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Studnicki J, Longbons T, Fisher J, Reardon DC, Skop I, Cirucci CA, Harrison DJ, Craver C, Tsulukidze M, Ras Z. A Cohort Study of Mental Health Services Utilization Following a First Pregnancy Abortion or Birth. Int J Womens Health 2023; 15:955-963. [PMID: 37342485 PMCID: PMC10278648 DOI: 10.2147/ijwh.s410798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023] Open
Abstract
Objective To determine whether exposure to a first pregnancy outcome of induced abortion, compared to a live birth, is associated with an increased risk and likelihood of mental health morbidity. Materials and methods Participants were continuously eligible Medicaid beneficiaries age 16 in 1999, and assigned to either of two cohorts based upon the first pregnancy outcome, abortion (n = 1331) or birth (n = 3517), and followed through to 2015. Outcomes were mental health outpatient visits, inpatient hospital admissions, and hospital days of stay. Exposure periods before and after the first pregnancy outcome, a total of 17 years, were determined for each cohort. Findings Women with first pregnancy abortions, compared to women with births, had higher risk and likelihood of experiencing all three mental health outcome events in the transition from pre- to post-pregnancy outcome periods: outpatient visits (RR 2.10, CL 2.08-2.12 and OR 3.36, CL 3.29-3.42); hospital inpatient admissions (RR 2.75, CL 2.38-3.18 and OR 5.67, CL 4.39-7.32); hospital inpatient days of stay (RR 7.38, CL 6.83-7.97 and OR 19.64, CL 17.70-21.78). On average, abortion cohort women experienced shorter exposure time before (6.43 versus 7.80 years), and longer exposure time after (10.57 versus 9.20 years) the first pregnancy outcome than birth cohort women. Utilization rates before the first pregnancy outcome, for all three utilization events, were higher for the birth cohort than for the abortion cohort. Conclusion A first pregnancy abortion, compared to a birth, is associated with significantly higher subsequent mental health services utilization following the first pregnancy outcome. The risk attributable to abortion is notably higher for inpatient than outpatient mental health services. Higher mental health utilization before the first pregnancy outcome for birth cohort women challenges the explanation that pre-existing mental health history explains mental health problems following abortion, rather than the abortion itself.
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Affiliation(s)
| | | | - John Fisher
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | - Ingrid Skop
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | - Donna J Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
| | | | - Maka Tsulukidze
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Zbigniew Ras
- Computer Science Department, University of North Carolina at Charlotte, Charlotte, NC, USA
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Chen JK, Wang SC, Wang LC. Syndemic Profiles and Sexual Health Risks Among Sexually Exploited Adolescent Girls in Taiwan: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1631-1641. [PMID: 36749407 DOI: 10.1007/s10508-023-02545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Sexually exploited adolescent girls are disproportionately affected by adverse psychosocial conditions, such as intra-familial child physical and sexual abuse, extra-familial violence and sexual assault, alcohol and drug use, and suicide. Syndemic theory suggests that these adverse psychosocial or syndemic conditions are concentrated and co-occurring in socially marginalized populations, including sexually exploited adolescents, and increase their sexual health risks, including pregnancy, abortion, and the acquisition of sexually transmitted diseases (STDs). To examine clusters of syndemic conditions, latent class analysis (LCA) was conducted to classify 335 sexually exploited girls in Taiwan into subgroups based on their probability of experiencing each syndemic condition. We used syndemic class membership to predict their sexual health outcomes, specifically pregnancy, abortion, and the acquisition of STDs. The results of LCA revealed three classes, which were "low-risk syndemic," "moderate-risk syndemic," and "high-risk syndemic." The risk of acquisition of STDs among sexually exploited girls in the "high-risk syndemic class" and "moderate-risk syndemic class" was 239% and 135% higher, respectively, than the risk of acquisition of STDs among sexually exploited girls in the "low-risk syndemic class." Differences between these three classes in pregnancy and abortion were not significant. Our findings support the syndemic theory that a pattern of syndemic conditions is associated with an increased risk of acquiring STDs. Interventions aimed at reducing the acquisition of STDs among sexually exploited girls in Taiwan should adopt a comprehensive approach to address co-occurring conditions.
