A relatively recent study from Norway finds a link between abortion and subsequent depression. Titled, Abortion and depression: A population-based longitudinal study of young women, the research was conducted by Willy Pedersen and published in the 2008 Scandinavian Journal of Public Health, volume 36, pages 424–428. Here is the abstract:

Induced abortion is an experience shared by a large number of women in Norway, but we know little about the likely social or mental health-related implications of undergoing induced abortion. International studies suggest an increased risk of adverse outcomes such as depression, but many studies are weakened by poor design. One particular problem is the lack of control for confounding factors likely to increase the risk of both abortion and depression. The aim of the study was to investigate whether induced abortion was a risk factor for subsequent depression.

Methods: A representative sample of women from the normal population (n5768) was monitored between the ages of 15 and 27 years. Questions covered depression, induced abortion and childbirth, as well as sociodemographic variables, family relationships and a number of individual characteristics, such as schooling and occupational history and conduct problems. Results: Young women who reported having had an abortion in their twenties were more likely to score above the cut-off point for depression (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.0–6.1). Controlling for third variables reduced the association, but it remained significant (OR 2.9; 95% CI 1.7–5.6). There was no association between teenage abortion and subsequent depression.

Conclusions: Young adult women who undergo induced abortion may be at increased risk for subsequent depression.

This was a longitudinal study with very high response rates at all responses time over the course of the effort (from 97% at time one to 82% at time four). The research team used questions about depression from the Symptom Checklist-90 (SCL-90), a well-accepted mental health measure.

Dr. Pedersen further describes the strengths of this study and notes other recent work which found a link between abortion and mental health.

This study is robust in several respects. The response rate is high, respondents were observed over a considerable length of time, and measures of the key variables are well validated. We have also controlled for a large number of other factors pertaining to the lives of the women that are likely to affect whether a pregnancy is brought to term or aborted, and the likelihood that depression will set in at a later date. Nonetheless, the sample’s abortion rate does indicate either underreporting or a slight non-response bias. The sample is, moreover, relatively small, making the abortion and childbirth groups small as well. The study would have benefited from a larger sample.

Studies in this area present an inconsistent picture. Most identify abortion as a mental health risk factor, but they typically have selected samples, poor response rates and/or inadequate control for
other aspects of the women’s lives that could affect future risk of depression. The most robust study was conducted in New Zealand [4,8]. This study found that abortion seemed to be a risk factor for poor mental health, including the likelihood of depression.

Reactions to abortion are, one may assume, strongly coloured by the local sociocultural climate. A sense of guilt, loss and lower self-esteem are assumed to mediate between an induced abortion and later onset of depression [21]. New Zealand’s abortion laws are much more stringent than Norway’s [8], and this in itself could possibly increase the risk of social stigmatization and negative sentiment regarding abortion. It is therefore worth noting that such reactions are also experienced by many Norwegian women following an abortion. In light of this finding, women who terminate a pregnancy would probably benefit from postabortion counselling.

Next week, the APA Mental Health and Abortion Task Force report is slated to be considered by the APA Council of Representatives. If that report adopts the findings of this and the New Zealand research reports noted in the Pedersen article, it would represent a departure from prior APA positions. Stay tuned…

Filed under: APA, Research news, abortion by Warren - 1 Comment →

In addition to my work in sexual identity issues, I am quite interested in policy relating to the psychological reactions of women who have had abortions.

I have observed over the past several years that women who associate their abortion with mental health distress have approached the American Psychological Association with their concerns and stories. I blogged about an effort like this in 2007. Briefly, the letter sent by advocacy group, Silent No More, offered to put APA researchers in touch with women who had adverse reactions and asked for a meeting with the APA to discuss means of helping women with post-abortion problems. Georgette informed me that 600 women signed the letter. However, Georgette’s group received no response from the APA.

Another group, Lumina: Hope and Healing After Abortion, led by Theresa Bonopartis, sent a letter to each member of the Mental Health and Abortion Task Force requesting the opportunity to provide information about post-abortion reactions. She also received no response.

Contrast the reaction of the APA to women who believe abortion has triggered harm with the APA reaction to clients who report harm as a result of participation in reparative therapy and/or ex-gay ministries. The APAs (both the psychiatric and psychological groups) have been quite responsive to them, crafting advisories and almost banning reparative therapy in advance of publications systematically demonstrating harm. The major study of adverse reactions by Ariel Shidlo and Michael Shroeder took 5 years to solicit nearly 200 reports of various types of harm. In addition to this study, groups representing glbt people have met with and requested assistance from the APA to oppose reparative therapies.

