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Abortion and mental health

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Research on the relationship between abortion and mental health indicates that abortion is associated with positive or neutral effects on mental health. Some pro-life advocates claim that there is evidence of a "post-abortion syndrome", where negative psychological effects are purported to follow abortion. No major medical association recognizes such a syndrome. The validity of the claim is disputed by physicians, researchers, and pro-choice advocates.

Potential neutral or positive psychological effects of abortion

Studies have indicated that those who have undergone abortion have experienced positive or no change to their mental health and well-being. A 1989 study of teenagers who sought pregnancy tests found that counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term. Another study in 1992 found that having one abortion was positively associated with higher global self-esteem, particularly feelings of self-worth, capableness, and not feeling one is a failure. It also noted that adverse emotional reactions to the abortion are influenced by pre-existing psychological conditions and other negative factors and, furthermore, that well-being was separately and positively related to employment, income, and education, but negatively related to total number of children. In a 2005 US study, the evidence was inconclusive as to whether abortion as compared to completion of an undesired first pregnancy was related to increased risk of depression.</ref>

Potential negative psychological effects of abortion

Post-abortion syndrome

Post-abortion syndrome (PAS) is a term used to describe a set of adverse psychopathological characteristics, with possible connections to post-traumatic stress disorder, which are proposed to occur in a small percentage of those who undergo an induced abortion, following the procedure. Primarily a term used by pro-life advocates, PAS is not a medically recognized syndrome; PAS is not listed in the Diagnostic and Statistical Manual of Mental Disorders, and neither the American Psychological Association nor American Psychiatric Association recognize it. Some physicians and pro-choice advocates have argued that attempts to popularize the term "post-abortion syndrome" are a tactic used by pro-life advocates for political purposes.

A study of 155 women seeking voluntary induced abortion sought to investigate whether different forms of pain control had a different effect on pain and psychological distress, including rates post-traumatic stress disorder, after the abortion. The authors found that cortisol levels are elevated in women who chose a local anesthetic and that while the choice of anesthetic "does not appear to impact on longer-term psychiatric outcomes or functional status" psychologiclal distress was prevelent among both groups of women. Specifically, they found that 11.4% of women met the criteria for a diagnosis of post-traumatic stress disorder (PTSD) prior to their abortions and that the overal rate of PTSD among the sample rose to 18.2% three months after their abortions, a rise of 61%. However, rates of depression and anxiety were lower after abortion than immediately before. In discussing their findings, the authors write that "Presently the weight of evidence suggests that abortion does not cause lasting negative consequences," but that from their findings regarding mid-term PTSD reactions "t would follow that screening women pre-termination for PTSD and disability and post-termination for high levels of dissociation is important in order to help identify women at risk of PTSD and to provide follow-up care."

A few studies suggest that abortion can be associated with short-term negative psychological effects in a minority of people.

While some studies have shown a correlation between abortion and clinical depression, anxiety, suicidal behaviors, or adverse effects on sexual functions for a small number of people, these correlations may be explained by pre-existing social circumstances and emotional health. According to the American Psychological Association, various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortion, may increase the likelihood of experiencing negative reactions. Studies have either failed to establish a causal relationship between abortion and negative psychological symptoms, or been inconclusive.

Reactions Associated With Abortion

Although many studies have found a significant statistical association between abortion negative emotional reactions, no irrefutable causal link has been proven to show that abortion itself causes the reactions which are statistically associated with it. In other words, negative reactions may be incidental to abortion, not caused by abortion. It may be that women who are predisposed to have these emotional problems are also more predisposed to have abortions. In any event, the following emotional and mental health problems are statistically associated with abortion.