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Affiliation(s)
- Ji-Kang Chen
- Department of Social Work, Chinese University of Hong Kong, Sha Tin, Hong Kong.
| | - Shu-Chen Wang
- National Academy for Educational Research, New Taipei, Taiwan
| | - Li-Chih Wang
- Department of Special Education, National Tsing Hua University, Hsinchu City, Taiwan
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3
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Reardon DC, Rafferty KA, Longbons T. The Effects of Abortion Decision Rightness and Decision Type on Women's Satisfaction and Mental Health. Cureus 2023; 15:e38882. [PMID: 37303450 PMCID: PMC10257365 DOI: 10.7759/cureus.38882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
Background A case series report based on the Turnaway Study has previously concluded that 99% of women with a history of abortion will continue to affirm satisfaction with their decisions to abort. Those findings have been called into question due to a low participation rate (31%) and reliance on a single yes/no assessment of decision satisfaction. Aim To utilize more sensitive scales in assessing decision satisfaction and the associated mental health outcomes women attribute to their abortions. Method A retrospective survey was completed by 1,000 females, aged 41-45, living in the United States. The survey instrument included 11 visual analog scales for respondents to rate their personal preferences and outcomes they attributed to their abortion decisions. A categorical question allowed women to identify if their abortions were wanted and consistent with their own values and preferences, inconsistent with their values and preferences, unwanted, or coerced. Linear regression models were tested to identify which of three decision scales best predicted positive or negative emotions, effects on mental health, emotional attachment, personal preferences, moral conflict, and other factors relevant to an assessment of satisfaction with a decision to abort. Results Of 226 women reporting a history of abortion, 33% identified it as wanted, 43% as accepted but inconsistent with their values and preferences, and 24% as unwanted or coerced. Only wanted abortions were associated with positive emotions or mental health gains. All other groups attributed more negative emotions and mental health outcomes to their abortions. Sixty percent reported they would have preferred to give birth if they had received more support from others or had more financial security. Conclusions Perceived pressure to abort is strongly associated with women attributing more negative mental health outcomes to their abortions. The one-third of women for whom abortion is wanted and consistent with their values and preferences are most likely over-represented in studies initiated at abortion clinics. More research is needed to understand better the experience of the two-thirds of women for whom abortion is unwanted, coerced, or otherwise inconsistent with their own values and preferences.
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Affiliation(s)
- David C Reardon
- Research, Elliot Institute, St. Peters, USA
- Research, Charlotte Lozier Institute, Arlington, USA
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4
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Rajkumar RP. The Relationship Between Access to Abortion and Mental Health in Women of Childbearing Age: Analyses of Data From the Global Burden of Disease Studies. Cureus 2022; 14:e31433. [DOI: 10.7759/cureus.31433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
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Coleman PK. The Turnaway Study: A Case of Self-Correction in Science Upended by Political Motivation and Unvetted Findings. Front Psychol 2022; 13:905221. [PMID: 35783786 PMCID: PMC9247501 DOI: 10.3389/fpsyg.2022.905221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
This review begins with a detailed focus on the Turnaway Study, which addresses associations among early abortion, later abortion, and denied abortion relative to various outcomes including mental health indicators. The Turnaway Study was comprised of 516 women; however, an exact percentage of the population is not discernable due to missing information. Extrapolating from what is known reveals a likely low of 0.32% to a maximum of 3.18% of participants sampled from the available the pool. Motivation for conducting the Turnaway Study, methodological deficiencies (sampling issues and others), and bias are specifically addressed. Despite serious departures from accepted scientific practices, journals in psychology and medicine have published dozens of articles generated from the study's data. The high volume of one-sided publications has stifled dialogue on potential adverse psychological consequences of this common procedure. Following a critical analysis of the Turnaway Study, an overview of the strongest studies on abortion and mental health is offered. This comprehensive literature comprised of numerous large-scale studies from across the globe has been largely overlooked by scientists and the public, while the Turnaway Study dominates the media, information provided to women, and legal challenges involving abortion restrictions. In the final section of this article, literature reviews by professional organizations are considered, demonstrating that the biased science characterizing the Turnaway Study is aligned with a pervasive and systemic phenomenon wherein deriving reliable and valid results via careful attention to methodology and scrutiny by the scientific community have been supplanted by politics.
