Saturday 3 January 2009

Higher risk of mental health problems and substance abuse after abortion

Southern Cross Bioethics Institute has sent me the following commentary on important, recently published, research looking at whether abortion carries the potential adversely to affect the psychological well being of women (Priscilla K Coleman, Katherine T Coyle, Martha Shuping & Vincent Rue, Induced abortion and anxiety, mood and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey, Journal of Psychiatric Research, in press, 2008).

"The data source that was used in this study was the “National Comorbidity Survey” (NCS). It is recognized as the first nationally representative survey of mental health in the USA. The sample of individuals interviewed in this survey was very wide. It provides the most comprehensive epidemiological data on the prevalence of psychological disorders in the US. The respondent’s ages range was 15-54 and they represent the non-institutionalised civilian population in the 48 coterminous United States. A response rate of 82.6% was achieved with a total of 8098 respondents participating in the survey. However, for the purposes of this study a subsample was used, which only included women for whom there were data available on all variables of interest. So the sample size was based on 399 women who had had one or more abortions compared with 2650 women who did not report an abortion. This is a relatively large sample size for a survey study of this kind.

"The paper begins with a brief discussion citing the expanding body of research conducted in previous years. Many of the studies indicate that there is indeed a link between abortion and mental health problems. However, most studies were limited in terms of their analysis of potentially confounding variables, which introduces a degree of uncertainty about whether there is a direct causative link between abortion and subsequent mental health problems. Coleman et al therefore set out to rectify this by using a large sample size, and also by including useful data regarding situational predictors of several different mental disorders, such as rape history, history of miscarriage or still birth, as well as childhood and adult abuse, amongst others.

Summary of Main Results

"In the first part of the study the authors looked at whether there were general differences between women who had previously had an abortion and women who had not had an abortion. There were differences observed in the following categories: marital status; race; number of residents in respondents household; educational attainment; feelings of being worthy/equal to others; history of miscarriage/still birth; rape; sexual abuse as a child; having been physically attacked as an adult; having experienced a life threatening accident.

"For example, of those women who had a history of abortion, 19.9% were separated or divorced, compared to 11.2% in the group who had no abortion history. Furthermore, amongst those with a history of abortion, a greater proportion were black - 17.9% compared with the non-abortion group of which only 11.8% were black.
In the analysis of the impact of abortion, all of the differences were taken into account to determine the specific effect of abortion alone.

"No differences were observed between the two groups in relation to: the degree to which the respondent relies on familial help; the frequency with which relatives make demands on the respondent; number of children; having been physically abused as a child; other terrible experience; difficulty paying bills; health problems.

"The next part of the study compared in detail the incidence of particular disorders between the abortion and non-abortion groups. The results indicate that the abortion group had a higher frequency of disorders including anxiety disorders, substance abuse disorders and mood disorders. For example, in the abortion group, 18% suffered from panic attacks compared with 12.3% in the non-abortion group. There was also a large difference in relation to alcohol abuse, 36.8% versus 16.3%. In relation to major depression, the difference between the two groups was 40.7% versus 26.6%.

Summary of discussion

"The results reveal that women who have had an abortion are at a higher risk of a variety of mental health problems and substance abuse, compared with women without a history of abortion. There were also interesting personal history variables that differed between the two groups. For example, women with an abortion history were more likely to be older, more educated, black, separated, divorced or widowed, live in smaller households, to have been working, have had a personal history of sexual abuse, and have reported unusually stressful events in adulthood.

"The most notable result in this study is that abortion independently contributed significant negative effects in relation to mental health problems above and beyond other traumatizing and stressful life experiences. The authors calculate 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.

"Indicative of the difficulty and complexity of deciphering the precise nature of the link between abortion and various disorders, the authors conclude that further research is required to elucidate the factors mediating this link. They suggest that it is likely that there are other variables that have to be taken into consideration, such as personal beliefs, which include moral or religious beliefs about abortion. A point the authors make is that while women may initially be ambivalent about their decision to abort, it is reasonable to assume that their beliefs may contribute to, or play some mediating role in, future episodes of anxiety or depression.

"The precise relationship between abortion and mental health disorders is potentially very complex; however, the results of this study and the significant body of previous research does indicate that having an abortion is likely to lead to an increased risk of developing mental health and other behavioural disorders."