Abortion and Depression

A MEDLINE Search by Ivan Goldberg, M.D.

Ugeskr Laeger 1996 Jul 29;158(31):4395-4398

Induced abortion after the 12th week of pregnancy in the county of Arhus 1993-1994. Psychological consequences.

[Article in Danish]
Meyer L, Petersson BH
Kobenhavns Universitet, Medicinsk Kvindeforskning, Afdelingen for Social Medicin.

The records of all women applying for permission to have an abortion performed after the 12th week of pregnancy during a one-year period in the County of Aarhus were continuously reviewed, and the women who had the abortion performed due to psychosocial reasons were interviewed with a questionnaire at the time of the abortion and again four months later. Of the 76 women who applied for permission for a late abortion the following were excluded from the study: 31 who had the abortion because a malformed child was suspected, six women who did not have the abortion although permission had been given, five women who did not receive permission, four who were under 18 years of age, one who had a miscarriage, 10 who were from another country of origin and did not understand Danish and finally four women who were allowed an abortion on a medical indication and who were either in hospital or in jail. Fifteen women were questioned concerning their age, length of pregnancy and psychological and social histories and were asked to fill out a depression scale. The data showed that none of them had planned their pregnancy and they had had no symptoms of pregnancy until the time at which they applied for the abortion. None of them regretted the abortion afterwards; half of the women were under psychological strain at the time of application, and a few of them had even more psychological symptoms four months after the abortion. Although they had many social problems, physical complications and psychological problems only a few of the women had seen a doctor in the four month period between the abortion and the follow-up.
PMID: 8759996, UI: 96359518

Contraception 1996 May;53(5):267-273 

A follow-up study of first trimester induced abortions at hospitals and family planning clinics in Sichuan province, China.

Luo L, Wu SZ, Chen XQ, Li MX, Pullum TW
Sichuan Family Planning Research Institute, Chengdu, China.

Four-thousand women aged 18-40 underwent an early induced abortion at hospitals and family planning clinics in six counties in Sichuan province, China, between 1 July 1990 and 30 June 1991. The subjects were followed-up three times, on days 15, 90 and 180 after the operation. Information was obtained about their age, parity, contraceptive use, social behaviors, and gynecological and psychological characteristics before and after the abortion. The results indicate that induced abortion is safe when provided by medically trained personnel in health facilities such as hospitals or clinics. Depressive symptomatology was assessed by the CES-D and SCL-90 scales. The depressive symptoms declined over time. A substantial proportion of the abortions were to unmarried women or resulted from non-use of contraception or contraceptive failure, implying that the incidence of unintended pregnancies and induced abortions could be reduced by more effective and accessible contraception. 
PMID: 8724615, UI: 96315382

Acta Obstet Gynecol Scand 1994 Nov;73(10):812-818 

Psychological responses following medical abortion (using mifepristone and gemeprost) and surgical vacuum aspiration. A patient-centered, partially randomised prospective study.

Henshaw R, Naji S, Russell I, Templeton A
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, United Kingdom.

BACKGROUND. A substantial body of objective data now exists to support the consensus view that induced abortion results in a low incidence of psychiatric morbidity. However, these data do not include more recent advances in abortion technology. Medical abortion entails a participatory role on the part of the woman, who may perceive more pain or see products of conception. The physical and psychological events experienced by women undergoing this procedure may lead to differences in psychopathology. METHODS. 363 women undergoing legal induced abortion up to 63 days gestation were allocated by a prospective partially randomised design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration performed under general anesthesia. This study design allowed women with a preference for a particular method to undergo that method; women without preferences were allocated at random. Women completed sensitive and reliable psychometric instruments (the Hospital Anxiety and Depression Scale and a semantic differential rating scale designed to measure self-esteem) prior to abortion and 16 days later. RESULTS. There were no significant differences between women allocated at random to medical abortion or vacuum aspiration in post-abortal anxiety, depression or low self-esteem. Women with high levels of mood disturbance prior to abortion, who were smokers or who had medical complications following abortion were at highest risk of post-abortal mood disorder. CONCLUSIONS. Medical abortion is a psychologically safe as surgical vacuum aspiration. The quantitative findings of the study support the consensus view that abortion is associated with high incidence of psychological benefit, whichever method is used. 
PMID: 7817735, UI: 95117491

J Pers Soc Psychol 1993 Dec;65(6):1224-1236 

Personality and self-efficacy as predictors of coping with abortion.

Cozzarelli C
Department of Psychology, Kansas State University, Manhattan 66502.

The present study explored the relationships among dispositional optimism, self-esteem, chronic perceptions of control, depression, and self-efficacy in predicting psychological adjustment among women undergoing an abortion. Self-efficacy was found to be a strong, proximal predictor of adjustment, both immediately after the abortion and 3 weeks later. Optimism, perceptions of personal control, and high self-esteem were all related to better postabortion adjustment (mainly through the mediator of increased self-efficacy for coping). In addition, the effects of these three personality variables were found to overlap considerably. Finally, preabortion depression had both direct and indirect (through self-efficacy) effects on adjustment. These effects did not overlap completely with the effects attributable to personality. 
PMID: 8295119, UI: 94125321

Br J Psychiatry 1992 Jun;160:742-749 

The psychological complications of therapeutic abortion.

Zolese G, Blacker CV
Department of Psychological Medicine, St Bartholomew’s Hospital, London. 

