Women who have an abortion are not at an increased risk of depression, although women who are already depressed are more likely to have an abortion, according to a large study that appears online this week in JAMA Psychiatry, a journal published by the American Medical Association.
This study’s findings offer yet more evidence that abortion is not associated with an increased risk of mental illness — a claim that is often used in the United States to justify restrictive anti-abortion legislation, such as requiring a woman to wait 24 to 72 hours between meeting with an abortion care provider and receiving the abortion.
“Policies based on the notion that abortion harms women’s mental health are misinformed,” said Julia Steinberg, the study’s lead author and an assistant professor of family sciences at the University of Maryland School of Public Health, in a released statement. “Abortion is not causing depression. Our findings show that women were not more likely to suffer from depression after an abortion compared to beforehand.”
Proponents of the view that women who have an abortion are more prone to depression after the procedure tend to rely on anecdotal stories or on studies with a major shortcoming: data that comes from women’s self-reported accounts of their history with mental health problems. Such reports are often unreliable because people’s memories can be both faulty and selective.
The current study used a more objective measure of depression: the use of antidepressant medications.
How the study was done
For the study, Steinberg and her co-authors, which included researchers at Aarhus University in Denmark, analyzed data on abortions, childbirths and antidepressant prescriptions for women born in Denmark between June 1, 1980, and Dec. 30, 1994 — almost 400,000 women in all. The data came from the Danish National Patient Registry, which has information on all treatments performed at Denmark’s hospitals, and the Danish National Patient Registry, which has information on all drug prescriptions dispensed from Danish pharmacies.
The researchers compared the use of antidepressants among women who had abortions — including when the drugs were first prescribed — with the use among women who did not have abortions.
“Compared with women who did not have an abortion, those who had an abortion had a higher rate of antidepressant use,” the researchers write in their paper. “A close look at the data, however, suggests that the higher rates of antidepressant use had less to do with having an abortion than with other risk factors for depression among women who had an abortion.”
“That is, the increased risk of depression did not change from the year before to the year after an abortion,” they explain. “And contrary to previous claims that abortion has long-term adverse effects, the risk of depression decreased as more time elapsed after the abortion.”
The women who had babies had a lower rate of antidepressant use in the year after their babies were born — perhaps, say the researchers, because of concerns about taking the medications while breastfeeding. But after this initial period, the rate of antidepressant use climbed higher among the women who had children than among those who did not.
“Taking all of these results together, it is possible that mental health problems may lead women to have unintended pregnancies and abortions, as other research has found,” the researchers add.
‘Confusion has been exploited’
The study has several limitations. For example, the pharmacy database used in the study did not include information on why the antidepressants were given to the women. Although antidepressants are usually prescribed for depression and anxiety, they are also sometimes recommended for other reasons, such as insomnia or pain, the study’s authors point out.
The researchers also note that it’s not clear if the study’s findings can be applied to other populations of women, particularly those living where access to abortion is legally restricted or where antidepressants are not widely available.
“Nevertheless, our conclusions are similar to those of other research conducted in the United States using nationally representative data,” they stress.
The study’s findings also represent the most rigorous look to date at this topic.
“The understanding, study, and reporting of the psychiatric outcomes of abortions is methodologically challenging,” write Dr. Nada Stotland, a former president of the American Psychiatric Association, and Dr. Angela Shrestha, a psychiatrist at the University of Illinois, in an editorial that accompanies the JAMA Psychiatry study. “The English language lends itself to a confusion between mental illnesses, such as mood and anxiety disorders, with normal human experiences, such as sadness and anxiety. This confusion has been exploited by antiabortion activists both in scientific publications and in public policy.”
“There is no evidence worldwide that limitations to abortion improve women’s health,” they point out. “However, there is substantial evidence of increased morbidity and mortality of women because of unsafe abortions in areas where safe abortions are either illegal or unattainable.”
“Pregnant patients who are contemplating abortion and concerned about [any subsequent effects on their health] should be given accurate information,” Stotland and Shrestha add. “The best outcomes prevail when women have the opportunity to review their own values, beliefs, and circumstances and come to autonomous decisions — and when they can expect nonjudgmental support regardless of the decisions they make.”
FMI: You’ll find abstracts of both the study and the editorial on the JAMA Psychiatry website, but the full papers are behind a paywall.