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Affiliation(s)
- Priscilla K. Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH, United States
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Saad H, Sinclair M, Bunting B. Maternal sociodemographic characteristics, early pregnancy behaviours, and livebirth outcomes as congenital heart defects risk factors - Northern Ireland 2010-2014. BMC Pregnancy Childbirth 2021; 21:759. [PMID: 34758755 PMCID: PMC8579547 DOI: 10.1186/s12884-021-04223-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Congenital Heart Defects (CHD) is the most commonly occurring congenital anomaly in Europe and a major paediatric health care concern. Investigations are needed to enable identification of CHD risk factors as studies have given conflicting results. This study aim was to identify maternal sociodemographic characteristics, behaviours, and birth outcomes as risk factors for CHD. This was a population based, data linkage cohort study using anonymised data from Northern Ireland (NI) covering the period 2010-2014. The study cohort composed of 94,067 live births with an outcome of 1162 cases of CHD using the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes and based on the European Surveillance of Congenital Anomalies (EUROCAT) grouping system for CHD. CHD cases were obtained from the HeartSuite database (HSD) at the Royal Belfast Hospital for Sick Children (RBHSC), maternal data were extracted from the Northern Ireland Maternity System (NIMATS), and medication data were extracted from the Enhanced Prescribing Database (EPD). STATA version 14 was used for the statistical analysis in this study, Odds Ratio (OR), 95% Confident intervals (CI), P value, and logistic regression were used in the analysis. Ethical approval was granted from the National Health Service (NHS) Research Ethics Committee. RESULT In this study, a number of potential risk factors were assessed for statistically significant association with CHD, however only certain risk factors demonstrated a statistically significant association with CHD which included: gestational age at first booking (AOR = 1.21; 95% CI = 1.04-1.41; P < 0.05), family history of CHD or congenital abnormalities and syndromes (AOR = 4.14; 95% CI = 2.47-6.96; P < 0.05), woman's smoking in pregnancy (AOR = 1.22; 95% CI = 1.04-1.43; P < 0.05), preterm birth (AOR = 3.01; 95% CI = 2.44-3.01; P < 0.05), multiple births (AOR = 1.89; 95% CI = 1.58-2.60; P < 0.05), history of abortion (AOR = 1.12; 95% CI = 1.03-1.28; P < 0.05), small for gestational age (SGA) (AOR = 1.44; 95% CI = 1.22-1.78; P < 0.05), and low birth weight (LBW) (AOR = 3.10; 95% CI = 2.22-3.55; P < 0.05). Prescriptions and redemptions of antidiabetic (AOR = 2.68; 95% CI = 1.85-3.98; P < 0.05), antiepileptic (AOR = 1.77; 95% CI = 1.10-2.81; P < 0.05), and dihydrofolate reductase inhibitors (DHFRI) (AOR = 2.13; 95% CI = 1.17-5.85; P < 0.05) in early pregnancy also showed evidence of statistically significant association with CHD. CONCLUSION The results of this study suggested that there are certain maternal sociodemographic characteristics, behaviours and birth outcomes that are statistically significantly associated with higher risk of CHD. Appropriate prevention policy to target groups with higher risk for CHD may help to reduce CHD prevalence. These results are important for policy makers, obstetricians, cardiologists, paediatricians, midwives and the public.
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Affiliation(s)
- Hafi Saad
- Maternal Fetal and Infant Research Centre, Ulster University, Jordanstown, UK.