  • Guilt
  • Anxiety
  • Depression
  • Sleep disorders
  • Anniversary reactions
  • Elevated risk of suicide
  • Bi-polar disorder

Peer reviwed studies have shown that some women are more likely than others to report emotional or mental health problems after an abortion. The statistically associated risk factors include:

  • Low self-efficacy for coping with the abortion
  • Low self-esteem
  • External locus of control
  • Difficulty with the decision to have an abortion
  • When there is emotional investment in the pregnancy
  • Perceptions of one's partner, family members, or friends as non-supportive
  • Timing during adolescence, being unmarried, or poor
  • A poor or insecure attachment relationship with one's mother or a childhood history of separation from one's mother for a year or more before age 16
  • Involvement in violent relationships
  • Traditional sex-role orientations
  • Conservative views of abortion and/or religious affiliation
  • When a pregnancy is initially intended
  • Abortion during the second trimester
  • When the woman is in an unstable partner relationship
  • Being forced into abortion by one's partner, others, or by life circumstances

In 2006, a team of researchers at the University of Otago Christchurch School of Medicine in New Zealand, published results relating to abortion reactions from a longitudinal study tracking approximately 500 women from birth to 25 years of age. Information was obtained on: a) the history of pregnancy/abortion for female participants over the interval from 15-25 years; b) measures of DSM-IV mental disorders and suicidal behaviour over the intervals 15-18, 18-21 and 21-25 years; and c) childhood, family and related confounding factors. The study concluded that compared to other women in the group those who had an abortion were subsequently more likely to have "mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors." The authors wrote, "The findings suggest that abortion in young women may be associated with increased risks of mental health problems," and "on the basis of the current study, it is our view that the issue of whether or not abortion has harmful effects on mental health remains to be fully resolved."

Studies

United States Surgeon General

American Surgeon General C. Everett Koop, who describes himself as pro-life, conducted a study of the medical and psychological impact of abortion on the patient, while he was in office. Koop summarized his findings in a letter to Ronald Reagan by saying that the psychological effects were "minuscule". Koop refused to publish the study, which was later found to have to have concluded that the procedure has no long-term mental health effects.

1987-1990 APA Task Force Review

When Koop was assigned to review information on abortion, he invited input from any individuals and organizations with material to present." The American Psychological Association Division on Population and Environmental Psychology prepared and presented to Koop their own summary of the literature and recommendations for his report. After Koop refused to issue the findings, division members published a synthesis of their own findings in which they concluded that "Case studies have established that some women experience severe distress or psychopathology after abortion" but "severe negative reactions are infrequent in the immediate and short-term aftermath, particularly for first-trimester abortions. Women who are terminating pregnancies that are wanted and personally meaningful, who lack support from their partner or parents for the abortion, or who have more conflicting feelings or are less sure of their decision before hand may be a relatively higher risk for negative consequences."

The task force further concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress," and that "The weight of the evidence does not pose a psychological hazard for most women."

Nancy Adler, professor of psychology at the University of California, San Francisco, has testified on behalf of the APA that "severe negative reactions are rare and are in line with those following other normal life stresses."

In 2007, APA established a new task force to review studies on abortion published since 1989. The new task force report is expected to be published in 2008.

Journal of the American Medical Association

Psychiatrist Nada Stotland of the University of Chicago, current president of the American Psychiatric Association, argued in a 1992 commentary published in the Journal of the American Medical Association (JAMA): "There is no evidence of an abortion-trauma syndrome.” To support her thesis, she cited research showing that only 11% of patients had significant short term emotional problems related to their abortions. In 2003, Stotland wrote, "Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."

