Catherine T. Coyle

Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey

The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers

Aim: This study explored maternal history of perinatal loss relative to risk of child physical abuse and neglect. Methods: The 518 study participants included 118 abusive mothers, 119 neglecting mothers, and 281 mothers with no known history of child maltreatment. Interviews and observations were conducted in the participants’ homes, and comparisons were made between women without a history of perinatal loss and women with one and multiple losses relative to risk for child maltreatment. Results: Compared to women with no history of perinatal loss, those with one loss (voluntary or involuntary) had a 99% higher risk for child physical abuse, and women with multiple losses were 189% more likely to physically abuse their children. Compared to women with no history of induced abortion, those with one prior abortion had a 144% higher risk for child physical abuse. Finally, maternal history of multiple miscarriages and/or stillbirths compared to no history was associated with a 1237% increased risk of physical abuse and a 605% increased risk of neglect.

Inadequate Preabortion Counseling and Decision Conflict as Predictors of Subsequent Relationship Difficulties and Psychological Stress in Men and Women

The purpose of this study was to examine associations between perceptions of preabortion counseling adequacy and partner congruence in abortion decisions and two sets of outcome variables involving relationship problems and individual psychological stress. Data were collected through online surveys from 374 women who had a prior abortion and 198 men whose partners had experienced elective abortion. For women, perceptions of preabortion counseling inadequacy predicted relationship problems, symptoms of intrusion, avoidance, and hyperarousal, and meeting full diagnostic criteria for posttraumatic stress disorder (PTSD) with controls for demographic and personal/situational variables used. For men, perceptions of inadequate counseling predicted relationship problems and symptoms of intrusion and avoidance with the same controls used. Incongruence in the decision to abort predicted intrusion and meeting diagnostic criteria for PTSD among women with controls used, whereas for men, decision incongruence predicted intrusion, hyperarousal, meeting diagnostic criteria for PTSD, and relationship problems. Findings suggest that both perceptions of inadequate preabortion counseling and incongruence in the abortion decision with ones partner are related to adverse personal and interpersonal outcomes.

Late-Term Elective Abortion and Susceptibility to Posttraumatic Stress Symptoms

The primary aim of this study was to compare the experience of an early abortion (1st trimester) to a late abortion (2nd and 3rd trimester) relative to Posttraumatic Stress Disorder (PTSD) symptoms after controlling for socio-demographic and personal history variables. Online surveys were completed by 374 women who experienced either a 1st trimester abortion (up to 12 weeks gestation) or a 2nd or 3rd trimester abortion (13 weeks gestation or beyond). Most respondents (81%) were U.S. citizens. Later abortions were associated with higher Intrusion subscale scores and with a greater likelihood of reporting disturbing dreams, reliving of the abortion, and trouble falling asleep. Reporting the pregnancy was desired by ones partner, experiencing pressure to abort, having left the partner prior to the abortion, not disclosing the abortion to the partner, and physical health concerns were more common among women who received later abortions. Social reasons for the abortion were linked with significantly higher PTSD total and subscale scores for the full sample. Women who postpone their abortions may need more active professional intervention before securing an abortion based on the increased risks identified herein. More research with diverse samples employing additional measures of mental illness is needed.

Reply to Letter to the Editor by Rachel K. Jones, Ph.D., Senior Research Associate, The Guttmacher Institute, New York, NY, USA

Sir, We appreciate the opportunity to respond to the commentary on our article titled ‘‘Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers’’ provided by Dr. Jones of the Guttmacher Institute (GI). Because the Guttmacher Institute [1] is a ‘‘special affiliate’’ of Planned Parenthood Federation of America (PPFA), sharing both funding and board membership, it is important for the reader to be aware of Dr. Jones’ obvious conflict of interest since PPFA is the largest abortion provider in the U.S. [2]. Furthermore, it is GI’s mission to protect and expand abortion rights as clearly stated in their mission and strategic planning. The first issue Dr. Jones raised pertains to the fact that we did not describe the implications of abortion concealment rates on our results. Underreporting of abortion experience does tend to be high on social science surveys; however, this is just one of the many problems plaguing abortion research and it is one that we have frequently noted in other published papers [3 /6]. The fact that this shortcoming is well known to abortion scholars and space limitations of the current article motivated our decision to focus our discussion on what we believed to be more pressing methodological issues: the causal question and the selection of the abuse and neglect cases. As we have pointed out many times in past publications [3 /6], there is evidence indicating that women who are unwilling to disclose an abortion are more likely to experience abortionrelated psychological distress [7]. Stress is a wellestablished correlate of child maltreatment [8]; therefore, it is likely that the unavoidable misplacement of abortion concealers in the no-abortion group obscured as opposed to accentuated the group differences observed. The second major issue raised by Dr. Jones is the possibility of a spurious association between abortion and child abuse due to the presence of uncontrolled third variables. As noted at the end of the methodology section, our choice of covariates to include from the data set was based on statistical criteria. Variables identified as significant correlates of physical abuse and incorporated as covariates in the primary analyses included number of children, number of residential moves, level of education, history of depression, ethnicity, interviewer-estimated intelligence, difficulty understanding interview questions, and a sad/dejected posture. Dr. Jones asserted that these are ‘‘unnecessary characteristics’’ to examine; however, because these variables are correlated with physical abuse, it is only appropriate to examine them. Finally, Dr. Jones’ conclusion that ‘‘The sample is not representative of any known population, and the authors’ attempts to identify policy implications based on this small group of women are problematic’’ is not founded. A more careful read by Dr. Jones of our conclusion section should prompt acknowledgement of our effort to clearly specify the limitations of our study, including restriction to one geographic locale, which renders generalizations at this stage inappropriate. Instead of baseless criticism that is more advocacy than research based, perhaps Dr. Jones would agree with us that the need for a prospective, nationally representative investigation is warranted, and, if confirmatory results are found, recommend using the results to inform improved intervention efforts.