Abstract
Background: Emerging data report 30% of women worldwide who obtain elective abortion experience negative and persistent psychological distress afterward. Studies find higher rates of psychological stress, depressive, substance, and anxiety disorders as well as suicidal behaviors, among some populations after abortion as compared to other reproductive events. Of concern, is that currenttheory and practice which promote abortion to relieve the stress of an unwanted pregnancy do not reflect new evidence. Moreover, the controversy on abortion inhibits research and treatment on its impact on women’s mental health. Thus, clinicians do not identify adverse psychological outcomes to abortion leaving many women untreated. Indeed, this knowledge-practice gap among healthcare providers may be the major reason that the incidence of adverse psychological outcomes after abortion continues to rise. Method: This paper proposes a theoretical understanding of psychological distress after abortion based on new data. A bio-psychosocial framework, including a psychological and biological theory, as well as a conceptual model is presented to explain the development of psychological distress after abortion. A comparison of risk factors between postpartum and post-abortion disorders is presented. Conclusion: A new theoretical model of psychological distress after abortion deepens understanding of the range of women’s responses to abortion and promotes evidence based practice. A scientific framework provides a much needed understanding of abortion aftermath as opposed to a political one. By providing assistance to clinicians in the identification, screening, and treatment of psychological disorders after abortion, this thesis aims to close the practice gap, and increase services after abortion to women who need them.
Highlights
Over one third of women worldwide who obtain elective abortions experience significant psychological distress afterwards [1]. Such post-abortion psychological distress includes higher rates of depression [2]-[5], suicide [6] [7], anxiety [2] [8], sleep problems [9], and substance disorders [10] compared to other reproductive events
The stress of the abortion itself may be one pathway which contributes to adverse mental health outcomes afterwards, and independently contributes to a full or partial episode of Post-Traumatic Stress Disorder (PTSD) for some women [8] [11] [16]-[18]
Untreated PTSD following an abortion can manifest as depressive, self-destructive behaviors, including suicide, and anxiety disorders
Summary
Over one third of women worldwide who obtain elective abortions experience significant psychological distress afterwards [1]. A third pathway suggests that abortion may partially contribute to psychological distress afterwards by exacerbating or compounding existing mental health problems, such as delayed PTSD from earlier adverse life events, or unresolved developmental conflicts. In such cases, the abortion may not relieve or diminish distress but add to latent distress. The etiology of psychological distress after abortion remains controversial and has long generated political debate Such controversy inhibits the development of effective treatment to relieve post abortion distress, especially for high risk populations, such as younger women. Of further concern is that many healthcare providers are unaware of new data linking abortion to adverse psychiatric sequelae for some populations, which further inhibits women from receiving treatment
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