Before I go on, I need to say that I am in favor of the APA taking seriously client concerns regarding reparative therapy and ex-gay ministries. I have been a persistent critic of reparative approaches as a general response to same-sex attraction. Further, I have consistently acknowledged that harm has been done by various methods to attempt sexual reorientation. The APA should vigorously pursue concerns about client welfare which are presented by clients and their advocates. Due respect should be shown to those who seek such services and ministries, but nonetheless, reports of adverse reactions should be addressed and investigated.

Having noted the appropriateness of the professional groups to attend to reports of adverse psychological reactions, I ask why the APA has not responded to the reports of adverse psychological reactions to abortion? These reports are common and compelling. Many more studies have found adverse reactions associated with abortion than have found such negative reactions to reparative therapy. I recognize that abortion is a much more common procedure than is reparative therapy but this fact should prompt an energetic response. In this context and speaking about APA conclusions about abortion and adverse reactions, I want to quote again a provocative question (see letter #2) from Bill Samuel, President of Consistent Life to APA president Alan Kazdin:

Is there any other phenomenon where the conclusion is based on those who do not have problems rather than on the therapeutic needs of those who do?

I might be misinformed, and in fact have an email in to the APA to check this, but I can find no indication that the APA has met with or responded directly to groups representing women who experienced adverse psychological reactions they attribute to abortion.

Now for some discussion. Am I missing something here? Is there something so different about these adverse reactions that could explain the differential response? At this point, I am thinking out loud…

Filed under: APA, abortion by Warren - 53 Comments →

Last week, I reported the concerns of peace advocates, Consistent Life, about the upcoming American Psychological Association report regarding potential mental health consequences of abortion. In one of their letters to APA President Alan Kazdin, CL Executive Director, Bill Samuel, wrote:

It is accordingly with great concern we note APA has not taken sufficient care with a highly volatile issue, that of abortion. APA has held a position of abortion as being a civil right for women since 1969, and therefore has a clear political stand. Yet the Task Force on Mental Health and Abortion had no call for nominations; it was formed by Division 35, whose position is stronger and more focused than that of the national organization; and the final make-up of the task force had half the members as strong public advocates of the pro-choice view. Advocates of the view that abortion is violence to both unborn children and to women, which could balance such biases, are ominously absent. There are several well-qualified researchers who would have been pleased to serve on the panel, had the panel been selected with balance in mind.

Consider also that the report of this task force is scheduled to come out during an election year, 2008. The APA position is in accord with that of one of the major political parties, and in opposition to that of the other. When a prestigious organization puts out a report on a politically volatile issue at a time when political passions run particularly high, any imbalance on the task force will not pass unnoticed. Surely critics and observers will highlight the fact that members of such a task force were unbalanced in favor of those whose views matched the political position of the organization. The absence of those who could best challenge assumptions, provide alternative explanations, and offer differing interpretations of the same data will not be overlooked. We hope you will pause to reflect upon how partisan this will appear.

Dr. Kazdin wrote back to say that the APA report “must be grounded in the strongest, peer-reviewed science available…” This is of course the correct answer but I maintain that the Consistent Life people have raised valid points of concern. The task force report is to be released in August at the APA convention if approved by the Council of Representatives.

Beyond the appearance of bias, there is a more obvious indication of how the APA will report the research on abortion and mental health consequences. In the June 2008, APA Monitor, Rebecca Clay wrote an article on how the right wing misuses scientific research. In her article titled, “Science vs. ideology: Psychologists fight back against the misuse of research,” Clay interviews abortion researcher Nancy Adler regarding how anti-abortion psychologists are seeking legitimacy for their perspective by, shudder, doing research and reporting in peer-reviewed journals. Do you think the task force will see things much differently than Dr. Adler?

In other issue areas, special-interest groups have assumed the trappings of science to bolster ideology-driven claims. One example is so-called “post-abortion syndrome,” a scientific-sounding name for something most researchers say doesn’t exist. Nancy E. Adler, PhD, a professor of medical psychology at the University of California, San Francisco, is one of them. She has found that the rate of distress among women who’ve had abortions is the same as that of women who’ve given birth. Adler and other experts reviewed the literature in the late 1980s as part of an APA panel and found no evidence of a post-abortion syndrome. Even the anti-abortion Surgeon General C. Everett Koop, MD, refused to issue a report on abortion’s supposed psychological impact when President Ronald Reagan asked him to, citing the lack of evidence of harm.

Since then, says Adler, anti-abortion advocates have become more world-wise.

