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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    • "A few abortion studies have measured a wide range of disorders, using the Composite Contraception xx (2015) xxx – xxx International Diagnostic Interview (CIDI)1213141516. However, in most of these studies [12,13,15,16], abortion was based on retrospective self-report only, which is methodologically problematic, especially in the case of large time intervals between waves [17]. In our psychiatric epidemiology study [14], the date of abortion could be determined, and the abortion-to-interview interval was equally short for all participants. "
    [Show abstract] [Hide abstract] ABSTRACT: The objective of this study is to investigate to what extent psychiatric history affects pre-abortion decision difficulty, experienced burden, and post-abortion emotions and coping. Women with and without a history of mental disorders might respond differently to unwanted pregnancy and subsequent abortion. Women who had an abortion (n=325) were classified as either with or without a history of DSM-IV mental disorders, using the Composite International Diagnostic Interview (CIDI) version 3.0. The two groups were compared on pre-abortion doubt, post-abortion decision uncertainty, experienced pressure, experienced burden of unwanted pregnancy and abortion, and post-abortion emotions, self-efficacy, and coping. The study was conducted in the Netherlands. Data were collected using structured face-to-face interviews, and analyzed with regression analyses. Compared to women without prior mental disorders, women with a psychiatric history were more likely to report higher levels of doubt (OR=2.30; CI=1.29-4.09), more burden of the pregnancy (OR=2.23; CI=1.34-3.70) and the abortion (OR=1.93; CI=1.12-3.34), and more negative post-abortion emotions (β=.16; CI=.05-.28). They also scored lower on abortion-specific self-efficacy (β=-.11; CI=-.22-.00) and higher on emotion-oriented (β=.22; .11-.33) and avoidance-oriented coping (β=.12; CI=.01-.24). The two groups did not differ significantly in terms of experienced pressure, decision uncertainty, and positive post-abortion emotions. Psychiatric history strongly affects women's pre- and post-abortion experiences. Women with a history of mental disorders experience a more stressful pre- and post-abortion period in terms of pre-abortion doubt, burden of pregnancy and abortion, and post-abortion emotions, self-efficacy and coping. Negative abortion experiences may, at least partially, stem from prior or underlying mental health problems. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · May 2015 · Contraception
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    • "Abortion stigma may be discursively enacted in various ways, such as implying that abortion is 'dirty or unhealthy' (Norris et al. 2011, S52 ). The specific notion of a 'postabortion syndrome' – which attempts to medicalise supposed physical and psychological risks of abortion (see Dadlez and Andrews 2010; Steinberg and Finer 2011) – appears to have less of a foothold in our sample than in US abortion discourse. However, framings of abortion as physically, emotionally and socially 'risky' do appear throughout our sample. "
    [Show abstract] [Hide abstract] ABSTRACT: The media play a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. Detailed examination of media constructions of abortion may help to identify emerging public discourse. Qualitative content analysis was used to examine if and how the print media in contributes to the stigmatisation of abortion. Articles from seven British and five Scottish national newspapers from 2010 were analysed for overall framings of abortion and emergent themes, including potentially stigmatising discursive constructs and language. Abortion was found to be presented using predominantly negative language and discursive associations as 'risky', and in association with other 'discredited' social practices. Key perspectives were found to be absent or marginalised, including those of women who have sought abortion. Few articles framed abortion as a positive and legitimate choice. Negative media representations of abortion contribute to the stigmatisation of the procedure and of women who have it, and reflect a discrediting of women's reproductive decision-making. There is a need to challenge the notion that abortion stigma is inevitable, and to encourage positive framings of abortion in the media and other public discourse.
    Full-text · Article · Aug 2014 · Culture Health & Sexuality
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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. "
    [Show abstract] [Hide abstract] 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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