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.
    Full-text · Article · Aug 2013 · Journal of Psychiatric Research
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    • "Past research on the association between abortion and mental health provides inconsistent findings. Recent reviews of research on mental health following abortion have found that social and personal factors are related to mental health, but not the abortion procedure itself (Adler et al. 1990; American Psychological Association 2008; Major et al. 2000; Munk-Olsen et al. 2011; Steinberg and Finer 2010). Despite the empirical evidence of no association, reports continue to cite that women experience elevated mental distress or depression after experiencing an abortion (Coleman et al. 2009; Fergusson, Horwood, and Ridder 2006; Gordon 2002; Turell, Armsworth, and Gaa 1990). "
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    ABSTRACT: Does state legal context modify the association between abortion and distress among women in the United States? Adjusting for individual characteristics that could be associated with distress based on stress and stigma frameworks, I examine if state legal context modifies the association between abortion and distress using a nationally representative sample of American women ages 25-45. The use of state-level factors as a proxy for social context in this research has not been part of previous studies of the consequences of abortion. In order to appropriately examine the cross-level modifying effects of state level legal context on abortion status with depressive symptoms (measured on a CES-D scale), I used hierarchical linear modeling. I compare women who have had abortions to women who have had an unintended birth or an intended birth. According to the stress process theory, a lack of control should be associated with higher distress; therefore I use pregnancy intention and outcome as a proxy for reproductive control. The results indicate that women who have had an intended birth experience significantly less distress than women who have had an unintended birth or an abortion, regardless of state context. Contrary to what the stigma framework suggests, state legalcontext does not modify the association between abortion history and distress. State legal context does, however, modify the association between unintended pregnancy history and distress. In states with more restrictive laws the association between unintended birth history and distress is lower than in states with fewer restrictive laws. These results suggest that distress associated with pregnancy intention and outcome is only partly influenced by state contexts. The stigma associated with abortion is likely to be more national than state specific. Further research is necessary to more fully explain the association between pregnancy intention and outcome, distress, and social context. Adviser: Julia McQuillan
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