“They’re using scientific terminology,” she points out. They’re also gaining credibility by getting published in mainstream journals.

But such research often has methodological problems, Adler claims.

“Women are not randomly assigned to have abortions,” she points out. “Women who are having abortions are having them in the context of an unwanted pregnancy, which usually has some other very stressful aspects. Their partners may have left them. They may have been raped.”
In addition, says Adler, proponents of the syndrome don’t mention the base rate of depression and other psychological problems in society as a whole. And they always attribute such problems to abortion rather than any other possible causes.

A new APA Task Force on Mental Health and Abortion will examine such issues in a report later this year.

I think this is probably signals how the APA’s task force report will turn out. The good guys use good methods and the bad guys use the “trappings of science” and are being sneaky by “getting published in mainstream journals.” I guess the way to tell the good research from the bad is not the quality of peer-reviewed work but the ideology of the researcher. What I get from Clay’s article is this: When an APA-approved policy position is supported, it is science; otherwise, it is ideology.

Filed under: APA, Professional issues, abortion, sexual orientation by Warren - 4 Comments →

Just over a year ago, I reported on the creation by the American Psychological Association of a task force to study the mental health issues related to abortion.

The task force is slated to report findings at the August, 2008 annual convention. I have obtained letters of concern regarding the timing and composition of the task from a group called Consistent Life. Their mission statement reads:

We are committed to the protection of life, which is threatened in today’s world by war, abortion, poverty, racism, capital punishment and euthanasia. We believe that these issues are linked under a ‘consistent ethic of life’. We challenge those working on all or some of these issues to maintain a cooperative spirit of peace, reconciliation, and respect in protecting the unprotected.

The first letter is here.

APA President Alan Kazdin replied here.

Consistent Life then wrote a follow up response.

The report is not available to the public as yet but will probably be made public during the APA convention. I will be surprised if the report provides reasonable guidelines for informing women of potential risks associated with abortion.

Filed under: APA, abortion by Warren - 5 Comments →

The other APA (the psychologists) has now commented on the appointment of Ken Zucker to the psychiatrist’s APA DSM task force.

American Psychological Association
Office of Public Affairs
(202) 336-5700
Public.affairs@apa.org

Statement on Gender Identity Disorder and the Planned Revision of the Diagnostic and Statistical Manual

May 2008

There has been some recent confusion regarding the American Psychological Association and work being done on the next version of the Diagnostic and Statistical Manual (DSM). The DSM is a publication of the American Psychiatric Association, not the American Psychological Association (APA). Questions regarding the DSM-V and the Sexual and Gender Identity Disorders Work Group should be directed to the American Psychiatric Association.

For many years, the American Psychological Association has worked to end discrimination, including discrimination based on sex, gender identity and sexual orientation. APA is committed to taking a leadership position among the mental health professionals, scientists and scholars who are addressing the issues surrounding gender identity and transgenderism. APA formed a task force in 2005 to study gender identity and gender variance. This group has been reviewing both the scientific literature and APA policies related to these issues and developing recommendations for education, training, practice, and further research.

The task force has completed a report that is slated to be presented to APA’s governing Council of Representatives in August. It will make a series of recommendations, including that APA call upon psychologists to provide appropriate, nondiscriminatory treatment to all transgender and gender-variant individuals. It is expected that the Council will adopt the report and its recommendations.

The task force did not take a position with regard to the gender identity disorder diagnosis because there was no consensus among its members. Indeed, there is no consensus among professionals working in the field; reputable scientists continue to disagree about GID. Regardless of the disagreement concerning the GID diagnosis, there is a need for greater consensus on treatment of gender dysphoria. The task force strongly supports the development of practice guidelines for transgender clients.

APA believes that no psychological disorder should be stigmatized or used as the basis for discrimination. People who are concerned about issues having to do with their gender identity should have access to appropriate and non-discriminatory treatment. Mental health providers need to educate themselves about how to provide such care.

Responses to Possible Questions:

Q.What is the American Psychological Association’s position with regard to the appointment of Dr. Kenneth Zucker and Dr. Ray Blanchard to the work group reviewing GID? Are you actively working to have them removed?

A. APA is pleased that well-qualified psychologists who are also members of APA have been included in the leadership of this aspect of the DSM revision. We are also aware that there are substantive disagreements in the field over the GID diagnosis and over the treatment of gender dysphoria. We call on this group and others working on the new DSM to apply the highest professional standards in reviewing the science and we encourage the careful consideration of all legitimate perspectives.

