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Abortion and mental health

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Post-abortion syndrome (PAS), post-traumatic abortion syndrome and abortion trauma syndrome, are terms used by opponents of abortion to describe a proposed diagnosis of psychopathological characteristics which are proposed to occur in some women following a therapeutic abortion.

PAS is not a medically recognized syndrome. The American Psychological Association and the American Psychiatric Association do not recognize PAS. PAS is not included in Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. It has been argued that PAS is a myth created by opponents of abortion for political purposes.

Academic research

Neutral and positive effect of abortion

Some studies have shown abortion to have neutral or positive effects on the mental well-being of some patients. 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 women's well-being was separately and positively related to employment, income, and education, but negatively related to total number of children. Abortion, as compared to completion, of an undesired first pregnancy was not found to directly pose the risk of significant depression in a 2005 study.

Studies on abortion and depression or stress

Academic research on abortion is not typically specific to the study of post-abortion syndrome. Rather, academic studies are usually concerned with the statistical incidence of stress or depression among women who have sought an abortion. No academic study to-date has been able to establish a causal relationship between abortion and depression. In 1989, the American Psychological Association (APA) convened a panel of psychologists with extensive experience in this field to review the data available to determine the existence of "post-abortion syndrome". The panel 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."

In 1989, the American Psychological Association (APA) convened a panel of psychologists with extensive experience in this field to review the data available to determine the existence of "post-abortion syndrome". The panel 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."

Denmark

A study conducted at University of Copenhagen has shown legal abortion is associated with few adverse effects on sexual function among women in Denmark. The study was conducted among 941 women who chose elective abortion. At 8 weeks follow-up, sexual intercourse was reported by 86.9% of women who sought an abortion, ranging from 65.8% of women not in a steady relationship to 93.7% of women in a relationship.

Finland

A Finnish study has shown a link between miscarriage (or spontaneous abortion) with depression and suicide, as well as between medically induced abortion with depression and suicide among women in Finland. The study found that suicide is slightly more common in women who have experienced miscarriage and more common after induced abortion, than in the general population. However, the study was unable to establish a causal link between abortion and suicide because it was not clear if abortion causes depression and suicide, or if women who are depressed and suicidal are more likely to elect to have an abortion. The article goes on to say, "Another explanation for the higher suicide rate after an abortion could be low social class, low social support, and previous life events or that abortion is chosen by women who are at higher risk for suicide because of other reasons."

New Zealand

A longitudinal study from New Zealand completed in 2006 which used gathered data about children and young women (ages 15-25) living in a small geographic area in New Zealand who sought abortions over a 25-year period, found an increased occurrence of clinical depression, anxiety, suicidal behavior, and substance abuse among women who had previously had an abortion compared to women who have not sought an elective abortion. Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. 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, "Those having an abortion had elevated rates of subsequent mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors." The study did not conclude that there was a causal link between abortion and depression.

Norway

A study in Norway compared the mental distress of women experienced a spontaneous abortion (miscarriage) and those who had a voluntary abortion. However, women who had had a miscarriage exhibited significantly quicker improvement on Impact of Event Scale (IES) scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group at two and five years after the pregnancy termination. Compared with the general population, women who had undergone induced abortion had significantly higher Hospital Anxiety and Depression Scale (HADS) anxiety scores at all four interviews, while women who had had a miscarriage had significantly higher anxiety scores only at ten days. The conclusion of the study showed that women who had experienced a miscarriage experienced more mental distress after 10 days and six months than those who had medically induced abortions, and that "The responses of women in the miscarriage group were similar to those expected after a traumatic and sad life event. However, the women in the induced abortion group had more atypical responses. This may be because the mental health of the aborting women was somewhat poorer than that of the miscarrying women before the pregnancy termination event. The more complex nature of the induced abortion event may also account for differences in the course of psychological responses between the two groups." The study recommended that women be informed about common psychological responses to pregnancy termination, and and that they be offered talks with health personnel.

PAS editorial from Spain

According to an article issued by Spanish social workers Gomez, Lavin C., & Zapata, symptoms attributed to PAS are "dreams and nightmares related with the abortion," and "feelings of guilt". Gomez, Lavin C., & Zapata examined ways to categorize PAS under the assumption that it exists and is related to Post Traumatic Stress Disorder. Abortion is illegal in Spain except in cases of rape or incest.

United States

University of Chicago

Researchers at the Department of Psychiatry at the University of Chicago Medical Center in the United States conducted a study and have concluded that PAS is a myth. PAS is listed in neither the DSM-IV-TR nor the ICD-10, and not considered a medical condition by the American Psychiatric Association.

Surgeon General

The former U.S. Surgeon General, C. Everett Koop, an opponent of abortion, conducted a review in 1989 of over 250 studies pertaining to the psychological impact of abortion, but told a congressional committee in 1999 that there was not enough evidence to assess the psychological effects of abortion on women and that a reliable scientific report was not possible. In a letter to Ronald Reagan, Koop wrote, "In the minds of some , it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade." He went on to note that, "...doctors had long ago concluded that the physical results of abortion are not major health factors and required little additional study."

Feelings experienced after miscarriage or abortion

Various studies suggest that women may experience stress after a miscarriage or abortion. The kind of stress and the amount of stress women experience varies from culture to culture. Studies also suggest that an individual woman's stress level is influenced by her economic status, family situation and the status of her mental health before the pregnancy. Although no studies have been able to find a causal relationship between abortion and depression or stress, as it would be unethical to require a woman to abort simply to test the causal relationship between abortion and negative health consequences, many studies cite the pre-existence of depression and stress in many women who seek abortions. Women who experience any life-stress often feel some of the following:

  • Guilt
  • Anxiety
  • Depression
  • Anniversary syndrome

Some empirical research suggests that some women are more likely than others to develop stress after after a miscarriage or abortion. The risk factors found in some clinical studies 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

Recent research and APA's Response

Fergusson, a self-described "pro-choice atheist", criticized the American Psychological Association (APA) for publishing reports that he says indicate little or no psychological harm associated with abortion while omitting references to studies which contradicted their official position in favor of abortion. In responding to this charge, Dr. Nancy Russo, who was referred to a Washington Time's reporter by the APA, explained that the APA's official position on abortion developed from the viewpoint that abortion is a civil right. According to the article, Russo states that "pre-existing mental health problems, relationship quality, and whether the pregnancy was wanted or unwanted are key factors determining postabortion mental distress, not the abortion itself".

References

  1. Bazelon, Emily. The New York Times. Is There a Post-Abortion Syndrome?
  2. "Research and Destroy", by Chris Mooney
  3. ^ Gomez, Lavin C & Zapata, Garcia R."Diagnostic categorization of post-abortion syndrome", Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.
  4. Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. PMID 15096333. Key summary points of article state that "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."
  5. Prior to 1994, the DSM III-R listed abortion as a "psychosocial stressor." Specifically, in Chapter Two, page 20 of that edition, a psychosocial stressor was described to include a "physical illness or injury: e.g., illness, accident, surgery, abortion." Abortion in this context is pregnancy loss before 20 weeks that can be spontaneous or therapeutically induced.
  6. Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
  7. Cooper, Cynthia L. Abortion Under Attack
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  11. 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.
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  17. ^ The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study - Norway
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  19. University of Chicago Study: The myth of the abortion trauma syndrome
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  21. New York Times: Koop Says Abortion Report Couldn't Survive Challenge
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  25. ^ Psychological effects of abortion Portugal
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