Abortion and mental health

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The relationship between abortion and mental health is a controvesial issue.[1] [2][3][4] A number of studies have concluded that abortion is associated with no more psychological risk than carrying an unwanted pregnancy to term. Other studies have reported a statistical correlation between abortion and negative psychological effects, though no studies have found a causal relationship.[5][3][6] Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.[7][8][9] Summarizing the evidence, the American Psychological Association has found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses."[10]

Post-abortion syndrome (PAS) is a term proposed to describe cases of post-traumatic stress disorder which may be attributable to abortion.[11] [12][13] [14] The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions.[15] It has been argued that the concept of abortion causing traumatic reactions is a "myth" created by opponents of abortion for political purposes.[16][17][2] [3][18][16][19]

Neutral and positive psychological effects of abortion

Studies have indicated that those who have undergone abortion have experienced positive or no change to their mental health. A 1989 study of teenagers who sought pregnancy tests found that counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term.[20] A study done at the University of Washington found no correlation between a history of abortion and suicide following a subsequent pregnancy.[21]

Another study in 1992 found that having one abortion was positively associated with higher global self-esteem, particularly feelings of self-worth, capableness, and not feeling one is a failure, but that this positive association was not significant after controlling for childbearing and resource variables. It also noted that adverse emotional reactions to the abortion are influenced by pre-existing psychological conditions and other negative factors and, furthermore, that well-being was separately and positively related to employment, income, and education, but negatively related to total number of children. The authors concluded that "No evidence of widespread post-abortion trauma was found."[22]

In a 2005 US study, the evidence was inconclusive as to whether abortion as compared to completion of an undesired first pregnancy was related to increased risk of depression.[23]

Negative feelings experienced after abortion

Various studies suggest that some women experience stress after a miscarriage or abortion. The kind of stress and the amount of stress women experience varies from culture to culture. Studies also suggest that an individual woman's stress level is influenced by her economic status, family situation and the status of her mental health before the pregnancy. Although no studies have been able to establish a causal relationship between abortion and depression or stress, many studies cite the pre-existence of depression and stress in a sub-set of women who procure abortions. No causal link has been established between abortion and mental illness. Emotional distress may occur in a minority of women who are contemplating or have had an abortion due to a number of factors, including pre-existing mental health problems, the status of the woman's relationship with her partner, poor economic status, poor social network, or conservative views held on abortion.[16][24][25]

Post-abortion syndrome

In 1981 psychologist and trauma specialist Vincent Rue testified before Congress that he had treated women who had experienced traumatic reactions to abortion resulting in the same type of post-traumatic stress disorder he had treated in VietnNam Vets, with the exception that the stressor in this case was abortion rather than battlefield violence. He proposed calling abortion induced PTSD by the new name "Post-Abortion Syndrome" (PAS)[26][27].

The American Psychological Association and the American Psychiatric Association do not recognize PAS as a valid diagnosis and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions.[28] It has been argued that the concept of abortion causing traumatic reactions is a "myth" created by opponents of abortion for political purposes.[16][17]

A small number of studies have found that abortion is associated with subsequent PTSD.[29][13][30][31] One study, using a PTSD scale specifically relating to symptoms attributable to abortion to assess PTSD two years after the abortion found that 1.4% of women had diagnosible abortion related PTSD.[30] Another study found that 11.4% of women met the criteria for a diagnosis of post-traumatic stress disorder (PTSD) prior to their abortions and that the overal rate of PTSD among the sample rose to 18.2% three months after their abortions.[31] Yet another study by Rue himself found that in the samples of women evaluated at a number of medical centers in the United States and Russia, 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for abortion associated PTSD.[29]

Studies by major institutions

United States Surgeon General

In 1987, President Ronald Reagan directed U.S. Surgeon General C. Everett Koop, an evangelical Christian and abortion opponent,[32] to issue a report on the health effects of abortion. Reportedly, the idea for the review was conceived by Reagan advisors Dinesh D'Souza and Gary Bauer as a means of "rejuvenat[ing]" the pro-life movement by producing evidence of the risks of abortion.[33] Koop was reluctant to accept the assignment, believing that Reagan was more concerned with appeasing his political base than with improving women's health.[32]

Ultimately, Koop reviewed over 250 studies pertaining to the psychological impact of abortion. Koop wrote in a letter to Reagan that "scientific studies do not provide conclusive data about the health effects of abortion on women."[34] Koop acknowleged the political context of the question in his letter, writing: "In the minds of some of [Reagan's advisors], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade."[35]