References

  1. ^ Zabin, L.S., Hirsch, M.B., Emerson, M.R. (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives, 21 (6), 248-55. Retrieved September 8, 2006.
  2. ^ Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280. Retrieved September 8, 2006.
  3. ^ Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version. British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.
  4. ^ Gómez Lavín C, Zapata García R (2005). "Diagnostic categorization of post-abortion syndrome". Actas Esp Psiquiatr. 33 (4): 267–72. PMID 15999304.
  5. Research and Destroy, by Chris Mooney. Published in Washington Monthly, October 2004.
  6. Is There a Post-Abortion Syndrome? By Emily Bazelon. Published in the New York Times Magazine, January 21 2007. Accessed January 11 2008.
  7. Science in support of a cause: the new research, by Michael Kranish. Published in the Boston Globe on July 31 2005; accessed November 27 2007.
  8. ^ Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract. 9 (2): 139–49. PMID 15985924.
  9. Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. PMID 15096333. Key summary points: "Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae." On p. 624, the authors state: "The alleged 'postabortion trauma syndrome' does not exist."
  10. ^ Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
  11. Cooper, Cynthia L. Abortion Under Attack
  12. Russo NF, Denious JE (2005). "Controlling birth: science, politics, and public policy". J Soc Issues. 61 (1): 181–91. PMID 17073030.
  13. ^ Suliman S, Ericksen T, Labuschgne P, de Wit R, Stein DJ, Seedat S (2007). "Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation". BMC Psychiatry. 7: 24. doi:10.1186/1471-244X-7-24. PMID 17565666.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  14. TIME. Abortion on Demand
  15. ^ Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE. "Psychological responses after abortion." Science, April 1990, 248: 41-44.
  16. American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.
  17. ^ Cite error: The named reference Broen was invoked but never defined (see the help page).
  18. ^ Sexual behavior during the first eight weeks after legal termination of pregnancy
  19. ^ Legal abortion: a painful necessity - Sweden
  20. Abortion and guilt, France
  21. ^ Psychological effects of abortion Portugal
  22. Predictors of anxiety and depression following pregnancy termination: a longitudinal five-year follow-up study, Norway
  23. DC Reardon and PK Coleman, Treatment Rates for Sleep Disorders and Sleep Disturbances Following Abortion and Childbirth: A Prospective Record Based-Study Sleep 29(1):105-106, 2006.
  24. Anniversary reactions and due date responses following abortion.
  25. Gissler M. et al.Suicides after pregnancy in Finland, 1987-94: register linkage study. BMJ. 1996 Dec 7;313(7070):1431-4.
  26. Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG.Psychiatric admissions of low income women following abortion and childbirth. Can Med Assoc J. CMAJ 2003; 168(10):1253-7.
  27. Major, B., Cozzarelli, C., Sciacchitano, A.M., Cooper, M.L., Testa, M., & Mueller, P.M. (1990). Perceived social support, self-efficacy, and adjustment to abortion. Journal of Personality and Social Psychology, 59, 186-197.
  28. Cozzarelli, C., Karrasch, A., Sumer, N., & Major, B. (1994). The meaning and impact of partner's accompaniment on women's adjustment to abortion. Journal of Applied Social Psychology, 24, 2028-2056.
  29. Cozzarelli, C. (1993). Personality and self-efficacy as predictors of coping with abortion. Journal of Personality and Social Psychology, 65, 1224-1236.
  30. Bracken, M.B. (1978). A causal model of psychosomatic reactions to vacuum aspiration abortion. Social Psychiatry, 13, 135-145.
  31. Osofsky, J.D., & Osofsky, H.J. (1972). The psychological reaction of patients to legalized abortion. American Journal of Orthopsychiatry, 42, 48-60.
  32. Lyndon, J., Dunkel-Schetter, C., Cohan, C.L., & Pierce, T. (1996). Pregnancy decision making as a significant life event: A commitment approach. Journal of Personality and Social Psychology, 71, 141-151.
  33. Remennick, L.I., & Segal, R. (2001). Sociocultural context and women's experiences of abortion: Israeli women and Russian immigrants compared. Culture, Health, and Sexuality, 3, 49-66.
