Talk:Abortion and mental health

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Fergusson et al.[edit]

PMID 23553240 concluded that "There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems." Having looked over this article I find it quite skimpy, as it does not even mention reviews and meta-analyses (with only one exception). I feel that we ought to add mention of this recently published review, which actually looked at the NCCMH data the editors of this page are so in love with, as well as some others, for instance, This one was also by Fergusson et al. Jinkinson (talk) 17:32, 12 July 2013 (UTC)

I'm not quite following... which paper are you suggesting we mention? MastCell Talk 17:39, 12 July 2013 (UTC)
(edit conflict) I think Jinkinson means Fergusson 2013 (PMID 23553240).

Fergusson's contributions to this literature has been discussed a number of times on this page (search the archives for his name), so the article ought to be understood in the lens of Fergusson's previous work. I think it might be best to just wait for the response of the broader scientific community before including it. The first response (PMID 23803898) already appears to be quite critical, and I don't think anyone else has addressed it yet. NW (Talk) 17:42, 12 July 2013 (UTC)

Yeah, that is what I meant, NW. It seems David M. Fergusson, who is pro-choice and an atheist, has a long history of publishing research alleging that abortion causes mental health problems. I suppose we could (but don't have to) add mention of some of his studies while pointing out that they have been slammed by the Guttmacher Institute, as well as by the Family Planning division of New South Wales. Jinkinson (talk) 18:20, 13 July 2013 (UTC)

Recent review of scientific studies on the question[edit]

The following account of a recent review of research papers has been reverted immediately after it was added:

Of research papers published between 1995 and 2011, thirteen found that abortion constituted a clear risk of mental problems as compared to childbirth, five found no difference, and one found that childbearing had worse results. In the case of unplanned pregnancies, four found abortion involved greater risk than continuing to childbirth, three found no difference. Three studies found that abortion gave rise to a greater risk than a miscarriage, four found no difference, and two found that the miscarriage group showed greater short-term anxiety and depression but that the abortion group had greater long-term anxiety and depression. A review of these papers, which appeared in the July 2013 number of Psychiatry and Clinical Neurosciences, concluded that childbirth brings lesser risk of mental disorders than any form of fetal loss, and that some studies show that abortion brings a higher risk than miscarriage; it also considered that further research is needed (Abstract of the study "Abortion and subsequent mental health: Review of the literature" by Carlo V. Bellieni and Giuseppe Buonocore in Psychiatry and Clinical Neurosciences, Volume 67, Issue 5, pages 301–310 (July 2013) ).</ref>

The revert (on the grounds: "I have read the article (not just the abstract) and see that unlike serious systematic reviews, it does not do any quality analysis of the studies in question") seems to be based on nothing better than the idea that an editor's personal opinion carries more weight than a reliable(?) published source that summarizes in the form of an abstract the content of the study. The deleted account follows closely the published information. Esoglou (talk) 17:11, 27 July 2013 (UTC)

Since neither the reverter nor anyone else has questioned the reliability of the cited source, I have restored the deleted information, making it yet clearer that it is only a report of the conclusions of the review, not a statement of judgement by Wikipedia on the actual facts. Esoglou (talk) 17:54, 28 July 2013 (UTC)
The reliably based information about what the review of evidence says has again been deleted, this time without even a pretence of an explanation. I'll wait until the day after tomorrow before restoring it, in order to give the reverters more time to explain their action. Esoglou (talk) 19:48, 28 July 2013 (UTC)
I agree with those who have reverted your edit. While I can't speak for them, I'll explain my view. A number of major expert bodies have summarized existing evidence on this subject. All of them have reached a similar conclusion: that induced abortion does not cause mental-health problems. You have selected a single review article which reached a different conclusion, and highlighted that article in the lead. On what basis did you choose to highlight this specific review (as opposed to any of the other numerous narrative reviews, systematic reviews, and meta-analyses published on the subject)? We as editors should not be in the business of trying to "debunk" or undermine reputable expert opinion, which in this case is quite clear. I think that your edit violated our policy on undue weight, by citing a single article as equivalent (or superior) to the views of multiple expert medical and scientific bodies.

Finally, while this is a more subjective issue, I agree with NuclearWarfare that the methodology of the article you cited was rather unimpressive, particularly compared to some of the rigorous work that's been done on this subject. In fact, I think it illustrates the finding by Charles et al. that the lower a study's methodologic quality, the more likely it is to report negative consequences of abortion. But that's a separate concern; the main justification in my view for reverting your edit was the violation of WP:WEIGHT. MastCell Talk 19:49, 28 July 2013 (UTC)