In later testimony before the United States Congress, Koop stated that the quality of existing evidence was too poor to prepare a report "that could withstand scientific and statistical scrutiny." Koop noted that "... there is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."[35] In his congressional testimony, Koop stated that while psychological responses to abortion may be "overwhelming" in individual cases, the risk of significant psychological problems was "miniscule from a public health perspective."[7][2][33][5]

Subsequently, a Congressional committee charged that Koop refused to publish the results of his review because he failed to find evidence that abortion was harmful, and that Koop watered down his findings in his letter to Reagan by claiming that the studies were inconclusive. Congressman Theodore S. Weiss, who oversaw the investigation, argued that when Koop found no evidence that abortion was harmful, "he therefore decided not to issue a report, but instead to write a letter to the president which would be sufficiently vague as to avoid supporting the pro-choice position that abortion is safe for women."[5]

1987-1990 APA Task Force Review

In response to Surgeon General Koop's review of available data, the American Psychological Association Division on Population and Environmental Psychology prepared and presented their own summary of the literature and recommendations for Koop's report. After Koop refused to issue their findings, division members published a synthesis of their own findings in which they concluded that "The weight of the evidence does not pose a psychological hazard for most women."[7]

The task force concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."[7] Nancy Adler, professor of psychology at the University of California, San Francisco, has testified on behalf of the APA that "severe negative reactions are rare and are in line with those following other normal life stresses."[36]

In 2007, APA established a new task force to review studies on abortion published since 1989. The new task force report is expected to be published in 2008.[2]

Nada Stotland

In 1992, psychiatrist Nada Stotland of the University of Chicago, and current vice president of the American Psychiatric Association, wrote in Journal of the American Medical Association, "...there is no evidence of an abortion-trauma syndrome."[16] Stotland identified three groups of women as being at risk of negative psychological reactions to abortion: those who were psychiatrically ill before pregnancy, those who undergo abortion under external pressure, and those who underwent abortion in "aversive" circumstances such as abandonment or stigmatization.[16] In a 2003 review article, Stotland wrote: "Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."[18]

Mika Gissler

A government record-based study of all Finnish women found that the suicide rate associated with abortion (34.7 per 100,000) was significantly higher than that associated with giving birth (5.9 per 100,000). The study concluded that "The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health."[37] The authors of the study noted that women who committed suicide after having an abortion tended to be from lower social classes and also tended to be unmarried.[38] The authors state:

The relation between suicide, mental disorders, life events, social class, and social support is a complex one. Abortion might mean a selection of women at higher risk for suicide because of reasons like depression. Another explanation for the higher suicide rate after an abortion could be low social class, low social support, and previous life events or that abortion is chosen by women who are at higher risk for suicide because of other reasons. Increased risk for a suicide after an induced abortion can, besides indicating common risk factors for both, result from a negative effect of induced abortion on mental wellbeing. With our data, however, it was not possible to study the causality more carefully. Our data clearly show, however, that women [in Finland] who have experienced an abortion have an increased risk of suicide, which should be taken into account in the prevention of such deaths.[39]