| | - Marlene Sinclair
- Maternal Fetal and Infant Research Centre, Ulster University, Jordanstown, UK
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Reardon DC, Craver C. Intervals and Outcomes of First and Second Pregnancies in Low-Income Women: A Record-Linkage Longitudinal Prospective Cohort Study. Med Sci Monit 2021; 27:e931596. [PMID: 34168106 PMCID: PMC8240602 DOI: 10.12659/msm.931596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The number of pregnancies and interval between pregnancies can have significant impact on a woman’s reproductive, psychological, and general health. Exposure to multiple reproductive losses is especially associated with higher rates of negative outcomes. Material/Methods Medical records from 1999–2012 for all Medicaid beneficiaries born after 1982 in the 17 states that provide coverage for all reproductive services (N=2 162 600) were examined to identify the timing of subsequent pregnancies and their outcomes within 3 years of a first known pregnancy. Results One year after their first pregnancy outcomes, 22.6%, 17.8%, and 11.7% of women who had an induced abortion, a natural loss, or a birth, respectively, conceived at least 1 additional pregnancy. By the second year, the percentage of repeat pregnancies rose to 37.5% after an abortion, 25.6% after a natural loss, and 23.1% after a birth. Graphing the weekly conception rates revealed that women who had abortions and natural losses showed similar patterns of rapid repeat pregnancy, with the rate of second conception spiking quickly within 3 to 4 months after the first pregnancy outcome. Conclusions These findings support the clinical evidence that pregnancy loss may contribute to rapid repeat pregnancies and may better inform interventions to reduce rapid repeat pregnancies.
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Affiliation(s)
- David C Reardon
- Department of Research, Elliot Institute, St. Peters, MO, USA
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8
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Zia Y, Mugo N, Ngure K, Odoyo J, Casmir E, Ayiera E, Bukusi E, Heffron R. Psychosocial Experiences of Adolescent Girls and Young Women Subsequent to an Abortion in Sub-saharan Africa and Globally: A Systematic Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:638013. [PMID: 36303958 PMCID: PMC9580653 DOI: 10.3389/frph.2021.638013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Unmet need for contraception, unintended pregnancy, and access to safe abortion remain global challenges preventing adolescent girls and young women (AGYW) from achieving optimal reproductive health. Furthermore, AGYW face difficulties navigating sexual autonomy, lack of agency or experience negotiating sexual acts, and challenges accessing sexual health information and services. The aim of this systematic review is to assess the psychosocial outcomes of AGYW who have experienced an abortion with particular focus on sub-Saharan Africa, which bears the global burden of unintended pregnancy and risk of death due to unsafe abortion. Materials and Methods: The systematic review was registered and used search terms to identify peer-reviewed articles relevant to “post-abortion,” “psychosocial,” “adolescent girls,” and “young women” from PubMed, Embase, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature. Examples of psychosocial experiences include quality of life, stigma, and mental health outcomes. Rayyan software (Qatar, 2020) was used by two reviewers to assess the relevance of each article to psychosocial outcomes of AGYW any time after an abortion or accessing post-abortion services. Analysis was conducted with a focus on data from Africa and comparisons are made to non-African settings. Results: A total of 2,406 articles were identified and 38 articles fit the criteria. Six selected articles were from Africa, including Ghana, Kenya, Uganda, and Zambia, and the remaining articles were from other regions. Themes around stigma, shame, and abandonment associated with the experience of abortion were prevalent in all regions. Studies of psychosocial outcomes of AGYW in sub-Saharan Africa highlight social isolation as well as learned resilience among young women who abort. Discussion: Navigating abortion as an AGYW involves managing internalized and perceived stigma, fear of violence, secrecy, and growing resilient in order to overcome the significant barriers that society and culture place on access to an essential service in sexual and reproductive health. Post-abortion psychosocial outcomes highlight the need for support services and investigation of contexts that perpetuate and necessitate unsafe abortion. Empowerment of AGYW may present an important opportunity to build self-agency and positive coping mechanisms to withstand social pressures during stigmatizing circumstances associated with abortion.
