Abortion and Mental Health

Abstract

A large number of studies have investigated the relation between abortion and mental illness. There have been mixed findings in most studies that reflect the limitations of available data and variation in methodology that do not allow adequate control for confounding variables. A previous study using data from the National Comorbidity Survey-Replication reported a strong association between abortion and several postabortion mental disorders. After adjusting for sociodemographic confounding factors, there was a significant association between lifetime abortion and lifetime mood disorders, anxiety disorders, substance use disorders, and suicidal ideation. However, the authors did not control for presence of mental disorders before abortion. The aim of this cohort study was to determine whether women’s risk for having mental health disorders was higher after a first abortion compared with after a first childbirth, with and without considering prepregnancy mental health and other possible confounding factors. The data set was the same used in the National Comorbidity Survey-Replication study discussed above. Cohort data were obtained using structured psychiatric interviews conducted between 2001 and 2003. Rates of 6 mental disorders (anxiety, mood, impulse-control, substance use, eating disorders, and suicidal ideation) were assessed among 259 women after abortion (abortion group) and 677 women after childbirth (childbirth group, control). Women in both groups were 18 to 42 years of age at the time of interview. The percentage of women with 1, 2, and 3 mental health disorders before their first abortion was higher than in the control women before their first childbirth (19.7%, 15.2%, and 27.3% vs 19.6%, 9.2%, and 13.3%, respectively; P < 0.001). Moreover, in unadjusted Cox proportional hazard models, there was a significantly higher likelihood of postpregnancy mental health problems in the abortion group than in the childbirth group (P < 0.001). However, associations were reduced after adjusting for confounding factors and became non–statistically significant for 5 disorders. The reduction in hazard ratios with 95% confidence intervals was as follows: anxiety disorders (from 1.52 [1.08–2.15] to 1.12 [0.87–1.46]), mood disorders (from 1.56 [1.23–1.98] to 1.18 [0.88–1.56]), impulse-control disorders (from 1.62 [1.02–2.57] to 1.10 [0.75–1.62]), eating disorders (from 2.53 [1.09–5.86] to 1.82 [0.63–5.25]), and suicidal ideation (from 1.62 [1.09–2.40] to 1.25 [0.88–1.78]). Only the association between abortion and substance use disorders remained significant (P < 0.005), although the hazard ratio was reduced after controlling for prepregnancy mental health problems from 3.05 (1.94–4.79) to 2.30 (1.35–3.92). These findings show that prepregnancy mental health was a strong predictor of postpregnancy mental health. After controlling for confounding factors, abortion was not a statistically significant predictor of postpregnancy anxiety, mood, impulse-control, and eating disorders or suicidal ideation.