References

  1. ^ Warren Throckmorton. "Abortion and mental health." Washington Times. January 21, 2005. Archived. Reprinted here
  2. ^ a b c d Is There a Post-Abortion Syndrome? By Emily Bazelon. Published in the New York Times Magazine, January 21 2007. Accessed January 11 2008.
  3. ^ a b c Research and Destroy, by Chris Mooney. Published in Washington Monthly, October 2004.
  4. ^ "Post-Abortion Politics" NOW with David Brancaccio on PBS
  5. ^ a b c Reagan's officials 'suppressed' research on abortion, by Christopher Joyce. Published in the New Scientist on December 16 1989. Accessed February 18 2008.
  6. ^ Family Planning and Perspectives by Nancy Adler
  7. ^ a b c d Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE (1990). "Psychological responses after abortion". Science. 248 (4951): 41–4. PMID 2181664.{{cite journal}}: CS1 maint: multiple names: authors list (link) An abstract of this article is available for free, and the full text is available for a fee.
  8. ^ American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.
  9. ^ Abortion study finds no long-term ill effects on emotional well-being
  10. ^ Family Planning and Perspectives by Nancy Adler
  11. ^ Speckhard, A. & Rue, V. Postabortion Syndrome: An Emerging Public Health Concern Journal of Social Issues, Vol.48, No. 3, 1992, pp.95-119
  12. ^ Rue VM, et al.Induced abortion and traumatic stress: a preliminary comparison of American and Russian women. Med Sci Monit. 2004 Oct;10(10):SR5-16. Epub 2004 Sep 23.
  13. ^ a b Gómez Lavín C, Zapata García R (2005). "Diagnostic categorization of post-abortion syndrome". Actas Esp Psiquiatr. 33 (4): 267–72. PMID 15999304.
  14. ^ Major, B., Cozzarelli, C., Cooper M.L., Zubek, J., Richards, C., Wilhite, M., Gramzow, R.H. (2000). Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry. 57(8):777-84.
  15. ^ Prior to 1994, the DSM III-R listed abortion as a "psychosocial stressor." Specifically, in Chapter Two, page 20 of that edition, a psychosocial stressor was described to include a "physical illness or injury: e.g., illness, accident, surgery, abortion." Abortion in this context is pregnancy loss before 20 weeks that can be spontaneous or therapeutically induced.
  16. ^ a b c d e f Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
  17. ^ a b Cooper, Cynthia L. Abortion Under Attack Ms. Magazine
  18. ^ a b Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract. 9 (2): 139–49. PMID 15985924. "Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."
  19. ^ Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. PMID 15096333. Key summary points: Citing Stotland the authors state: "The alleged 'postabortion trauma syndrome' does not exist."
  20. ^ Zabin, L.S., Hirsch, M.B., Emerson, M.R. (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives, 21 (6), 248-55. Retrieved September 8, 2006.
  21. ^ Pediatrics: Official Journal of the American Academy of Pediatrics
  22. ^ Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280. Retrieved September 8, 2006.
  23. ^ Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version. British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.
  24. ^ Legal abortion: a painful necessity - Sweden
  25. ^ Psychological effects of abortion Portugal
  26. ^ Vincent Rue, "Abortion and Family Relations," testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).
  27. ^ Speckhard, A. & Rue, V. Postabortion Syndrome: An Emerging Public Health Concern Journal of Social Issues, Vol.48, No. 3, 1992, pp.95-119
  28. ^ Prior to 1994, the DSM III-R listed abortion as a "psychosocial stressor." Specifically, in Chapter Two, page 20 of that edition, a psychosocial stressor was described to include a "physical illness or injury: e.g., illness, accident, surgery, abortion." Abortion in this context is pregnancy loss before 20 weeks that can be spontaneous or therapeutically induced.
  29. ^ a b Rue VM, et al.Induced abortion and traumatic stress: a preliminary comparison of American and Russian women. Med Sci Monit. 2004 Oct;10(10):SR5-16. Epub 2004 Sep 23.
  30. ^ a b Major, B., Cozzarelli, C., Cooper M.L., Zubek, J., Richards, C., Wilhite, M., Gramzow, R.H. (2000). Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry. 57(8):777-84.
  31. ^ a b Suliman S, Ericksen T, Labuschgne P, de Wit R, Stein DJ, Seedat S (2007). "Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation". BMC Psychiatry. 7: 24. doi:10.1186/1471-244X-7-24. PMID 17565666.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  32. ^ a b The C. Everett Koop Papers: Reproduction and Family Health. A profile by the National Library of Medicine. Accessed February 23 2008.
  33. ^ a b Bucking the Gipper, by Chris Mooney. Published in Washington Monthly, October 2004. Accessed February 18 2008.
  34. ^ Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike, by Martin Tolchin. Published in the New York Times on January 11 1989; accessed February 18 2008.
  35. ^ a b Koop Says Abortion Report Couldn't Survive Challenge, by Warren E. Leary. Published in the New York Times on March 17 1989; accessed February 18 2008.
  36. ^ Family Planning and Perspectives by Nancy Adler
  37. ^ Gissler M, Hemminki E, Lönnqvist J (1996). "Suicides after pregnancy in Finland, 1987-94: register linkage study". BMJ. 313 (7070): 1431–4. PMID 8973229.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ "Suicides after pregnancy in Finland, 1987-94: register linkage study."
  39. ^ Suicides after pregnancy in Finland, 1987-94: register linkage study

External links

Major media coverage
Pro-choice sources
Pro-life sources
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