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Affiliation(s)
- Yasaman Zia
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- *Correspondence: Renee Heffron
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9
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Grauerholz KR, Berry SN, Capuano RM, Early JM. Uncovering Prolonged Grief Reactions Subsequent to a Reproductive Loss: Implications for the Primary Care Provider. Front Psychol 2021; 12:673050. [PMID: 34054675 PMCID: PMC8149623 DOI: 10.3389/fpsyg.2021.673050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction There is a paucity of clinical guidelines for the routine assessment of maladaptive reproductive grief reactions in outpatient primary care and OB-GYN settings in the United States. Because of the disenfranchised nature of perinatal grief reactions, many clinicians may be apt to miss or dismiss a grief reaction that was not identified in the perinatal period. A significant number of those experiencing a reproductive loss exhibit signs of anxiety, depression, or post-traumatic stress disorder. Reproductive losses are typically screened for and recorded numerically as part of a woman’s well-visit intake, yet this process often fails to identify patients emotionally troubled by a prior pregnancy loss. Materials and Methods A summative content analysis of 164 recent website blogs from female participants who self-reported having experienced a miscarriage or abortion in their lifetime was conducted. The narratives were reviewed for details regarding the time span between the pregnancy loss and the composition of the blog post. The stories were analyzed for subsequent relationship problems and detrimental mental health conditions. Maladaptive reactions were contrasted for those that indicated a greater than 12 months’ time-lapse and those who had not. Results More than a third (39.6%) of the women reported in the narrative that at least one year or more had passed since experiencing the miscarriage or abortion. For those women, the median time span between the loss and composing the blog was 4 years with a range of 47 years. Mental health conditions attributed to the reproductive loss by those who reported longer bereavement times included subsequent relationship problems, substance misuse, depression, suicidal ideation, and PTSD. The percent of reported maladaptive issues was more than double (136.9% vs. 63.6%) for those who reported that a year or more had passed since the loss of the pregnancy. Discussion Grief reactions following the loss of a pregnancy may be prolonged or delayed for several months which can contribute to adverse biopsychosocial outcomes. Recognition and treatment of maladaptive grief reactions following a pregnancy loss are critical. Screening methods should be enhanced for clinicians in medical office settings to help identify and expedite the appropriate mental health assistance.
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Affiliation(s)
| | - Shandeigh N Berry
- Life Perspectives, San Diego, CA, United States.,Department of Nursing, College of Arts and Sciences, St. Martin's University, Lacey, WA, United States
| | - Rebecca M Capuano
- Life Perspectives, San Diego, CA, United States.,Blue Ridge Women's Center, Roanoke, VA, United States
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Reardon DC, Craver C. Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042179. [PMID: 33672236 PMCID: PMC7926811 DOI: 10.3390/ijerph18042179] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 01/28/2023]
Abstract
Pregnancy loss, natural or induced, is linked to higher rates of mental health problems, but little is known about its effects during the postpartum period. This study identifies the percentages of women receiving at least one postpartum psychiatric treatment (PPT), defined as any psychiatric treatment (ICD-9 290-316) within six months of their first live birth, relative to their history of pregnancy loss, history of prior mental health treatments, age, and race. The population consists of young women eligible for Medicaid in states that covered all reproductive services between 1999-2012. Of 1,939,078 Medicaid beneficiaries with a first live birth, 207,654 (10.7%) experienced at least one PPT, and 216,828 (11.2%) had at least one prior pregnancy loss. A history of prior mental health treatments (MHTs) was the strongest predictor of PPT, but a history of pregnancy loss is also another important risk factor. Overall, women with a prior pregnancy loss were 35% more likely to require a PPT. When the interactions of prior mental health and prior pregnancy loss are examined in greater detail, important effects of these combinations were revealed. About 58% of those whose first MHT was after a pregnancy loss required PPT. In addition, over 99% of women with a history of MHT one year prior to their first pregnancy loss required PPT after their first live births. These findings reveal that pregnancy loss (natural or induced) is a risk factor for PPT, and that the timing of events and the time span for considering prior mental health in research on pregnancy loss can significantly change observed effects. Clinicians should screen for a convergence of a history of MHT and prior pregnancy loss when evaluating pregnant women, in order to make appropriate referrals for counseling.
