Abortion and Clinical Depression Linked in Major Study

Springfield, IL (January 18, 2002) — This week the prestigious British Medical Journal published a study showing that women who abort a first pregnancy are at greater risk of subsequent long term clinical depression compared to women who carry an unintended first pregnancy to term. Publication of the study coincides with anniversary events related to the Supreme Court’s January 22, 1973 Roe v. Wade decision legalizing abortion.

Data from a national study of American youths, begun in 1979, was used to conduct the research. In 1992, a subset of 4,463 women were surveyed about depression, intendedness of pregnancy, and pregnancy outcome. A total of 421 women had had their first abortion or first unintended delivery between 1980 and 1992.

An average of eight yeas after their abortions, married women were 138 percent more likely to be at high risk of clinical depression compared to similar women who carried their unintended first pregnancies to term. Among women who were unmarried in 1992, rates of high risk depression were not significantly different.

The authors suggest that the lack of significance in unmarried women may be explained by the higher rate of nonreporting of abortions among unmarried women. Compared with national averages, unmarried women in this study report only 30 percent of the expected abortions compared with married women, who report 74 percent of the expected abortions. This may make the results for married women more reliable, say the authors. Another explanation is that unmarried women who are raising a child without the support of a husband experience significantly more depression than their married counterparts.

Since feelings of shame, secrecy, and thought suppression regarding an abortion are all associated with greater post-abortion depression, anxiety, and hostility, the authors conclude that the high rate of concealing past abortions in this population (60 percent overall) would tend to suppress the full effect of abortion on subsequent depression. Unreported abortions would result in women who experience depression following an abortion being misclassified as delivering women.

“Given the very high rate of concealment of past abortions, the fact that significant differences still emerged suggests that we are just catching the tip of the iceberg,” said David C. Reardon, Ph.D., the study’s lead author.

Reardon, the director of the Elliot Institute in Springfield, Illinois, said the study’s findings are consistent with other recent research that has shown a four to six fold increased risk of suicide and substance abuse associated with prior abortion. He said the findings are also important because this is the first national representative study to examine rates of rates of depression many years after an abortion, on average approximately eight years later in this sample.

The data set used was the same as that used by feminist psychologist Nancy Russo of Arizona State University, whose examination of a self-esteem scale revealed no significant difference between aborting women and women who carried to term. Russo concluded that the absence of difference in self-esteem scores in this large national data set proved that abortion has no “substantial and important impact on women’s well-being.” (See critique of the Russo study here.)

According to Reardon, Russo’s much publicized study has frequently been used to support the claim that, on average, abortion has no significant effect on women’s mental health. The Elliot Institute’s new analysis of the same data set reveals that significant differences do exist.

“The most serious flaw of the Russo study is that the authors did not even comment on the extraordinarily high rate of concealment of past abortions in the sample,” Reardon said. “Women who do not want to mention a past abortion are most likely the ones who will have unresolved feelings of shame, guilt, or grief.”

Reardon said that another problem with the prior analysis was that Russo’s team relied solely on a measure of self-esteem that is not sensitive to post-abortion stress. He said the examination of depression scores is more relevant to the known negative reactions to abortion.

“Russo’s previous analysis of this data set was methodologically weak and was frankly a poor basis on which to build the claim that abortion has no measurable effect on women’s well- being,” he said. “The results of our reexamination of this data set — especially in combination with other studies showing higher rates of suicide, substance abuse, and other mental health disorders associated with prior abortion — shows that the ‘no effect’ hypothesis should be rejected. Something is going on here. Where there is this much smoke, despite the problem of high concealment rates, there is likely to be a fire beneath the haze.”

Another important aspect of this study, said Reardon, is that is one of only a few studies to use any pre-pregnancy psychological score as a control variable. The most commonly used control variable used in regarding emotional reactions is “pre-abortion” evaluation on the day of the abortion when the woman is in the crux of emotional distress. This is why a pre-pregnancy score is much more useful than a pre-abortion score for evaluating the independent effect of abortion on long term emotional reactions.

Asked what the practical implications of this study are for physicians, Reardon responded, “We recommend that physicians should routinely inquire about the outcome of all the patient’s pregnancies.”

“The simple question, ‘Have you experienced any pregnancy losses such as miscarriage, abortion, adoption, or stillbirth?’ may be sufficient to give women permission to discuss unresolved issues related to prior pregnancy losses,” he said. “Physicians should remember that there are few social contexts in which women feel it is appropriate to discuss unresolved feelings about prior pregnancy loss. Many patients will appreciate the opportunity to discuss their pregnancy losses with an empathetic person and may welcome referrals for additional counseling.”

The new study was funded by the Elliot Institute, a non-profit organization that is involved in research and education regarding post-abortion complications and also promotes outreach and counseling programs for women.

Reardon is also the author of several books on post-abortion issues, including The Jericho Plan: Breaking Down the Walls Which Prevent Post-Abortion Healing, and Making Abortion Rare: A Healing Strategy for a Divided Nation. His newest book, Forbidden Grief: The Unspoken Pain of Abortion, co-authored with Dr. Theresa Burke of Rachel’s Vineyard, will be published in March of 2002. Information on these titles and other research conducted by Dr. Reardon and the Elliot Institute can be found at www.afterabortion.org.