Hi Esoglou; I missed your talk page post in my watchlist yesterday; in future, perhaps using the new notifications system, could you inform me about the discussion if I appear to not be responding? As for the substance of your comment, I have nothing more to add beyond what MastCell has said. NW (Talk) 20:33, 28 July 2013 (UTC)
As explained by MastCell above, WP:WEIGHT is the primary issue. — ArtifexMayhem (talk) 21:42, 28 July 2013 (UTC)
Thank you all for your comments. I am new here, and will not stay long. But I do think that what the latest issue of a scientific journal that seems to have a certain prestige reports as a review of all the scientific papers published between 1995 and 2011 deserves a mention in the same context as some of those papers. It deals specifically not only with cases of unplanned pregnancy but also with the mental health effects of abortion as compared with miscarriage. So I don't see on what valid grounds it is being excised. However, since three Wikipedia editors want it excluded and nobody (apart from me) defends its mentioning, I will not restore it. Esoglou (talk) 07:58, 29 July 2013 (UTC)

I would like to get your opinion on this review[edit]

This review has been brought up before, but after searching the archives I could not find a specific rebuttal to it, so I was hoping if I posted a link here, someone would tell me why it is not even mentioned in the article. I am bringing it up because I want to know what the science says, and this review concluded that "...induced abortion increased the risks for...mood disorders substantial enough to provoke attempts of self-harm." I realize that Johns Hopkins is pretty prestigious, but it isn't gospel. Jinkinson (talk) 18:22, 28 July 2013 (UTC)

Only yesterday did I come to this article. So I don't understand why the 2003 study was not mentioned. There must be some reason other than the difficulty that, unlike the 1990 and the 2008 reports that are mentioned, information about it is not sourced to publications with the names Family Planning Perspectives or Contraception: An International Reproductive Health Journal. Esoglou (talk) 19:50, 28 July 2013 (UTC)
I think the paper isn't cited because it's 10 years old, and a huge amount of evidence has subsequently been published which renders its conclusions outdated (see WP:MEDDATE). The 1990 APA panel is mentioned because it's notable in a historical context. Also, the 1990 APA findings were published in a little journal called Science (as PMID 2181664), not in Family Planning Perspectives or Contraception, so your imputation of motive is not only lazy but also ignorant. The 2008 APA findings are clearly notable, as they express the current position of a major expert body on the subject. MastCell Talk 19:57, 28 July 2013 (UTC)
Is it necessary to mention that I set aside ("There must be some reason other than ...") as a reason the choice of citations for the 2008 and 1990 reports (I should indeed have specified which 2008 report) in footnotes 4 and 9? At least you did advance a reason for omitting the 2003 study: it is five years older than the mentioned 2008 papers (which in their turn are five years older than the unmentioned 2013 report). By the way, the article says nothing of the inconclusive judgement of the APA 2008 report on abortions other than a first. Esoglou (talk) 08:01, 29 July 2013 (UTC)
Actually, it does: "The [APA] panel noted a lack of quality data on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predipose her to mental health difficulties; therefore, they declined to draw a firm conclusion on multiple abortions." MastCell Talk 18:47, 29 July 2013 (UTC)
What I said was intended in reference to the lead. I should not have written "the article". You are right. I apologize. Esoglou (talk) 06:24, 30 July 2013 (UTC)
No worries. MastCell Talk 21:21, 30 July 2013 (UTC)

recent edits[edit]

I removed the references to Fergusson and Belleini because after rewording them, they seemed a lot more tenuous than the Cochrane and J. Clin Psych references later in the paragraph. There were some WP:PEACOCK words in there too, and I note that the editor who inserted them has also been inserting Belleini et al references into a number of other neonatology (and other) articles. These particular ones did pass MEDRS, but as i noted in my reversion, i think that there is a weight issue here, and the Fergusson and Belleini studies are much less useful; the methodology of the Belleini article actually looked pretty shaky based on the abstract, though i did not read the entire article yet. -- UseTheCommandLine ~/talk ]# ▄ 22:24, 30 August 2013 (UTC)

I can agree that there is a weight issue here, but these 2 reviews are independend and their limits are not greater than those of previous reviews. I do not understand why they cannot be quoted here. Principina. 1 September 2013

I notice that quite a number of your edits so far have been the insertion of references to articles by Bellieni, et al, sometimes with no obvious compelling reason. While that could be a coincidence, my experience is that it's usually someone connected with the authors. If that's the case, you may want to review our policies on conflict of interest as well as our policies on citation spam and self-citation (which are sometimes conflated).
As for the Bellieni paper itself, it comes back to undue weight for me. Perhaps it could be acceptable with less effusive language or in an external links section, but I'm still rather skeptical. Since it was just published, and thereby has fewer opportunities to be cited than even the Cochrane paper, I'm inclined to wait a bit anyway, but open to other arguments. -- UseTheCommandLine ~/talk ]# ▄ 23:55, 1 September 2013 (UTC)
I have the same concerns about self-citation. More broadly, we've tried to move away from detailed descriptions of individual studies to a broader overview of current medical opinion on the subject. A lot of literature has been published on this subject, of greatly varying quality. We've generally tried to wait until specific studies have been appraised by reputable expert bodies (the APS, the Royal College of Psychiatry, Cochrane, etc) before incorporating them, in order to head off long talk-page debates about study methodology. Thus, I'd favor waiting to incorporate this particular article until it's clear how much weight it will be assigned by the relevant expert community. MastCell Talk 23:09, 2 September 2013 (UTC)

NuclearWarfare's revert of my edit[edit]