Q.Why did the American Psychological Association allow Dr. Kenneth Zucker to be part of its task force on gender identity?

A. APA’s Task Force on Gender Identity was given a very specific charge — to complete a review of the research literature on gender identity and transgenderism and to make recommendations based on that review. Nominations to the Task Force were widely sought and appointments to the task force, including that of Dr. Zucker, were made through a very thorough review process based on an individual psychologist’s research, clinical expertise and experience. As is the case with all APA task forces, the final work product is grounded in the strongest, peer-reviewed science available and undergoes a rigorous review process within the APA governance structure before it can become APA policy. Ultimately, what becomes APA policy must be well-grounded in science not individual opinion.

UPDATE - Elsewhere the American Psychiatric Association issued a statement reviewing the credentials of Dr. Zucker, which are impressive indeed.

Filed under: APA, Professional issues, gender identity by Warren - 6 Comments →

There appears to be a growing schism within LGBT circles regarding the APA appointments of Kenneth Zucker and Ray Blanchard to the Sexual and Gender Identity Disorders Work Group (see the APA statement here). Today, the National Gay and Lesbian Task Force issued a press release calling Zucker and Blanchard “clearly out of step with the occurring shift in how doctors and other health professionals think about transgender people and gender variance.”

The APA and Jack Drescher has stepped up in favor of the appointments.

Thus far, to the best of my knowledge, the opposition has primarily been from transgender advocacy groups and writers. The press release stops short of calling for the appointments of Zucker and Blanchard to be canceled, but rather expresses disappointment. I wonder if any other advocacy groups will follow suit.

Filed under: APA, Professional issues, gender identity, transgender by Warren - 4 Comments →

Part of the chorus of dissent bringing down the recent APA symposium was an April 24 article in the Gay City News, called “Junk Science on Stage.” In that article, some false claims were made about sexual identity therapy and my work. I addessed themhere on the blog recently.

Generally, “junk science” is a phrase used by advocates when they want to discredit views with which they disagree. The tobacco industry used the term to describe the research on second hand smoke and generally the term is little more than an ad hominem attack. Such was the case in the GCN report.

So I am glad that Paul Schindler, editor of GCN and author of the article in question, allowed me to make the record clear about the SIT framework. At the end of the letter, he acknowledges the error.

UNDERSTANDING SEXUAL IDENTITY THERAPY
05/22/2008

To the Editor:

In “Junk Science on Stage” (by Paul Schindler, Apr. 24-30), a claim was made about the Sexual Identity Therapy framework. The SIT framework was to be presented at the cancelled May 5 American Psychiatric Association symposium on religion, therapy, and homosexuality.

Gay City News described SIT this way: “‘Sexual Identity Therapy,’ which [Throckmorton] says he has successfully applied to help patients ‘alter homosexual feelings or behaviors’ and live their lives ‘heterosexually’ with ‘only very few weak instances of homosexual attraction.’”

This is false. The article attributes to me claims about SIT I have never made. In fact, the SIT framework says this: “Prior to outlining the recommendations, let us define what they are not. They are not sexual reorientation therapy protocols in disguise.”

The SIT framework, first contemplated formally in 2005, does not provide any means to do what the Gay City article references - “alter homosexual feelings…” etc. These quotes are taken out of context from a 1999 speech. Putting these phrases in quotes makes it appear that I was interviewed for the article and quoted in reference to SIT, which is not true.

Endorsed by Robert Spitzer, the former editor of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and former American Psychological Association president Nicholas Cummings, the SIT framework provides guidance for therapists who work with clients experiencing sexual identity conflicts but does not prescribe beliefs about homosexuality or religion. The SIT framework specifically discourages several practices conducted by reparative therapists and so it is disappointing that the Gay City News wrongly suggested that my presentation would somehow support their work.

Warren Throckmorton, PhD
www.sexualidentity.blogspot.com

EDITOR’S NOTE: Paul Schindler acknowledges Dr. Warren Throckmorton’s advisory that he made the statements about the results of his therapeutic work, quoted in Schindler’s article, prior to the development of his Sexual Identity Therapy framework.

Note my statement about reparative therapy. You cannot be in compliance with the SIT framework and tell clients that you (the therapist) know why people are homosexual. Explaining a theory and helping clients find themselves in it is not the way we believe this work should be done. We likewise do not promote a view of same-sex attraction that views it as a disorder to be cured or grow out of. The GCN article created a false picture of what the symposium would discuss and falsely attacked me for trying to promote views I do not hold.

Filed under: APA, Professional issues, sexual identity, sexual identity therapy by Warren - 282 Comments →