  34. Major et al. (1990).
  35. Major, B., & Cozzarelli, C. (1992). Psychological predictors of adjustment to abortion. Journal of Social Issues, 48, 121-142.
  36. Adler, N.E. (1975). Emotional responses of women following therapeutic abortion: How great a problem? Journal of Applied Social Psychology, 6, 240-259.
  37. Bracken, M.B., Hachamovitch, M., & Grossman, G. (1974). The decision to abort and psychological sequelae. Journal of Nervous and Mental Disease, 158, 155-161.
  38. Campbell, N., Franco, K., & Jurs, S. (1988). Abortion in adolescence. Adolescence, 23, 813-823.
  39. Cozzarelli, C., Sumer, N., & Major, B. (1998). Mental models of attachment and coping with abortion. Journal of Personality and Social Psychology, 74, 453-467.
  40. Kitamura, T., Toda, M.A., Shima, S., & Sugawara, M. (1998). Single and repeated elective abortions in Japan: A psychosocial study. Psychosomatic Obstetrics and Gynecology, 19, 126-134.
  41. Payne, E., Kravitz, A., Notman, M., & Anderson, J. (1976). Outcome following therapeutic abortion. Archives of General Psychiatry, 33, 725-733.
  42. Allanson, S., & Astbury, J. (2001). Attachment style and broken attachments: Violence, pregnancy, and abortion. Australian Journal of Psychology, 53, 146-151.
  43. Russo, N., & Denious, J.E. (2001). Violence in the lives of women having abortions: Implications for policy and practice. Professional Psychology Research and Practice, 32, 142-150.
  44. Gold, D., Berger, C., & Andres, D. (1979). The abortion choice: Psychological determinants and consequences. Concordia University, Department of Psychology, Montreal.
  45. Bogen, I. (1974). Attitudes of women who have had abortions. Journal of Sex Research, 10, 97-109.
  46. Osofsky & Osofsky (1972)
  47. Soderberg, H., Janzon, L., & Slosberg, N.-O. (1998). Emotional distress following induced abortion: A study of its incidence and determinants among adoptees in Malmo, Sweden. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 79, 173-178.
  48. Ashton, J. (1980). The psychosocial outcome of induced abortion. British Journal of Obstetrics and Gynecology, 87, 1115-1122.
  49. Friedman, C., Greenspan, R., & Mittleman, F. (1974). The decision-making process and the outcome of therapeutic abortion. American Journal of Psychiatry, 131, 1332-1337.
  50. Lazarus, A. (1985). Psychiatric sequelae of legalized first trimester abortion. Journal of Psychosomatic Obstetrics and Gynecology, 4, 141-150.
  51. Major, B., Mueller, P., & Hildebrandt, K. (1985). Attributions, expectations, and coping with abortion. Journal of Personality and Social Psychology, 48, 585-599.
  52. Miller, W.B. (1992). An empirical study of the psychological antecedents and consequenes of induced abortion. Journal of Social Issues, 48, 67-93.
  53. Anthanasiou, R., Oppel, W., Michelson, L., Unger, T., & Yager, M. (1973). Psychiatric sequelae to term birth and induced early and late abortion: A longitudinal study. Family Planning Perspectives, 5, 227-231.
  54. Llewellyn, S.P., & Pytches, R. (1988). An investigation of anxiety following termination of pregnancy. Journal of Advanced Nursing, 51, 468-471.
  55. Soderberg, H., Andersson, C., Janzon, L., & Slosberg, N.-O. (1997). Continued pregnancy among abortion applicants. A study of women having a change of mind. Act Obstetrica Gynecologica Scandinavia, 76, 942-947.
  56. Söderberg H, Janzon L, Sjöberg NO. Emotional distress following induced abortion: a study of its incidence and determinants among abortees in Malmö, Sweden. Eur J Obstet Gynecol Reprod Biol. 1998 Aug;79(2):173-8.
  57. Friedman, et. al (1974)
  58. Fergusson, D.M., Horwood, L.J., & Ridden, E.M. (2006. Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47(1), 16-24.
  59. ^ "Dr. Koop's Abortion Advice" New York Times
  60. "Reagan's officials 'suppressed' research on abortion" New Scientist
  61. Family Planning and Perspectives by Nancy Adler
  62. Abortion and American Psychology Warren Throckmorton, PhD
  63. Ibid, citing B. Lask, "Short-term psychiatric sequelae to therapeutic termination of pregnancy," Br J Psychiatry. 1975; 126:173-177 (1975).

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