Abortion and Mental Health

Abstract

Objective To examine whether a first abortion increases risk of mental health disorders compared to a first childbirth, with and without considering prepregnancy mental health and adverse exposures, childhood economic status, miscarriage history, age at first abortion or childbirth, and race or ethnicity. Methods A cohort study compared rates of mental disorders (anxiety, mood, impulse-control, substance use, eating disorders, and suicidal ideation) among 259 women postabortion and 677 women postchildbirth aged 18 to 42 at the time of interview from The National Comorbidity Survey-Replication Results The percentage of women with no, one, two, and three or more mental health disorders before their first abortion was 37.8%, 19.7%, 15.2% and 27.3%, and before their first childbirth was 57.9%, 19.6%, 9.2%, and 13.3% respectively, indicating that women in the abortion group had more prior mental health disorders than women in the childbirth group, p < .001. Although in unadjusted Cox proportional hazard models, abortion compared to childbirth was associated with statistically significant higher hazards of postpregnancy mental health disorders, associations were reduced and became nonstatistically significant for five disorders after adjusting for the aforementioned factors. Hazard ratios (HR) and associated 95% confidence intervals dropped from 1.52 (1.08-2.15) to 1.12 (0.87-1.46) for any anxiety disorder; from 1.56 (1.23-1.98) to 1.18 (0.88-1.56) for mood disorders; from 1.62 (1.02-2.57) to 1.10 (0.75-1.62) for impulse-control disorders; from 2.53 (1.09-5.86) to 1.82 (0.63-5.25) for eating disorders; and from 1.62 (1.09-2.40) to 1.25 (0.88-1.78) for suicidal ideation. Only abortion and substance use disorders remained statistically significant, although the HR dropped from 3.05 (1.94-4.79) to 2.30 (1.35-3.92). Conclusions After accounting for confounding factors, abortion was not a statistically significant predictor of subsequent anxiety, mood, impulse-control, and eating disorders or suicidal ideation.

Psychosocial factors and pre-abortion psychological health: The significance of stigma

“…This is one of the first studies to examine predictors of pre-abortion psychological health; results were in the expected direction and they were consistent with other research that has examined some of these factors as predictors of post-abortion psychological health in a nationally representative sample of women (Steinberg & Finer, 2011; Steinberg et al, 2014). Future research could verify these findings in other samples of women having abortions.…”

“…We focused on pre-abortion psychological health for two main reasons. First, psychological distress before an abortion is higher compared to any time afterwards (Bradshaw & Slade, 2003; Major et al, 2000; Lowenstein et al, 2006) and compared to other samples as described just above (Antony et al, 1998; Lee et al, 2005; Miller et al, 2006; Thomas et al, 2001); and second, pre-abortion psychological health has consistently been shown to be a strong predictor of post-abortion psychological health (Major et al, 2000; Steinberg et al, 2014). Therefore, helping women reduce pre-abortion psychological distress is warranted and to do that, we need to understand what predicts pre-abortion psychological health.…”

“…The first framework, the common-risk factors approach, is mutually exclusive with abortion as a trauma perspective, and they both are used to answer the question of whether or not abortion causes mental health problems. Abortion as trauma contends that abortion is a trauma that causes mental health problems; studies that rely on this approach have serious methodological flaws and have been discredited (Major et al, 2009; National Collaborating Centre for Mental Health [NCMH], 2011; Schmiege & Russo, 2005; Steinberg & Finer, 2012; Steinberg & Russo, 2008; Steinberg et al, 2012; 2014). The common risk factors approach argues that the correlation between abortion and subsequent mental health is spurious, and driven by factors that are common—e.g., pre-existing mental health problems, violence, social disadvantage—among women having abortions and women having mental health problems.…”

“…The common risk factors approach argues that the correlation between abortion and subsequent mental health is spurious, and driven by factors that are common—e.g., pre-existing mental health problems, violence, social disadvantage—among women having abortions and women having mental health problems. Studies using this approach find that abortion is not associated with worse subsequent mental health problems when these confounding factors are considered in analyses (Foster et al, 2015; Major et al, 2009; NCMH, 2011; Steinberg & Finer, 2011; Steinberg et al, 2014). Furthermore, these studies find that confounding factors such as childhood adversities, intimate partner violence (IPV), and pre-existing mental health problems are associated with poorer post-pregnancy (including post-abortion) psychological health.…”

Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion

“…The simple association between abortion and subsequent mental-health disorders—including mood, anxiety, substance-use disorders, and suicidal ideation—appears open to alternative explanations (Steinberg, Becker, & Henderson, 2011; Steinberg & Finer, 2011; Steinberg, McCulloch, & Adler, 2014; Steinberg & Russo, 2008; Taft & Watson, 2008). In models that control for confounding factors—such as prior mental health, prior or current adverse experiences, and sociodemographic factors—the association between abortion and subsequent mental health evaporates for mood and anxiety disorders, and suicidal ideation (Fergusson, Horwood, & Boden, 2013; Steinberg et al, 2011; Steinberg & Finer, 2011; Steinberg et al, 2014; Steinberg & Russo, 2008; Taft & Watson, 2008). Furthermore, strong predictors of post-pregnancy (including post-birth and post-abortion) mental health were prior mental health, and adverse experiences.…”