and a host of policies, public education, and action programs aimed at reducing gender-based violence have been undertaken around the world. This article highlights new conceptualizations, methodological issues, and selected research findings that can inform such activities. In addition to describing recent research findings that document relationships between gender, power, sexuality, and intimate violence cross-nationally, it identifies cultural factors, including linkages between sex and violence through media images that may increase women's risk for violence, and profiles a host of negative physical, mental, and behavioral health outcomes associated with victimization including unwanted pregnancy and abortion. More research is needed to identify the causes, dynamics, and outcomes of gender-based violence, including media effects, and to articulate how different forms of such violence vary in outcomes depending on cultural context.
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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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Coleman PK, Maxey CD, Rue VM, Coyle CT. Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers. Acta Paediatr 2005; 94:1476-83. [PMID: 16299880 DOI: 10.1111/j.1651-2227.2005.tb01823.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study explored maternal history of perinatal loss relative to risk of child physical abuse and neglect. METHODS The 518 study participants included 118 abusive mothers, 119 neglecting mothers, and 281 mothers with no known history of child maltreatment. Interviews and observations were conducted in the participants' homes, and comparisons were made between women without a history of perinatal loss and women with one and multiple losses relative to risk for child maltreatment. RESULTS Compared to women with no history of perinatal loss, those with one loss (voluntary or involuntary) had a 99% higher risk for child physical abuse, and women with multiple losses were 189% more likely to physically abuse their children. Compared to women with no history of induced abortion, those with one prior abortion had a 144% higher risk for child physical abuse. Finally, maternal history of multiple miscarriages and/or stillbirths compared to no history was associated with a 1237% increased risk of physical abuse and a 605% increased risk of neglect. CONCLUSION Perinatal loss may be a marker for elevated risk of child physical abuse, and this information is potentially useful to child maltreatment prevention and intervention efforts.
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Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, USA.
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Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers. Acta Paediatr 2005. [DOI: 10.1080/08035250510042960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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