Long-Term Depression Linked to Abortion • AfterAbortion.org

Top Medical Journal Publishes Elliot Institute’s New Findings

A new Elliot Institute study published in the prestigious British Medical Journal (BMJ) found that women who abort a first pregnancy face a significantly greater risk of subsequent long term clinical depression compared to women who carry an unintended first pregnancy to term.

Publication of the study coincided with anniversary events related to the Supreme Court’s Roe v. Wade decision legalizing abortion. Despite promotion of the study’s release by BMJ, however, the findings received little or no coverage in the mainstream American media.

Main Findings

The Elliot Institute study was conducted using data from a national study of American youths that was begun in 1979. In 1992, a subset of 4,463 women were surveyed about depression, intendedness of pregnancy, and pregnancy outcome.

A total of 421 women had their first abortion or first unintended delivery between 1980 and 1992. An average of eight years 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 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, while married women report 74 percent of the expected abortions. This may make the results for married women more reliable. 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 shame, secrecy, and thought suppression regarding an abortion are all associated with greater post-abortion depression, anxiety, and hostility, the authors concluded 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, this would suggest that the high depression risk among post-abortive women is only the tip of the iceberg.

The Elliot Institute study is important not only because of the findings, but because it is the first national representative study to examine rates of depression many years after an abortion, approximately eight years on average for this sample. The research findings are consistent with other recent studies that have shown a four- to six-fold increased risk of suicide and substance abuse associated with prior abortion.

Another important aspect of the Elliot Institute study is that it is one of only a few studies to use any pre-pregnancy psychological score as a control variable. Most studies, if they use any control variables at all, are limited to a “pre-abortion” measure of the woman’s emotional state on the day of the abortion, when she is in the crux of emotional distress.

These measures of depression and anxiety, for example, can hardly be representative of the woman’s emotional state before her pregnancy. The use of a pre-pregnancy score, as was used in the Elliot Institute survey, is therefore a much more useful control for evaluating the independent effect of abortion on long term emotional reactions.

Comparisons to the Russo Study

The data set used in the Elliot Institute study was the same as that used in an earlier study published by feminist psychologist Nancy Russo of Arizona State University. Rather than examining depression, Russo analyzed a self-esteem scale and found no statistically significant difference between aborting women and women who carried to term. She 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.”

Unlike the Elliot Institute study, which was ignored by the national media, Russo’s study was widely publicized in many news accounts. Her conclusion that abortion has no significant effect on average on women’s mental health has also been frequently repeated in the academic literature.

The Elliot Institute’s new analysis of the same data reveals that Russo’s general conclusions are simply wrong. Significant differences do exist. Moreover, the new study underscores major flaws in Russo’s methodology.

Perhaps one of the most serious problems with Russo’s study is that she and her fellow authors did not even comment on the extraordinarily high rate of concealment of past abortions in the sample. Yet it is women who don’t want to mention a past abortion who are most likely the ones who will have unresolved feelings of shame, guilt, or grief. That this concealment problem was not discussed is itself revealing of the authors’ agenda.

Another problem with Russo’s analysis was that her team relied solely on a measure of self-esteem that is not sensitive to post-abortion stress. The examination of depression scores is more relevant to the known negative reactions to abortion than is measuring women’s self-esteem.

Third, Russo’s pro-abortion political views, expressly stated in her paper, led her to draw grandiose conclusions from a single null result. Clearly, self-esteem is just one aspect of a person’s overall well-being, but Russo treats the two as one. Indeed, she substitutes the word’s “well-being” for “self-esteem” throughout her study (and in the title).

The flaw in Russo’s over generalization of her findings can be demonstrated by a simple analogy. If a scientist measured the average body temperature of 4,000 AIDS patients and found that it was not different from that of the general population, would he be justified in drawing the conclusion that AIDS does not exist? Of course not. The disease simply may not manifest itself in changes in body temperature. Yet this is essentially what Russo does. She finds no difference in self-esteem scores, only one of many aspects of mental health, and asserts that this is proof that post-abortion trauma does not exist.

The results of the Elliot Institute’s 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 Russo’s broad general conclusions are simply wrong. Significant differences between women who abort and those who carry unintended pregnancies to term do exist, and can be clearly detected in a nationally representative sample of women–even with high concealment rates–if one looks at the right variables.

Moreover, on average, aborting women fare worse, not better, than women who carry to term. By contrast, there is still no research showing that abortion has improved the mental health or well-being of women.

Giving Women What They Need

Clinical depression is a serious mental health problem. It therefore has a direct bearing on informed consent standards and the liability of abortionists in regard to full disclosure of abortion risks. Since abortion is associated with a significantly higher risk of clinical depression than carrying an unintended pregnancy to term, women should be notified of this risk and physicians should be held liable for not considering this risk before making a recommendation for abortion.

State prepared informed consent booklets should reflect this new finding–in addition to the findings of other studies showing a link between abortion and increased rates of substance abuse and suicide. States that refuse to update their informed consent booklets may be subject to lawsuits on behalf of women of reproductive age for failing to comply with the statutes which require these booklets to adequately inform women of abortion related risks.

This study also has many practical implications regarding the treatment physicians provide for their patients. Perhaps most important, the findings underscore the need for doctors to 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. Many patients will appreciate the opportunity to discuss their pregnancy losses with a sympathetic person and may welcome referrals for additional counseling.

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Referenced Studies

D.C. Reardon and J.R. Cougle, “Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study,” British Medical Journal 324:151-152 ( 2002). The full text of the article is available at www.bmj.com.

N.F. Russo and K. Zierk, “Abortion, childbearing, and women’s well-being,” Professional Psychology: Research and Practice 23:269-280 (1992).