Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS)

Abstract

While there is a large body of research demonstrating that having an abortion is not associated with adverse mental health outcomes, less research has examined which factors may contribute to elevated levels of mental health symptoms at the time of abortion seeking. This study aims to develop and validate a new tool to measure dimensions of psychosocial burden experienced by people seeking abortion in the United States. To develop scale items, we reviewed the literature including existing measures of stress and anxiety and conducted interviews with experts in abortion care and with patients seeking abortion. Thirty-five items were administered to 784 people seeking abortion at four facilities located in three U.S. states. We used exploratory factor analysis (EFA) to reduce items and identify key domains of psychosocial burden. We assessed the predictive validity of the overall scale and each sub-scale, by assessing their associations with validated measures of perceived stress, anxiety, and depression using multivariable linear regression models. Factor analyses revealed a 12-item factor solution measuring psychosocial burden seeking abortion, with four subdomains: structural challenges, pregnancy decision-making, lack of autonomy, and others’ reactions to the pregnancy. The alpha reliability coefficients were acceptable for the overall scale (α = 0.83) and each subscale (ranging from α = 0.82–0.85). In adjusted analyses, the overall scale was significantly associated with stress, anxiety and depression; each subscale was also significantly associated with each mental health outcome. This new scale offers a practical tool for providers and researchers to empirically document the factors associated with people’s psychological well-being at the time of seeking an abortion. Findings suggest that the same restrictions that claim to protect people from mental health harm may be increasing people’s psychosocial burden and contributing to adverse psychological outcomes at the time of seeking abortion.

Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study

“…Using the 4-item Perceived Stress Scale (PSS-4), Harris et al [ 10 ] revealed minimal stress among 254 women seeking first-trimester abortions in the U.S. (mean of 4.2 on a 0–16 scale). Another study also conducted in the U.S. reported an average PSS-4 score of 7.24 among 784 women at the time of abortion seeking but placed no limitation on gestational age [ 11 ]. Variability in findings may be related to heterogeneity in women's gestation and reliability of the PSS-4.…”

Intervals and Outcomes of First and Second Pregnancies in Low-Income Women: A Record-Linkage Longitudinal Prospective Cohort Study

“…A review of the literature reveals that the percentage of abortion patients describing their pregnancy as wanted or meaningful ranges from as low as 11% to as high as 63% [ 6 ]. A more recent study has reported that only 42% of women receiving induced abortions identify the pregnancy as unwanted [ 14 ]. Therefore, without survey data regarding the intentionality of and/or emotional attachment to these pregnancies, our findings cannot distinguish between intentional replacement pregnancies, unconsciously desired replacement pregnancies, contraceptive failures, or lack of contraceptive use.…”

Serious mental illness in women

“…Finally, despite data showing that depriving women of their reproductive rights has negative consequences on maternal and offspring mental health and that those limitations disproportionately impact minorities, women remain hostage to restrictive laws and scarcity of resources in several parts of the globe [63].…”