An Explanatory Model to Guide Assessment, Risk and Diagnosis of Psychological Distress after Abortion

Abstract

Background: Emerging data report 30% of women worldwide who obtain elective abortion experience negative and persistent psychological distress afterward. Studies find higher rates of psychological stress, depressive, substance, and anxiety disorders as well as suicidal behaviors, among some populations after abortion as compared to other reproductive events. Of concern, is that current theory and practice which promote abortion to relieve the stress of an unwanted pregnancy do not reflect new evidence. Moreover, the controversy on abortion inhibits research and treatment on its impact on women's mental health. Thus, clinicians do not identify adverse psychological outcomes to abortion leaving many women untreated. Indeed, this knowledge-practice gap among healthcare providers may be the major reason that the incidence of adverse psychological outcomes after abortion continues to rise. Method: This paper proposes a theoretical understanding of psychological distress after abortion based on new data. A bio-psychosocial framework, including a psychological and biological theory, as well as a conceptual model is presented to explain the development of psychological distress after abortion. A comparison of risk factors between postpartum and post-abortion disorders is presented. Conclusion: A new theoretical model of psychological distress after abortion deepens understanding of the range of women's responses to abortion and promotes evidence based practice.A scientific framework provides a much needed understanding of abortion aftermath as opposed to a political one. By providing assistance to clinicians in the identification, screening, and treatment of psychological disorders after abortion, this thesis aims to close the practice gap, and increase services after abortion to women who need them.

The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities

“…148 The APA's TFMHA proposed four models: (a) abortion as a traumatic experience, (b) abortion within a stress and coping perspective, (c) abortion within a socio-cultural context, and (d) abortion as associated with co-occurring risk factors. 7 Additional models could be built on biological responses, 149,150 attachment theory, [151][152][153][154] bereavement, 153,[155][156][157][158] complicated, prolonged or impacted grief, [159][160][161][162][163] ambiguous loss, 156,161,[164][165][166][167] or within a paradigm of psychological responses to miscarriage. 74,[168][169][170] The complexity of considering so many models, or pathways, combined with the multiplicity of symptoms women attribute to their abortions, 45 contributes to discord in the literature produced by AMH proponents and AMH minimalists.…”