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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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12
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Guo C, Pang L, Wen X, Zheng X. Risky Sexual Behaviors and Repeat Induced Abortion Among Unmarried Young Women in China: Results from a Large, Nationwide, Population-Based Sample. J Womens Health (Larchmt) 2019; 28:1442-1449. [DOI: 10.1089/jwh.2018.7097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chao Guo
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
| | - Lihua Pang
- Institute of Population Research, Peking University, Beijing, China
| | - Xu Wen
- Institute of Population Research, Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
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13
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Jacob L, Kostev K, Gerhard C, Kalder M. Relationship between induced abortion and the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder in Germany. J Psychiatr Res 2019; 114:75-79. [PMID: 31048110 DOI: 10.1016/j.jpsychires.2019.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/31/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022]
Abstract
AIM The goal of this retrospective cohort study was to analyze the relationship between induced abortion and the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder in Germany. METHODS Women who had undergone induced abortions for the first time in 281 gynecological practices in Germany between January 2007 and December 2016 were included (index date). Women with live births were matched (1:1) to those with induced abortion by age, index year, and physician. The main outcome of the study was the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder as a function of induced abortion. Survival analyses and Cox regression models were used to investigate the association between induced abortion and psychiatric disorders. RESULTS This study included 17581 women who had had an induced abortion and 17581 women who had had a live birth. Within 10 years of the index date, 6.7% of the participants with induced abortions and 5.4% of those with live births were diagnosed with depression (log-rank p-value = 0.003). The respective figures were 3.4% and 2.7% for anxiety disorder (log-rank p-value = 0.255), 6.2% and 5.6% for adjustment disorder (log-rank p-value = 0.116), and 19.3% and 13.3% for somatoform disorder (log-rank p-value<0.001). Induced abortion was significantly associated with depression (hazard ratio [HR] = 1.34), adjustment disorder (HR = 1.45) and somatoform disorder (HR = 1.56), but not with anxiety disorder (HR = 1.17). CONCLUSIONS There was a positive association between induced abortion and several psychiatric disorders in Germany. Further analyses are recommended to assess how induced abortion can have such a negative impact on mental health.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | | | - Christian Gerhard
- Department of Gynecology and Obstetrics, Philipps University of Marburg, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, Marburg, Germany
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Sullins DP, Harrison D. Danish-like Regulations May Improve Postabortion Mental Health Risk. JAMA Psychiatry 2019; 76:99-100. [PMID: 30422159 DOI: 10.1001/jamapsychiatry.2018.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- D Paul Sullins
- Department of Sociology, Catholic University of America, Hyattsville, Maryland.,Ruth Institute, Lake Charles, Louisiana
| | - Donna Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, Michigan
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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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Reardon DC. The Embrace of the Proabortion Turnaway Study: Wishful Thinking? or Willful Deceptions? LINACRE QUARTERLY 2018; 85:204-212. [PMID: 30275603 DOI: 10.1177/0024363918782156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The abortion advocacy group Advancing New Standards in Reproductive Health (ANSIRH) has published over twenty papers based on a case series of women taking part in their Turnaway Study. Following the lead of ANSIRH news releases, major media outlets have described these results as proof that (a) most women who have abortions are glad they did, (b) there is no evidence of negative mental health effects following abortion, and (c) the only women really suffering are those who are being denied late-term abortions due to legal restrictions based on gestational age. Buried in ANSIRH's papers are the facts that over 68 percent of the women they sought to interview refused, their own evidence confirms that the remnant who did participate were atypical, there are no known benefits from abortion, their methods are misleadingly described, and their results are selectively reported. Summary: Widely publicized claims regarding the benefits of abortion for women have been discredited. The Turnaway Study, conducted by abortion advocates at thirty abortion clinics, reportedly proves that 95 percent of women have no regrets about their abortions and that abortion causes no mental health problems. But a new exposé reveals that the authors have misled the public, using an unrepresentative, highly biased sample and misleading questions. In fact, over two-thirds of the women approached at the abortion clinics refused to be interviewed, and half of those who agreed dropped out. Refusers and dropouts are known to have more postabortion problems.
