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ss triple helix - Christmas 2009,  Abortion and mental health

Abortion and mental health

More methodologically robust evidence

Until recent research from New Zealand (1) it was a medical mantra that it was safer for a mother's mental health to have an abortion than to continue with the pregnancy. I have twice reviewed this topic (2)(3) and in further developments about abortion affecting mental health Fergusson et al (4) have extended the analysis and strengthened their earlier evidence. (1)

Data were collected on the pregnancy and mental health history of a cohort of over 500 female subjects in Christchurch, New Zealand from birth to age 30. Abortion was associated with a small increase in the risk of mental disorders. Women who had abortions had rates of anxiety and substance misuse about 30% higher than in other pregnancy outcomes like live birth, or unwanted pregnancy leading to live birth or pregnancy loss (miscarriage, ectopic or stillbirth). Even women without a history of mental ill health could have problems after an abortion.

These findings persisted following extensive controlling for prospectively and concurrently measured confounders, and the study was therefore methodologically very robust.

Most recently Fergusson et al state that women reporting distress at having an abortion were 40-80% more likely to experience mental ill health than those not having an abortion. (5) They write 'the important implications of our research relate to the interpretation of the abortion laws in legislations such as those in the UK and New Zealand where the mental health risks of unwanted pregnancy are the principal grounds on which abortion is authorised'. (4) Their findings are the more significant because 94% of British abortions are signed by a doctor because of 'risk to mental health' for the mother.

The other important implication is that patients should be advised of this risk and what to do if they suffer any mental disorder following an abortion. The Royal College of Psychiatrists (6) has very sensibly called for discussion in the consultation, so the doctor can be assured a patient is fully informed before she consents. They also rightly called for other colleges and professional bodies to incorporate this evidence into their guidelines for women considering abortion.

Fergusson et al conclude: 'First, exposure to abortion is an adverse life event which is associated with a modest increase in risks of mental health problems. Second, the mental health risks associated with abortion may be larger, and certainly are not smaller, than the mental health risks associated with unwanted pregnancies that come to term.' (7) As Christians in medicine it is important we consider how to convey this far reaching evidence to our patients.

References
  1. Fergusson DM et al. Abortion in young women and subsequent mental health. J Child Psychol Psychiatry 2006;47:16-24
  2. Beer MD. Psychological trauma after abortion. Triple Helix 2002; Autumn: 6-7
  3. Beer MD. Psychological effects after abortion. Triple Helix 2006; Autumn: 12-13
  4. Fergusson DM et al. Abortion and mental health disorders: evidence from a 30-year longitudinal study. British Journal of Psychiatry 2008;193:444-451
  5. Fergusson DM et al. Reactions to abortion and subsequent mental health. British Journal of Psychiatry 2009;195:420-426
  6. Royal College of Psychiatrists. Position statement on women's mental health in relation to induced abortion. 14 March 2008 www.rcpsych.ac.uk/members/currentissues/ mentalhealthandabortion.aspx
  7. Fergusson DM et al. Abortion and mental health (correspondence). British Journal of Psychiatry 2009;195:83-84
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