New Zealand study examines abortion and mental health link

Joining the Coleman et al study is a study reported by this Medical News Today news release:

Women who have an abortion face a small increase in the risk of developing common mental health problems such as depression and anxiety, according to a new study from New Zealand.
But the researchers, writing in the December issue of the British Journal of Psychiatry, say their findings point to a “middle-of-the-road” position on abortion – and do not support either the strong pro-life or pro-choice arguments.
Researchers from the University of Otago studied the pregnancy and mental health history of over 500 women born in Christchurch, a city in South Island.
The women were interviewed six times between the ages of 15 and 30. At each assessment, the women were asked whether they had been pregnant and, if so, what the outcome of that pregnancy had been. The women were asked whether the pregnancy was wanted or unwanted, and if this had caused them to be upset or distressed.
The women were also given a mental health assessment during each interview, to see if they met the diagnostic criteria for major depression, anxiety disorders, alcohol dependence and illicit drug dependence. The researchers took other confounding factors which might be associated with increased risks of various pregnancy or mental health outcomes into account.
Overall, 284 women reported a total of 686 pregnancies before the age of 30. These included: 153 abortions (occurring to 117 women), 138 pregnancy losses (including miscarriage, stillbirth and termination of ectopic pregnancy), 66 live births that resulted from an unwanted pregnancy (or one that provoked an adverse reaction), and 329 live births resulting from a wanted pregnancy (where there was no reported adverse reaction).
The study found that women who had had abortions had rates of mental health problems that were about 30% higher than other women. The conditions most associated with abortion included anxiety disorders and substance use disorders. In contrast, none of the other pregnancy outcomes were consistently related to significantly increased risks of mental health problems.
However, the overall affects of abortion on mental health were found to be small. The researchers estimated that exposure to abortion accounted for between 1.5% and 5.5% of the overall rate of mental disorders in this group of women.
Professor David Fergusson, John Horwood and Dr Joseph Boden said their study had “important implications for the ongoing debates between pro-life and pro-choice advocates about the mental health effects of abortion”.
Writing in the British Journal of Psychiatry they said: “Specifically, the results do not support strong pro-life positions that claim that abortion has large and devastating effects on the mental health of women. Neither do the results support any strong pro-choice positions that imply that abortion is without any mental health effects.
“In general, the results lead to a middle-of-the-road position that, for some women, abortion is likely to be a stressful and traumatic life event which places those exposed to it at a modestly increased risk of a range of common mental health problems.”
Reference:
“Abortion and mental health disorders: evidence from a 30-year longitudinal study.” Fergusson D, Horwood LJ and Boden JM (2008). British Journal of Psychiatry, 193: 444-451

I am still reviewing the study but it looks like the APA should have waited to bring out their report on abortion and mental health.

Abortion and mental health disorders: New study finds relationship

A new study published online today finds varying degress of connection between induced abortion and later mental health problems. The article, published by the Journal of Psychiatric Research, used the National Comorbidity Study, a large representative sample of people carried out in the early 1990s. Here is the abstract:

The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

In the discussion section, the authors believe that abortion contributes to the effect independent of other factors.

What is most notable in this study is that abortion contributed significant independent effects to numerous mental health problems above and beyond a variety of other traumatizing and stressful life experiences. The strongest effects based on the attributable risks indicated that abortion is responsible for more than 10% of the population incidence of alcohol dependence, alcohol abuse, drug dependence, panic disorder, agoraphobia, and bipolar disorder in the population. Lower percentages were identified for 6 additional diagnoses.

Given the multidetermination of mental health disorders, these risks should be taken into account, especially those in double figures.
I believe another significant abortion and mental health study is due out next week as well.
The reference is: Coleman PK et al., Induced abortion and anxiety, mood, and substance abuse disorders: Isolating, Journal of Psychiatric Research (2008), doi:10.1016/j.jpsychires.2008.10.009

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.

Wall Street Journal previews APA Mental Health and Abortion task force report

Today’s Wall Street Journal’s Stephanie Simon has an article regarding the APA Mental Health and Abortion Task Force. Titled “New Front on the Abortion Battle,” the article previews the APA committee’s report due to be considered tomorrow (Wed. 8/13/08).
The article begins:

For decades, the cultural battle over abortion has been about what goes on inside a woman’s womb. But more and more, the focus is shifting to what goes on inside her head.
Activists on both sides are awaiting a comprehensive report reviewing two decades of published research on mental health and abortion, to be presented this week at the American Psychological Association’s annual conference in Boston.
The report comes at a pivotal time as some judges and lawmakers have begun to make decisions in part based on peer-reviewed studies suggesting women who have had abortions are at higher risk of anxiety, depression and substance abuse.

The article also refers readers to an annotated list of some studies relevant to mental health and abortion.