KEY POINTS:

* The association between abortion and subsequent depression persists over at least eight years.

* Screening patients for a history of abortion may help physicians to identify women who would benefit by a referral to counseling.

* The null hypothesis (the conjecture that there are no differences on average between having an abortion and carrying an unintended pregnancy to term) is rejected.

Referenced Studies:

Reardon DC, Cougle JR. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study British Medical Journal, 324: 151-152. Full text available at www.bmj.com.

Russo NF, Zierk K. Abortion, childbearing, and women’s well-being. Professional Psychology: Research and Practice, 1992; 23: 269-280.

A sample of references to studies finding abortion to be associated with subsequent substance abuse and suicide attempts:

Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland: 1987-94: register linkage study. British Medical Journal, 1996; 313: 1431-1434.

Tischler C. Adolescent suicide attempts following elective abortion. Pediatrics, 1981; 68(5): 670- 671.

Morgan CM, Evans M, Peter JR, Currie C. Mental health may deteriorate as a direct effect of induced abortion. British Medical Journal, 1997; 314: 902.

Reardon DC, Ney, PG. Abortion and subsequent substance abuse. American Journal Drug Alcohol Abuse, 2000; 26(1): 61-75.

Frank DA, Zuckerman BS, Amaro H, Aboagye K, Bauchner H, Cabral H, Fried L, Hingson R, Kayne H, Levenson SM, et al Cocaine use during pregnancy, prevalence and correlates, Pediatrics, 1988 Dec; 82(6): 888-95.

Amaro H, Zuckerman B, Cabral H. Drug use among adolescent mothers: profile of risk. Pediatrics, 1989 Jul;84(1):144-51.

Wilsnack RW, Wilsnack SC, Klassen AD. Women’s drinking and drinking problems: Patterns from a 1981 national survey. American Journal Public Health, 1984; 74: 1231-1238.

Klassen, A, Wilsnack S. Sexual experience and drinking among women in a U.S. national survey. Archives Sexual. Behavior, 1986; 15(5): 363.

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4 Responses to Abortion and Clinical Depression Linked in Major Study

  1. Nicolas Edwards says:

    You distorted the studies. Most find that there are more mental health problems for those who have the baby as opposed to those who have an abortion. The numbers indicate that it is the act of being pregnant and having your hormones change that causes the increase in both cases.

    Further studies are needed as well to indicate for both groups whether the intended pregnancies were planed/wanted or not. This is felt to have a major bearing on the mental status of those in these groups.

    Examples: If you are pregnant, it was planed and wanted and you are forced to get an abortion do to some unforeseen reason. You are pregnant and did not want the kid but could not get an abortion. And then the 2 extremes you don’t want the kid and you get and abortion and you do want the kid and you carry it to full term. There are 4 groups that need studied but at this time those 4 groups have been lumped into 2.

    • EI says:

      Please post a citation to at least one study with statistically significant results showing that women who give birth have more mental health problems than those who have an abortion. Just one. If you can cite more, all the better. I’m unaware of even one. I’ll go further. For every one you cite, I’ll cite five, yes five, showing more mental health problems for women who had abortions compared to those who have given birth.

      Regarding your suggestion that research should look at four groups of women, examining various levels of intent behind the pregnancy, wantedness, coercion — yes, I agree that such research is needed.

      I’d also agree with the idea implied by your identification of these four groups that those women who feel coerced into aborting a wanted pregnancy, are most likely at greater risk of more severe psychological reactions than women who never wanted to have children and freely chose an abortion.

      It may also be true that the women in this high risk group account for much if not most of the higher rate of mental health problems among women who have had abortions compared to women who carry to term. But even in that case, the bottom line is that these women do belong in the group of women who have had abortions and so the statistics showing more mental health problems after abortion properly includes women who are predictably more likely to have problems afterwards precisely because the problem of women being coerced into unwanted abortions is a big one . . . including hundreds of thousands of women each year. What are you going to do to help these women from being victimized by unsafe and unwanted abortions?

  2. Nicolas Edwards says:

    INDUCED ABORTION AND MENTAL HEALTH A SYSTEMATIC REVIEW OF THE MENTAL HEALTH OUTCOMES OF INDUCED ABORTION, INCLUDING THEIR PREVALENCE AND ASSOCIATED FACTORS. DECEMBER 2011 academy of medical royal colleges

    “For women with no prior recorded history of psychiatric contact up to 9 months
    before a pregnancy event:
    • those who have an abortion have significantly higher rates of psychiatric contact
    before the abortion than do women in the same 9 month period prior to birth
    • those who have an abortion have rates of psychiatric contact after an abortion
    no greater than before the abortion
    • those who go onto birth have rates of psychiatric contact after birth significantly
    higher than before birth.”