Psychological or psychiatric disturbances occur in association with therapeutic abortions but they seem to be marked, severe, or persistent in only a minority (approximately 10%) of women. These consist mostly of caseness depression and anxiety. Psychoses are very uncommon, being reported in only 0.003% of cases – most of whom have a history of previous psychiatric illness. Certain groups are especially at risk from adverse psychological sequelae; these include those with a past psychiatric history, younger women, those with poor social support, the multiparous, and those belonging to sociocultural groups antagonistic to abortion. This is not to overlook the fact that, adopting a crisis-resolution framework, subsequent termination of an unwanted pregnancy is itself ‘therapeutic’. A better understanding of the nature of the risk factors would enable clinicians to identify vulnerable women for whom some form of psychological intervention might be beneficial.

Comment in: Br J Psychiatry 1992 Sep;161:424

PMID: 1617354, UI: 92314801

South Med J 1990 Jul;83(7):736-738

Postabortion dysphoria and religion.

Tamburrino MB, Franco KN, Campbell NB, Pentz JE, Evans CL, Jurs SG
Department of Psychiatry, Medical College of Ohio, Toledo 43699-0008.

This study explores psychosocial factors, especially religion, in women identified as dysphoric 1 to 15 years after abortion. The Millon Clinical Multiaxial Inventory (MCMI) and a demographic questionnaire were mailed to patient-led support groups for women who had poorly assimilated a previous abortion experience. Of the 150 surveys mailed, 71 (47%) were returned. Thirty-three women (46%) stated they had changed to a Fundamentalist or Evangelical church. On the MCMI, members of these conservative denominations scored significantly lower on the subscales for passive-aggressive behavior, ethanol abuse, and avoidance. Religion was strongly perceived by the women as playing a healing role. These findings suggest that conservative personal values may be more critical in understanding attitudes toward abortion than other demographic characteristics. Previous follow-up studies that reported no change in postabortion religiosity may have been too short to detect changes in religion. Implications for treatment of postabortion dysphoria include sensitivity to patients’ religious beliefs, with support for the healing aspects of their religion.
PMID: 2371593, UI: 90319835

Arch Gen Psychiatry 1976 Jun;33(6):725-733

Outcome following therapeutic abortion.

Payne EC, Kravitz AR, Notman MT, Anderson JV

Psychological outcome of abortion was studied in 102 patients, measuring multiple variables over four time intervals. Five measured affects–anxiety, depression, anger, guilt, and shame-were significantly lower six months after the preabortion period. The following variables describe subgroups of patients with significant variations in patterns of responses as indicated by changes in affects: marital status, personality diagnosis, character of object relations, past psychopathologic factors, relationship to husband or lover, relationship to mother, ambivalence about abortion, religion, and previous parity. A complex multivariate model, based on conflict and conflict resolution, is appropriate to conceptualize, the unwanted pregnancy and abortion experience. Data suggest that women most vulnerable to conflict are those who are single and nulliparous, those with previous history of serious emotional problems, conflictual relationships to lovers, past negative relationships to mother, strong ambivalence toward abortion, or negative religious or cultural attitudes about abortion.
PMID: 938192, UI: 76230774

Br J Psychiatry 1976 Jan;128:74-79 

Psychosocial consequences of therapeutic abortion King’s termination study III.

Greer HS, Lal S, Lewis SC, Belsey EM, Beard RW

A follow-up study is reported of a consecutive series of 360 women who underwent termination of first trimester pregnancies by vacuum aspiration. Each patient received brief counselling before termination. Follow-up examinations were carried out by means of detailed, structured interviews at three months and between 15 months and two years (mean: 18 months) after termination. Outcome was assessed in terms of psychiatric symptoms, guilt feelings, and adjustment in marital and other interpersonal relationships, sexual responsiveness and work record. Compared with ratings of psychosocial adjustment before termination, significant improvement had occurred at follow-up in respect of psychiatric symptoms, guilt feelings and interpersonal and sexual adjustment; there was no significant change in marital adjustment. Adverse psychiatric and social sequelae were rare.
PMID: 943199, UI: 76137023

Can Med Assoc J 1975 Oct 18;113(8):754-757

Therapeutic abortion and its psychological implications: the Canadian experience.

Greenglass ER
Department of Psychology, York University, Downsview, ON.

Approximately 9 months after a legal therapeutic abortion, 188 Canadian women were interviewed. One half were single and the rest were married, separated or divorced. They were matched closely for a number of demographic variables with control women who had not had abortions. Neurotic disturbance in several areas of personality functioning was assessed from questionnaire responses. Out of 27 psychological scales, differences between the abortion and control groups were found on only 3: in general, women who had had abortions were more rebellious than control women, abortion tended to be associated with somewhat greater depression in married women, and single women who had had abortions scored higher on the shallow-affect scale. However, all the personality scores were well within the normal range. Perceived social support was strongly associated with favourable psychological reactions after abortion. Use of contraceptives improved greatly after the abortion, when over 90% of women reported using contraceptives regularly.
PMID: 803127, UI: 90213362 

Am J Orthopsychiatry 1975 Apr;45(3):446-454 

Emotional responses of women following therapeutic abortion.

Adler NE

Factor analysis of post-abortion emotional responses revealed three factors. Negative emotions split into two factors: socially-and internally-based. Positive emotions, constituting the third factor, were experienced most strongly. Correlations with background variables suggest two influences on response: the woman’s social environment and her internalized concerns about the abortion.
PMID: 1146976, UI: 75202478