Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors model

Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California St., Ste 335, Box 0744, San Francisco, CA 94143-0744, United States.
Social Science [?] Medicine (Impact Factor: 2.89). 01/2011; 72(1):72-82. DOI: 10.1016/j.socscimed.2010.10.006
Source: PubMed


Using the US National Comorbidity Survey (NCS), Coleman, Coyle, Shuping, and Rue (2009) published an analysis indicating that compared to women who had never had an abortion, women who had reported an abortion were at an increased risk of several anxiety, mood, and substance use disorders. Here, we show that those results are not replicable. That is, using the same data, sample, and codes as indicated by those authors, it is not possible to replicate the simple bivariate statistics testing the relationship of ever having had an abortion to each mental health disorder when no factors were controlled for in analyses (Table 2 in Coleman et al., 2009). Furthermore, among women with prior pregnancies in the NCS, we investigated whether having zero, one, or multiple abortions (abortion history) was associated with having a mood, anxiety, or substance use disorder at the time of the interview. In doing this, we tested two competing frameworks: the abortion-as-trauma versus the common-risk-factors approach. Our results support the latter framework. In the bivariate context when no other factors were included in models, abortion history was not related to having a mood disorder, but it was related to having an anxiety or substance use disorder. When prior mental health and violence experience were controlled in our models, no significant relation was found between abortion history and anxiety disorders. When these same risk factors and other background factors were controlled, women who had multiple abortions remained at an increased risk of having a substance use disorder compared to women who had no abortions, likely because we were unable to control for other risk factors associated with having an abortion and substance use. Policy, practice, and research should focus on assisting women at greatest risk of having unintended pregnancies and having poor mental health-those with violence in their lives and prior mental health problems.

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    • "Some researchers who have taken pre-abortion mental health into account, did so for one or a few mental disorders only, such as depression or anxiety (Steinberg and Russo, 2008; Major et al., 2000). Other studies controlled for a wide range of pre-abortion mental disorders (Steinberg and Finer, 2011) or assessed whether various mental disorders had started before or after the abortion (Mota et al., 2010), but in these studies the timing of the abortion was reported retrospectively, which might introduce information bias (Charles et al., 2008; APA, 2008; Major et al., 2009). To our knowledge, no study has investigated the pre-abortion prevalence of a wide range of mental health disorders, with verifiable data about the timing of the abortion. "
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    ABSTRACT: Prior research has focused primarily on the mental health consequences of abortion; little is known about mental health before abortion. In this study, the psychiatric history of women who have had an abortion is investigated. 325 Women who recently had an abortion were compared with 1902 women from the population-based Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Lifetime prevalence estimates of various mental disorders were measured using the Composite International Diagnostic Interview 3.0. Compared to the reference sample, women in the abortion sample were three times more likely to report a history of any mental disorder (OR = 3.06, 95% CI = 2.36-3.98). The highest odds were found for conduct disorder (OR = 6.97, 95% CI = 4.41-11.01) and drug dependence (OR = 4.96, 95% CI = 2.55-9.66). Similar results were found for lifetime-minus-last-year prevalence estimates and for women who had first-time abortions only. The results support the notion that psychiatric history may explain associations that have been found between abortion and mental health. Psychiatric history should therefore be taken into account when investigating the mental health consequences of abortion.
    Journal of Psychiatric Research 08/2013; 47(11). DOI:10.1016/j.jpsychires.2013.07.024 · 3.96 Impact Factor
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    ABSTRACT: Some abortion policies in the U.S. are based on the notion that abortion harms women's mental health. The American Psychological Association (APA) Task Force on Abortion and Mental Health concluded that first-trimester abortions do not harm women's mental health. However, the APA task force does not make conclusions regarding later abortions (second trimester or beyond) and mental health. This paper critically evaluates studies on later abortion and mental health in order to inform both policy and practice. Using guidelines outlined by Steinberg and Russo (2009), post 1989 quantitative studies on later abortion and mental health were evaluated on the following qualities: 1) composition of comparison groups, 2) how prior mental health was assessed, and 3) whether common risk factors were controlled for in analyses if a significant relationship between abortion and mental health was found. Studies were evaluated with respect to the claim that later abortions harm women's mental health. Eleven quantitative studies that compared the mental health of women having later abortions (for reasons of fetal anomaly) with other groups were evaluated. Findings differed depending on the comparison group. No studies considered the role of prepregnancy mental health, and one study considered whether factors common among women having later abortions and mental health problems drove the association between later abortion and mental health. Policies based on the notion that later abortions (because of fetal anomaly) harm women's mental health are unwarranted. Because research suggests that most women who have later abortions do so for reasons other than fetal anomaly, future investigations should examine women's psychological experiences around later abortions.
    Women s Health Issues 05/2011; 21(3 Suppl):S44-8. DOI:10.1016/j.whi.2011.02.002 · 1.61 Impact Factor
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