    [According to a parenting blog post referencing a study by Munk-Olsen]:

    “The New England Journal of Medicine has taken on one of the pillar arguments in the abortion debate, asking whether having the procedure increases a woman’s risk of mental-health problems and concluding that it doesn’t. In fact, researchers found, having a baby brings a far higher risk.

    “The study, by Danish scientists (and financed in part by the Susan Thompson Buffett Foundation, which supports research on abortion rights), is the most extensive of its kind to date. It studied 365,550 Danish women who had an abortion or gave birth for the first time between 1995 and 2007. Of those, 84,620 terminated their pregnancies and 280,930 gave birth. “

    When you look back at the studies that suppose there is a link you find that many of the studies have been done earlier with certain assumptions being made. As more and more data is coming in there we are refining the studies and from what I have seen the studies indicating higher mental illness for full term deliveries are harder to pick apart and dispute.

    [Comment edited, as shown in brackets, to add links to references used by Mr. Edwards]

    • EI says:

      You claimed that rates of psychological illness are higher for women who have given birth than women who have had abortions. The challenge I posed to you was to show me studies with data confirming that claim.

      The New England Journal of Medicine article you cite actually disproves your point. The blog post you cite is just one of many which misinterprets the findings and introduces falsity by replacing precise language contained in the study with broad ideological statements.

      As you can see here, both in the abstract of the paper and in the details, this study by Munk-Olsen looked at psychiatric treatment rates for 12 months after abortion and childbirth. They found that the rate of psychiatric treatment during that 12 months was 15.2 per 1000 people years after an abortion compared to 6.7 after delivery. This is over twice as high. Therefore, you own source totally contradicts your claim that psychological illness rates are higher for women who give birth than for women who have abortions. The opposite is indisputably true. An even better measure is found in research showing that the risk of suicide in the first year after birth or delivery is over six times higher for women who had an abortion.

      Now it is important to note that Munk-Olsen’s study was funded by a pro-abortion group specifically in an effort to refute other studies which have shown elevated rates of psychiatric treatment following abortion compared to childbirth. One of these, examined medical records of low income women in California over a six year follow-up period and controlled for prior psychiatric treatments over a longer period than Munk-Olsen. As you can see in the accompanying graph, this study showed that the increase in psychiatric inpatient treatment was also time sensitive, with the elevation of risk highest closer to the abortion. As mentioned, this study also controlled for prior psychiatric history. In fact, it arguably did a better job because it controlled for over one year prior to the women becoming pregnant while Munk-Olsen made the odd decision to control for only nine-months prior to the pregnancy outcome — meaning she included as the pre-measure only the time in which delivering women were pregnant, while for women who aborted, approximately three months was while they were pregnant and the rest was pre-pregnancy.

      Munk-Olsen has made a lot of choices in regard to selection criteria, control variables, and how she presents the data . . . and how she has declined requests for further analysis . . . which may lead one to suspect that she is choosing criteria in a way that produces results that most closely fit her thesis. That thesis is that women who have abortions are more likely to be mentally ill and that this may be sufficient to explain the higher rates of mental illness regularly found in groups of women who have abortions. But even this thesis she does not want to explore too closely, for she does nothing to investigate whether women with a prior history of mental illness have more frequent or severe issues after an abortion. Nor does she bother to examine if the women who actually had prior mental illness were the same ones who sought subsequent mental health care or were mostly different women.

      In any case, Munk-Olsen’s study actually disproves your claim. What she claims is not that psychological problems are less frequent among women who abort, but rather that the rise in mental health care among women who have post-partum depression is greater than the rise in mental health care among women who abort. That’s a different claim. And while there is plenty of evidence to show that post-partum depression is a real phenomena, as previously indicated, other studies have found that the rise in mental health problems is greater following abortion, both in the short term and the long term.

      The citation you gave to the royal college also refers to the Munk-Olsen study and needs to be carefully read and understood in that context. Again, it does not state that women who give birth have more mental health issues than women who abort. It merely affirms that the rates for at least on psychiatric treatment in the period examined rise for women in the post-partum period, but they do not rise as high as the rates seen among women who have abortions . . . either in the 9 month period preceding the abortion nor in the 12 months following the abortion.

      None of the other sources you subsequently cited, many of them just commentaries, provide any data supporting the claim that women who give birth have higher rates of mental illness than those who have abortions. Citations to ideologues claiming abortion has no mental health risks greater than those associated with childbirth are simply not supported by the raw data. These claims are based on the unproven assertion that all of the evidence showing higher rates of mental illness among women with a history of abortion compared to women in the general population and delivering women can be explained away by blaming these women for already having been mentally unstable prior to their abortions. But that introduces some interesting issues itself, doesn’t it. If it’s true, shouldn’t mentally ill women be given more counseling before doing an abortion on them . . . especially since even the APA admits that multiple abortions are associated with elevated rates of mental illness . . . and about half of all abortions are for women with a history of one or more previous abortions.

      If you really want to look at the trend in all of the recent studies examining abortion and mental health, please watch this video which illustrates the findings regarding abortion and mental health in the form of a meta-analysis that lays over twenty studies side by side.

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