Clinical Depression After Unintended Pregnancy Linked To Abortion

     Springfield, IL (January 18, 2002) -- This week's prestigious British Medical Journal reports that women who abort a first pregnancy are at greater risk of subsequent long term clinical depression compared to women who carry an unintended first pregnancy to term. Publication of the study coincides with anniversary events related to the Supreme Court's January 22, 1973 Roe v. Wade decision legalizing abortion.

Data from a national study of American youths, begun in 1979, was used to conduct the research. In 1992, a subset of 4,463 women were surveyed about depression, intendedness of pregnancy, and pregnancy outcome. A total of 421 women had had their first abortion or first unintended delivery between 1980 and 1992.

An average of eight yeas after their abortions, married women were 138 percent more likely to be at high risk of clinical depression compared to similar women who carried their unintended first pregnancies to term. Among women who were unmarried in 1992, rates of high risk depression were not significantly different. The authors suggest that the lack of significance in unmarried women may be explained by the higher rate of nonreporting of abortions among unmarried women. Compared with national averages, unmarried women in this study report only 30 percent of the expected abortions compared with married women, who report 74 percent of the expected abortions. This may make the results for married women more reliable, say the authors. Another explanation is that unmarried women who are raising a child without the support of a husband experience significantly more depression than their married counterparts.

Since shame, secrecy, and thought suppression regarding an abortion are all associated with greater post-abortion depression, anxiety, and hostility, the authors conclude that the high rate of concealing past abortions in this population (60 percent overall) would tend to suppress the full effect of abortion on subsequent depression. Unreported abortions would result in women who experience depression following an abortion being misclassified as delivering women.

"Given the very high rate of concealment of past abortions "the fact that significant differences still emerged suggests that we are just catching the tip of the iceberg," said David C. Reardon, Ph.D., the study's lead author.

Reardon, the director of the Elliot Institute in Springfield, Illinois, says the study's findings are consistent with other recent research that has shown a four to six fold increased risk of suicide and substance abuse associated with prior abortion. He says the findings are also important because this is the first national representative study to examine rates of rates of depression many years after an abortion, on average approximately eight years later in this sample.

The data set used was the same as that used by feminist psychologist Nancy Russo of Arizona State University, whose examination of a self-esteem scale revealed no significant difference between aborting women and women who carried to term. Russo concluded that the absence of difference in self-esteem scores in this large national data set proved that abortion has no "substantial and important impact on women's well-being." (see critique of Russo study here.)

According to Reardon, Russo's much publicized study has frequently been used to support the claim that, on average, abortion has no significant effect on women's mental health. The Elliot Institute's new analysis of the same data set reveals that significant differences do exist.

"The most serious flaw of the Russo study is that the authors did not even comment on the extraordinarily high rate of concealment of past abortions in the sample," Reardon said. "Women who do not want to mention a past abortion are most likely the ones who will have unresolved feelings of shame, guilt, or grief."

Reardon says that another problem with the prior analysis was that Russo's team relied solely on a measure of self-esteem that is not sensitive to post-abortion stress. He says the examination of depression scores is more relevant to the known negative reactions to abortion.

"Russo's previous analysis of this data set was methodologically weak and was frankly a poor basis on which to build the claim that abortion has no measurable effect on women's well- being," he said. "The results of our reexamination of this data set—especially in combination with other studies showing higher rates of suicide, substance abuse, and other mental health disorders associated with prior abortion—shows that the ‘no effect' hypothesis should be rejected. Something is going on here. Where there is this much smoke, despite the problem of high concealment rates, there is likely to be a fire beneath the haze."

Another important aspect of this study, says Reardon, is that is one of only a few studies to use any pre-pregnancy psychological score as a control variable. The most commonly used control variable used in regarding emotional reactions is "pre-abortion" evaluation on the day of the abortion when the woman is in the crux of emotional distress. This is why a pre-pregnancy score is much more useful than a pre-abortion score for evaluating the independent effect of abortion on long term emotional reactions.

Asked what the practical implications of this study are for physicians, Reardon said: "We recommend that physicians should routinely inquire about the outcome of all the patient's pregnancies. The simple question, ‘Have you experienced any pregnancy losses such as miscarriage, abortion, adoption, or stillbirth?' may be sufficient to give women permission to discuss unresolved issues related to prior pregnancy losses. Physician's should remember that there are few social contexts in which women feel it is appropriate to discuss unresolved feelings about prior pregnancy loss. Many patients will appreciate the opportunity to discuss their pregnancy losses with an empathetic person and may welcome referrals for additional counseling."

The new study was funded by the Elliot Institute, a non-profit organization that is involved in research and education regarding post-abortion complications and also promotes outreach and counseling programs for women. Reardon is the author of numerous books on post-abortion issues, including The Jericho Plan: Breaking Down the Walls Which Prevent Post-Abortion Healing and Making Abortion Rare: A Healing Strategy for a Divided Nation. His newest book, Forbidden Grief: The Unspoken Pain of Abortion, co-authored with Theresa Burke, will be published in March of 2002. Information on these titles and other research conducted by Dr. Reardon and the Elliot Institute can be found at www.afterabortion.org.

KEY POINTS:

* The association between abortion and subsequent depression persists over at least eight years.

* Screening patients for a history of abortion may help physicians to identify women who would benefit by a referral to counseling.

* The null hypothesis (the conjecture that there are no differences on average between having an abortion and carrying an unintended pregnancy to term) is rejected.

Referenced Studies:

Reardon DC, Cougle JR. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study British Medical Journal, 324: 151-152. Full text available at www.bmj.com.

Russo NF, Zierk K. Abortion, childbearing, and women's well-being. Professional Psychology: Research and Practice, 1992; 23: 269-280.

A sample of references to studies finding abortion to be associated with subsequent substance abuse and suicide attempts.

Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland: 1987-94: register linkage study. British Medical Journal, 1996; 313: 1431-1434.

Tischler C. Adolescent suicide attempts following elective abortion. Pediatrics, 1981; 68(5): 670- 671.

Morgan CM, Evans M, Peter JR, Currie C. Mental health may deteriorate as a direct effect of induced abortion. British Medical Journal, 1997; 314: 902.

Reardon DC, Ney, PG. Abortion and subsequent substance abuse. American Journal Drug Alcohol Abuse, 2000; 26(1): 61-75.

Frank DA, Zuckerman BS, Amaro H, Aboagye K, Bauchner H, Cabral H, Fried L, Hingson R, Kayne H, Levenson SM, et al Cocaine use during pregnancy, prevalence and correlates, Pediatrics, 1988 Dec; 82(6): 888-95.

Amaro H, Zuckerman B, Cabral H. Drug use among adolescent mothers: profile of risk. Pediatrics, 1989 Jul;84(1):144-51.

Wilsnack RW, Wilsnack SC, Klassen AD. Women's drinking and drinking problems: Patterns from a 1981 national survey. American Journal Public Health, 1984; 74: 1231-1238.

Klassen, A, Wilsnack S. Sexual experience and drinking among women in a U.S. national survey. Archives Sexual. Behavior, 1986; 15(5): 363.