Priscilla K. Coleman

Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009

BACKGROUND Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians. AIMS To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome. METHOD After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios. RESULTS Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour. CONCLUSIONS This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

Substance Use Associated with Unintended Pregnancy Outcomes in the National Longitudinal Survey of Youth.

Abortion is known to be associated with higher rates of substance abuse, but no studies have compared substance use rates associated with abortion compared to delivery of an unintended pregnancy. This study examines data for women in the National Longitudinal Survey of Youth whose first pregnancy was unintended. Women with no pregnancies were also used as a control group. Use of alcohol, marijuana, cocaine, and behaviors suggestive of alcohol abuse were examined an average of four years after the target pregnancy among women with prior histories of delivering an unintended pregnancy (n = 535), abortion (n = 213), or those who reported no pregnancies (n = 1144). Controls were instituted for age, race, marital status, income, education, and prepregnancy self‐esteem and locus of control. Compared to women who carried an unintended first pregnancy to term, those who aborted were significantly more likely to report use of marijuana (odds ratio: 2.0), with the difference in these two groups approaching significance relative to the use of cocaine (odds ratio: 2.49). Women with a history of abortion also reported more frequent drinking than those with a history of unintended birth. With the exception of less frequent drinking, the unintended birth group was not significantly different from the no pregnancy group. Resolution of an unintended pregnancy by abortion was associated with significantly higher rates of subsequent substance use compared to delivering an unintended pregnancy. A history of abortion may be a useful marker for identifying women in need of counseling for substance use.

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.

The psychology of abortion: A review and suggestions for future research

The literature base pertaining to abortion decision-making and adjustment has grown substantially since legalization of abortion in the U.S. 30 years ago. However, the available research has suffered from various theoretical and methodological shortcomings and the findings do not seem to do justice to the complexity of abortion experiences among women residing in a cultural context that continues to exhibit intense conflict over the legality and morality of abortion. The purpose of this review is to summarize previous research, offer suggestions for improving the quality of work on the topic of abortion, and to highlight specific content areas holding considerable promise for enhancing our understanding of the risks and benefits of abortion.

Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy

OBJECTIVE The primary objectives of this study were to explore maternal history of perinatal loss and pregnancy wantedness as correlates of substance use during pregnancy. METHOD The research design involved interviewing women who gave birth in Washington DC hospitals during 1992. Interview data included pregnancy history (prior births, induced abortions, miscarriages, and stillbirths), desire for the pregnancy (wanted, not wanted, mistimed), socio-demographic information, timing of onset of prenatal care, and substance use (cigarettes, alcohol, and drugs) during pregnancy. RESULTS A history of induced abortion was associated with elevated risk for maternal substance use of various forms; whereas other forms of perinatal loss (miscarriage and stillbirth) were not related to substance use. Unwanted pregnancy was associated with cigarette smoking during pregnancy, but not with any other forms of substance use. CONCLUSIONS Reproductive history information may offer insight to professionals pertaining to the likelihood of women using substances in a later pregnancy.

Interpersonal Correlates of Peer Victimization Among Young Adolescents

Empathy, prosocial behavior, the number of friends, self-reported popularity, and various forms of interpersonal forgiveness were examined as predictors of peer victimization among 52 7th and 8th graders attending a private school. Popularity was the strongest individual predictor of teacher-reported victimization with high popularity associated with low victimization. Malestudents reported significantly higher rates of victimization than females, prompting the decision to examine correlates of self-reported victimization separately by gender. Interpersonal forgiveness scores were the strongest predictors of self-reported victimization; however, different forms of forgiveness were the greatest predictors of male and female self-reported victimization. Implications are discussed.

Induced abortion and intimate relationship quality in the Chicago Health and Social Life Survey.

OBJECTIVES To examine associations between abortion and relationship functioning. STUDY DESIGN Independent variables included abortion in a previous relationship and abortion in a current relationship. Perceptions of quality-of-life changes associated with terminating the relationship, conflict, aggressiveness and sexual dysfunction were the outcome measures. METHODS Data were derived from interviews with an ethnically diverse urban sample of men (n=658) and women (n=906). Surveys were conducted in person using computer-assisted personal interview technology by the National Opinion Research Center affiliated with the University of Chicago, USA. RESULTS For men and women, the experience of an abortion in a previous relationship was related to negative outcomes in the current relationship; perceptions of improved quality of life if the current relationship also ended and intimate partner violence. Experience of an abortion within a current relationship was associated with 116% and 196% increased risk of arguing about children for women and men, respectively. Among females, experience of an abortion within a current relationship was associated with increased risk for various forms of sexual dysfunction (122-182%), increased risk of arguments about money (75%), increased risk of conflict about the partners relatives (80%), and increased risk of arguing about the respondents relatives (99%). Men whose current partners had experienced an abortion were more likely to report jealousy (96% greater risk) and conflict about drugs (385% greater risk). CONCLUSION Abortion may play a vital role in understanding the aetiology of relationship problems.

Induced Abortion and Increased Risk of Substance Abuse: A Review of the Evidence

Research conducted over the last few decades has revealed an association between induced abortion history and substance abuse. The experience of induced abortion may be associated with psychological discomfort in some women and substance use offers a convenient remedy for alleviating the negative emotions without the necessity of disclosing the source of the discomfort. On the other hand many characteristics related to the choice to abort are also systematically related to the likelihood of using substances (e.g. relationship difficulties pre-existing emotional problems a tendency to engage in risk-taking behavior etc.) and the correlations observed in the literature may be due to the presence of uncontrolled third variables. Therefore the general purpose of this review is to critically evaluate the available evidence linking induced abortion and substance abuse with sensitivity to the contextual complexity of both variables. Specific objectives include the following: 1) provision of an overview of substance use disorders in women 2) review of evidence for a causal model highlighting methodological deficiencies in the published literature 3) identification of process mechanisms (direct and indirect) through which induced abortion may enhance risk for substance abuse 4) provision of recommendations for further research and 5) consideration of practice implications of the available findings. (authors)

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.