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Women who have had an abortion are more likely to use antidepressants than women who have not had an abortion, but new research suggests that this association is a result of differences in risk factors for depression.
“Thus, policies based on the notion that abortion harms women’s mental health may be misinformed,” wrote Julia R. Steinberg, PhD, and her coauthors in JAMA Psychiatry.
Dr. Steinberg and her coauthors looked at a cohort of Danish women, intending to examine the association between first-time antidepressant use and either first-trimester abortion or first childbirth. “One shortcoming of many studies in the field is their reliance on self-report of both abortion and mental health problems, which is subject to both faulty memory and social desirability in reporting,” wrote Dr. Steinberg of the University of Maryland, College Park, and her coauthors. Using data on abortion, childbirth, and antidepressants from the Danish population registries, which were collected over time, avoided that limitation.
Of the 396,397 women, 17,294 (4.4%) had at least one first-trimester abortion and no children, 72,052 (18.2%) had no abortions and at least one childbirth, 13,540 (3.4%) had at least one abortion and at least one childbirth, and 293,511 (74.1%) had neither an abortion nor a childbirth.
Of 30,834 women who had an abortion and filled at least one antidepressant prescription, 5,705 (18.5%) initiated antidepressant use after a first abortion. Of 85,592 women who gave birth and filled at least one antidepressant prescription, 10,825 (12.7%) initiated antidepressant use after a first childbirth.
The researchers were limited to 2-month increments of incidence rates for patient confidentiality reasons.
While women who had an abortion were more likely than women who had not to obtain an antidepressant prescription, “the rate of new antidepressant use was the same in the year before and year after and decreased with increasing time after the abortion,” the researchers wrote. “ after the abortion.”
The strongest risk factors for initiating antidepressant use were indicators for earlier mental health problems, such as a previous psychiatric contact. The authors speculated that mental health problems may lead women to have unintended pregnancies and therefore abortions, as Kelli Stidham Hall, PhD, and associates discussed (Soc Sci Med. 2014 Jan;0:62-71).
The combination of the absence of a postprocedure increase in antidepressant use, the gradual decrease in their use over time, and the lack of statistical significance of the incidence rate ratios when adjusted for risk factors led Dr. Steinberg and her coauthors to conclude that “compared with women who do not have an abortion, women who have an abortion may be at higher risk of depression after undergoing the procedure because they were at higher risk to begin with.”
Dr. Steinberg disclosed that she has served as a scientific expert on the topic of abortion and mental health in legal cases and has consulted for the Center for Reproductive Rights and Planned Parenthood Federation of America. The study was supported by grants from the Society of Family Planning, the American Foundation for Suicide Prevention, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research.
SOURCE: Steinberg JR et al. JAMA Psychiatry. 2018 May 30. doi: 10.1001/jamapsychiatry.2018.0849.
The study by Julia R. Steinberg, PhD, and her associates adds to the body of evidence showing that abortion is not associated with an increased risk of mental disorders, wrote Nada L. Stotland, MD, and Angela D. Shrestha, MD, in an editorial accompanying the article in JAMA Psychiatry (2018 May 30. doi: 10.1001/jamapsychiatry.2018.0838).
“The authors report that, compared with women who had not had an abortion, women who had a first abortion had a higher risk of first-time antidepressant prescription,” Dr. Stotland and Dr. Shrestha wrote. “However, the risk of first-time antidepressant prescription was similar to the year before and after an abortion. Giving birth was associated with a lower likelihood of a prescription, but this likelihood rose after childbirth and continued to rise for 5 years after delivery.”
Dr. Stotland and Dr. Shrestha also praised the methodology used by Dr. Steinberg and her associates, particularly the decision to make pregnant women who choose to remain pregnant a control group. However, women who opt to continue their pregnancies are more likely to have supportive and healthy circumstances that influence them to make that decision, Dr. Stotland and Dr. Shrestha said.
The decision to have an abortion is fraught with complexities. Ultimately, clinicians must recognize that abortions are indeed significant events for women, and offer them both accurate information and nonjudgmental support, they wrote.
Dr. Stotland is affiliated with Rush University in Chicago and the University of Illinois at Chicago. Dr. Shrestha also is affiliated with the University of Illinois at Chicago. They reported no conflicts of interest.
The study by Julia R. Steinberg, PhD, and her associates adds to the body of evidence showing that abortion is not associated with an increased risk of mental disorders, wrote Nada L. Stotland, MD, and Angela D. Shrestha, MD, in an editorial accompanying the article in JAMA Psychiatry (2018 May 30. doi: 10.1001/jamapsychiatry.2018.0838).
“The authors report that, compared with women who had not had an abortion, women who had a first abortion had a higher risk of first-time antidepressant prescription,” Dr. Stotland and Dr. Shrestha wrote. “However, the risk of first-time antidepressant prescription was similar to the year before and after an abortion. Giving birth was associated with a lower likelihood of a prescription, but this likelihood rose after childbirth and continued to rise for 5 years after delivery.”
Dr. Stotland and Dr. Shrestha also praised the methodology used by Dr. Steinberg and her associates, particularly the decision to make pregnant women who choose to remain pregnant a control group. However, women who opt to continue their pregnancies are more likely to have supportive and healthy circumstances that influence them to make that decision, Dr. Stotland and Dr. Shrestha said.