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Luo M, Jiang X, Wang Y, Wang Z, Shen Q, Li R, Cai Y. Association between induced abortion and suicidal ideation among unmarried female migrant workers in three metropolitan cities in China: a cross-sectional study. BMC Public Health 2018; 18:625. [PMID: 29764402 PMCID: PMC5952593 DOI: 10.1186/s12889-018-5527-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Despite reports of mental health issues, suicidality has not been closely examined among the migrant population. The association between induced abortion and suicidal ideation is unknown among unmarried female migrant workers of reproductive age in China. This study aims to examine induced abortion and suicidality among the Chinese migrant population. Methods We recruited 5115 unmarried female migrant workers during 2015 to 2016 from Shanghai, Beijing and Guangzhou, and collected demographic, psychosocial, reproductive and mental health information using structured questionnaires. We used logistic regression models to examine the association between lifetime induced abortion and suicidal ideation during the past year among the subjects. Results Overall, 8.2% of the subjects had suicidal ideation during the past year, and 15.5% of the subjects experienced induced abortion. Induced abortion was associated with nearly twice the odds of having past-year suicidal ideation (Odds ratio, OR = 1.89; 95% confidence interval, CI: 1.46, 2.44) after adjusting for age, education, years in the working place, tobacco use, alcohol consumption, daily internet use, attitude towards premarital pregnancy, multiple induced abortion, self-esteem, loneliness, depression, and anxiety disorders. The association was stronger in those aged > 25 (OR = 3.37, 95% CI = 2.16, 5.28), with > 5 years of stay in the working place (OR = 2.98, 95% CI = 2.02, 4.39), the non-anxiety group (OR = 2.28, 95% CI = 1.74, 3.00), and the non-depression group (OR = 2.94, 95% CI = 2.08, 4.15). Conclusions Induced abortion was associated with increased odds for suicidal ideation among the unmarried female migrant workers in urban cities in China. More attention should be paid to the mental health of the population.
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Affiliation(s)
- Mengyun Luo
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Xueqin Jiang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Ying Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Zezhou Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Qiuming Shen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Rui Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA.
| | - Yong Cai
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China.
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Reardon DC, Thorp JM. Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis. SAGE Open Med 2017; 5:2050312117740490. [PMID: 29163945 PMCID: PMC5692130 DOI: 10.1177/2050312117740490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 10/09/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Measures of pregnancy associated deaths provide important guidance for public health initiatives. Record linkage studies have significantly improved identification of deaths associated with childbirth but relatively few have also examined deaths associated with pregnancy loss even though higher rates of maternal death have been associated with the latter. Following PRISMA guidelines we undertook a systematic review of record linkage studies examining the relative mortality risks associated with pregnancy loss to develop a narrative synthesis, a meta-analysis, and to identify research opportunities. METHODS MEDLINE and SCOPUS were searched in July 2015 using combinations of: mortality, maternal death, record linkage, linked records, pregnancy associated mortality, and pregnancy associated death to identify papers using linkage of death certificates to independent records identifying pregnancy outcomes. Additional studies were identified by examining all citations for relevant studies. RESULTS Of 989 studies, 11 studies from three countries reported mortality rates associated with termination of pregnancy, miscarriage or failed pregnancy. Within a year of their pregnancy outcomes, women experiencing a pregnancy loss are over twice as likely to die compared to women giving birth. The heightened risk is apparent within 180 days and remains elevated for many years. There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors. CONCLUSIONS Both miscarriage and termination of pregnancy are markers for reduced life expectancy. This association should inform research and new public health initiatives including screening and interventions for patients exhibiting known risk factors.
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Affiliation(s)
| | - John M Thorp
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ely GE, Hales T, Jackson DL, Bowen EA, Maguin E, Hamilton G. A trauma-informed examination of the hardships experienced by abortion fund patients in the United States. Health Care Women Int 2017; 38:1133-1151. [PMID: 28850325 DOI: 10.1080/07399332.2017.1367795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010 to 2015 in the United States. All patients received financial assistance from an abortion fund to help pay for abortion. Case data were analyzed to assess types and numbers of hardships experienced by age, race, and geographic origin. Hardships ranged from homelessness to parenting multiple children. Patients from the geographic South experienced the most hardships, followed by those from the Midwest. Hardships experienced by abortion fund patients are like those reported in other samples of abortion patients; hardships potentially cause or exacerbate trauma. Results are discussed in the context of a trauma-informed perspective.
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Affiliation(s)
- Gretchen E Ely
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Travis Hales
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - D Lynn Jackson
- b Department of Social Work , Texas Christian University , Fort Worth , Texas , USA
| | - Elizabeth A Bowen
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Eugene Maguin
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Greer Hamilton
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , New York , USA
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20
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Reardon DC. Missed opportunities and overstated results in anxiety and quality of life study following termination of pregnancy. Acta Obstet Gynecol Scand 2016; 96:382. [DOI: 10.1111/aogs.13053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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