Tag: APA

Psychiatric Bulletin publishes David Fergusson editorial on mental health and abortion

I posted extensively on the APA Task Force on Mental Health and Abortion in August, including comments from New Zealand researcher David Fergusson. This month, the Psychiatric Bulletin published an editorial by Dr. Fergusson.
The editorial supports the recent Royal College of Psychiatrists’ statement regarding abortion and mental health.
Fergusson’s editorial notes the contrast between a RCP statements in 1994 and 2008. The 1994 view was that no relationship existed between abortion and mental health. Currently, the RCP cautions about the possible effects and suggests post-abortion counseling.
Fergusson notes that such debates are important, especially in the UK since mental health concerns are offered as the major reason a woman is granted an abortion. If mental health status is not improved, or may be worsened, the effects of abortion have major relevance to policy.
He concludes:

It is unlikely that these problems of evidence, uncertainty and the law will be resolved by further medicolegal debates between pro-life and pro-choice advocates. What is required is a well-designed, well-funded and, above all, impartial programme of research into the mental health risks, benefits and consequences of abortion. The recent Royal College of Psychiatrists’ statement makes an important contribution to this process by highlighting the real uncertainties that exist in the current evidence on abortion and mental health.

It is hard for me to read this in any other way but as a critical contrast to the recent APA report.

Lancet: Women should be offered post-abortion psychological care

The British medical journal, The Lancet, published an editorial in their August 23 issue regarding appropriate care for women after an abortion. Although the editorial could have taken a stronger stance on the APA report, I believe they have issued an important caution to those reviewing literature on mental health and abortion.

More than a third of American women will have an abortion by the age of 45 years, if current rates continue. A study published in The Lancet last year showed that 1·5 million abortions were done in the USA and Canada in 2003, compared with 42 million abortions worldwide.
Much attention has been given to the ethical considerations of terminating a pregnancy, but little effort has been directed at the long-term mental health effects of abortion on women. In 1989, the American Psychological Association (APA) undertook a systematic review of the literature and concluded that a single elective abortion did not result in long-term mental health problems. However, in 2006, a study published in the Journal of Youth & Adolescence concluded that abortion had a greater risk of adverse mental health outcomes compared with childbirth. This review was used in a South Dakota court to support a proposal to have abortion made illegal. The proposal failed, but doctors in the state must now inform women having a termination that they will be at risk of future mental health problems.
Recognising the need for a definitive decision on the issue, the APA commissioned the Mental Health and Abortion report, released on Aug 13. The authors systematically reviewed 50 studies, published in peer-reviewed journals since their last report in 1989, and concluded that, among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have an elective first-trimester abortion than if they deliver that pregnancy.
Although this report shows that there is no causal link between abortion and mental ill-health, the fact that some women do experience psychological problems after a termination should not be trivialised. The APA report concludes that such cases are often the result of confounding issues, such as a history of mental ill-health. Abortion is an important part of comprehensive reproductive health services. Women choosing to terminate must be offered an appropriate package of follow-up care, which includes psychological counselling when needed.

Washington Times: Is abortion a mental health risk?

This morning, the Washington Times published my article on the American Psychological Association Mental Health and Abortion Task Force.
In it, I call for the APA to start over on this topic. One study formed the essential basis for the Task Force conclusions. I do not agree that the Gilchrist study is better than the 2005 Fergusson study which did demonstrate a reason to be cautious. However, even if one concludes Gilchrist is best, that does not mean it is sufficient or adequate to make a dogmatic conclusion. By calling one study, the 1995 Gilchrist study, “the best scientific evidence,” the task force has misled the public by portraying the best evidence as being good enough evidence.

News coverage of the APA Mental Health and Abortion Task Force report

I have several posts about the APA task force report and will have more to come. I have been following this story since late 2005, when David Fergusson’s research finding a link between abortion and negative outcomes first hit the landscape. I have written four op-eds about the matter and will have a couple more at least. This is an intriguing study in how the APA makes policy. For myself as well as for readers who are keeping up with the issue here, I am posting links to various media reports relating to the task force report:
Study Fails to Find Link On Abortion, Mental Health – Wall Street Journal
No link between abortion and mental health – UPI
One abortion no threat to mental health: group – Reuters
One abortion no threat to mental health: panel – MSNBC
National briefing – New York Times
Lifenews
Worldnetdaily
Citizenlink
And then read this article by abortion researcher Priscilla Coleman regarding the report…

David Fergusson reacts to the APA Mental Health and Abortion task force report

I asked New Zealand researcher, David Fergusson, about the APA Mental Health and Abortion task force report out today. He was one of 20 reviewers who commented extensively on the draft report. I specifically asked him what he thought of this statement from Task Force chair, Brenda Major in a Reuter’s report:

“The best scientific evidence published indicates that among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion or deliver that pregnancy,”

In addition, he commented on the report as a whole:

By the admission of the report, studies in this area (including my own) have significant flaws relating to sampling, measurement and confounding. What this means is that “the best scientific evidence” to which they refer, is really not all that good. Given that this is true then it would be inappropriate to draw strong conclusions on the basis of such limited evidence. The APA report, in fact, does draw a very strong and dogmatic conclusion that cannot be defended on the basis of evidence since this evidence is lacking by the admission of the report. As I stated to the APA committee in my review [of an earlier draft], the only scientfically defensible position to take is that the evidence in the area is inconsistent and contested. Under these conditions the only scientifically defensible conclusion is to recognise the uncertainty in the evidence and propose better research and greater investments in this area. What the Committee has, in effect, said is that until there is compelling evidence to the contrary, people should act as though abortion has no harmful effects. This is not a defensible position in a situation in which there is evidence pointing in the direction of harmful effects. In this respect, the response of the APA committee to this situation appears to follow the type of logic used by the Tobacco industry to defend cigarettes: since, in our opinion, there is no conclusive evidence of harm then the product may be treated as safe. A better logic is that used by the critics of the industry: since there is suggestive evidence of harmful effects it behooves us to err on the side of caution and commission more and better research before drawing strong conclusions. History showed which side had the better arguments.
What I also think the APA committee has failed to recognise is the size of the research investment needed to pin these issues down thoroughly. The tobacco example is a clear one: there have been literally tens of thousands of studies in this area (I have in fact published over 10 papers on tobacco related topics). This amount of research is needed in an area in which there are strongly divided opinions and deeply rooted agendas. The moral of all of this is very simple: In science drawing strong conclusions on the basis of weak evidence is bad practice. The APA report on abortion and mental health falls into this error.