Mere moments ago, NuclearWarfare reverted my edit in which I removed all mentions of Charles et al.'s review, which at the time seemed like the clearly correct thing to do since previous discussions on this talk page have made it clear that major medical bodies' opinions are what count the most. However it seems the cabal insists on including Charles et al., even though it was done by researchers from Johns Hopkins, which is not a major medical body like the APA or NCCMH. NuclearWarfare's pathetic attempt to justify its inclusion by saying that "Just because seven folks on an APA Committee have a report doesn't automatically mean it's superior to a well done systematic analysis from a team out of a single un[iversity]" isn't fooling any of us, since the last time I checked neither he nor MastCell was the final arbiter of whether an analysis is "well done". (I mention MastCell because he has used his own monumental scientific expertise to dismiss another review on this page less than a year ago.) So if someone would care to explain why we include only the non-major medical body reviews that just so happen to say that abortion doesn't cause mental health problems, and provide a logical reason for our doing so, then I think we can consider this issue resolved. Jinkinson talk to me 01:50, 23 April 2014 (UTC)

Have you done a systematic review before? If you haven't, it's a rather interesting methodological exercise, so please give me the opportunity to explain how it usually works: You take your topic at hand and you find literally every source in multiple databases that could possibly be related. You're up to hundreds or even thousands of studies. You then start whittling. You can't just exclude a source because you think the source's conclusions are iffy or not in line with the rest of the evidence, but you need instead to cite a clear reason for exclusion. What you can do is then take your remaining studies and perform a quality assessment of all of them. You're looking for things like sample size (the more the better!) but also research design: randomization, positive and negative controls, blinding, etc. Only then can you go ahead and summarize/interpret the evidence (Khan, K. S.; Kunz, R; Kleijnen, J; Antes, G (2003). "Five steps to conducting a systematic review". Journal of the Royal Society of Medicine 96 (3): 118–21. PMC 539417. PMID 12612111.  edit).

Statements and position papers by large medical bodies are ideally nothing more than well-done systematic reviews. The medicine-related articles' reliable sources page is unequivocal about this (WP:MEDASSESS): "In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom. The medical guidelines or position statements produced by nationally or internationally recognised expert bodies often contain an assessment of the evidence as part of the report." (emphasis mine). I'm not dismissing the APA's findings. The people on that committee that wrote that report are all far smarter than I am and have put far more work into summarizing the position of their fellow learned mental health professionals. But the exact same is true for Dr. Blum's work, which seems to be widely-cited and accepted in the broader family planning literature (as per a quick Google Scholar search).

I feel like I have rambled on for a while. I hope this explains my position a bit more. NW (Talk) 02:46, 23 April 2014 (UTC)

Not really--your response above is indeed rambling, but contains very little that pertains to the question I actually wanted answered (see a few sentences down for the actual question). I am tempted to add Bellieni's review myself but I don't want to get topic banned or anything, given that this article is subject to discretionary sanctions. Given the ambiguity of the response I received previously here, I will try to rephrase my question less ambiguously: What makes Charles et al. better than Bellieni et al.? I think we should be consistent as far as including literature reviews is concerned; that is, we should include Charles and Bellieni's reviews, or neither of them, and it seems to me that the only arguments about only including one consist of nothing more than special pleading. However, I'm willing to change my mind if someone can answer this question. I might also note that since apparently being highly cited has something to do with your scientific work being good, perhaps Bellieni's GS cites (h-index 17) will sway your views on this. As it is, I think that by cherry picking the reviews that say abortion doesn't cause mental health problems the article does a huge disservice to our readers by creating an impression that differs significantly from reality. Jinkinson talk to me 22:56, 24 April 2014 (UTC)
I disagree with your addition of the Bellieni review. You ask what makes Charles et al. "better" than Bellieni et al. The answer should be obvious: the Charles paper has been accorded far more weight by experts in the field compared to the Bellieni paper. The Charles paper is cited extensively in the reports from various expert bodies, and informed their conclusions on the subject. In contrast, the Bellieni paper has had no discernible impact on expert opinion in the field. (Granted, it's a more recent paper; if it turns out to impact expert opinion down the line, then we can always revise our article accordingly).

It is our job to clearly convey the state of knowledge and expert opinion in a field. In this case, reputable expert bodies are unanimous in finding that abortion does not cause mental-health problems. It is misleading to present the Bellieni review in a he-said-she-said manner, as a "rebuttal" to the Charles review. Doing so creates false equivalence and a false impression as to the degree of expert support for these viewpoints. It is completely legitimate—and, in fact, required by fundamental site policy—to weight the Charles paper more substantially than the Bellieni paper, because experts in the field have weighted them thusly. It is "cherry-picking" (to use your term) to artificially prop up studies which have failed to gain traction among experts in the field.

Since you raise the question of Bellieni's credentials, it's perhaps notable that he is an anti-abortion advocate and a prominent member of the Pontifical Academy for Life, an anti-abortion lobbying arm of the Catholic Church. These associations do not discredit his published research, but neither are they totally irrelevant. MastCell Talk 21:11, 28 April 2014 (UTC)