The decision to have an abortion is fraught with complexities. Ultimately, clinicians must recognize that abortions are indeed significant events for women, and offer them both accurate information and nonjudgmental support, they wrote.
Dr. Stotland is affiliated with Rush University in Chicago and the University of Illinois at Chicago. Dr. Shrestha also is affiliated with the University of Illinois at Chicago. They reported no conflicts of interest.
The study by Julia R. Steinberg, PhD, and her associates adds to the body of evidence showing that abortion is not associated with an increased risk of mental disorders, wrote Nada L. Stotland, MD, and Angela D. Shrestha, MD, in an editorial accompanying the article in JAMA Psychiatry (2018 May 30. doi: 10.1001/jamapsychiatry.2018.0838).
“The authors report that, compared with women who had not had an abortion, women who had a first abortion had a higher risk of first-time antidepressant prescription,” Dr. Stotland and Dr. Shrestha wrote. “However, the risk of first-time antidepressant prescription was similar to the year before and after an abortion. Giving birth was associated with a lower likelihood of a prescription, but this likelihood rose after childbirth and continued to rise for 5 years after delivery.”
Dr. Stotland and Dr. Shrestha also praised the methodology used by Dr. Steinberg and her associates, particularly the decision to make pregnant women who choose to remain pregnant a control group. However, women who opt to continue their pregnancies are more likely to have supportive and healthy circumstances that influence them to make that decision, Dr. Stotland and Dr. Shrestha said.
The decision to have an abortion is fraught with complexities. Ultimately, clinicians must recognize that abortions are indeed significant events for women, and offer them both accurate information and nonjudgmental support, they wrote.
Dr. Stotland is affiliated with Rush University in Chicago and the University of Illinois at Chicago. Dr. Shrestha also is affiliated with the University of Illinois at Chicago. They reported no conflicts of interest.
Women who have had an abortion are more likely to use antidepressants than women who have not had an abortion, but new research suggests that this association is a result of differences in risk factors for depression.
“Thus, policies based on the notion that abortion harms women’s mental health may be misinformed,” wrote Julia R. Steinberg, PhD, and her coauthors in JAMA Psychiatry.
Dr. Steinberg and her coauthors looked at a cohort of Danish women, intending to examine the association between first-time antidepressant use and either first-trimester abortion or first childbirth. “One shortcoming of many studies in the field is their reliance on self-report of both abortion and mental health problems, which is subject to both faulty memory and social desirability in reporting,” wrote Dr. Steinberg of the University of Maryland, College Park, and her coauthors. Using data on abortion, childbirth, and antidepressants from the Danish population registries, which were collected over time, avoided that limitation.
Of the 396,397 women, 17,294 (4.4%) had at least one first-trimester abortion and no children, 72,052 (18.2%) had no abortions and at least one childbirth, 13,540 (3.4%) had at least one abortion and at least one childbirth, and 293,511 (74.1%) had neither an abortion nor a childbirth.
Of 30,834 women who had an abortion and filled at least one antidepressant prescription, 5,705 (18.5%) initiated antidepressant use after a first abortion. Of 85,592 women who gave birth and filled at least one antidepressant prescription, 10,825 (12.7%) initiated antidepressant use after a first childbirth.
The researchers were limited to 2-month increments of incidence rates for patient confidentiality reasons.
While women who had an abortion were more likely than women who had not to obtain an antidepressant prescription, “the rate of new antidepressant use was the same in the year before and year after and decreased with increasing time after the abortion,” the researchers wrote. “ after the abortion.”
The strongest risk factors for initiating antidepressant use were indicators for earlier mental health problems, such as a previous psychiatric contact. The authors speculated that mental health problems may lead women to have unintended pregnancies and therefore abortions, as Kelli Stidham Hall, PhD, and associates discussed (Soc Sci Med. 2014 Jan;0:62-71).
The combination of the absence of a postprocedure increase in antidepressant use, the gradual decrease in their use over time, and the lack of statistical significance of the incidence rate ratios when adjusted for risk factors led Dr. Steinberg and her coauthors to conclude that “compared with women who do not have an abortion, women who have an abortion may be at higher risk of depression after undergoing the procedure because they were at higher risk to begin with.”
Dr. Steinberg disclosed that she has served as a scientific expert on the topic of abortion and mental health in legal cases and has consulted for the Center for Reproductive Rights and Planned Parenthood Federation of America. The study was supported by grants from the Society of Family Planning, the American Foundation for Suicide Prevention, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research.
SOURCE: Steinberg JR et al. JAMA Psychiatry. 2018 May 30. doi: 10.1001/jamapsychiatry.2018.0849.
Women who have had an abortion are more likely to use antidepressants than women who have not had an abortion, but new research suggests that this association is a result of differences in risk factors for depression.
“Thus, policies based on the notion that abortion harms women’s mental health may be misinformed,” wrote Julia R. Steinberg, PhD, and her coauthors in JAMA Psychiatry.
Dr. Steinberg and her coauthors looked at a cohort of Danish women, intending to examine the association between first-time antidepressant use and either first-trimester abortion or first childbirth. “One shortcoming of many studies in the field is their reliance on self-report of both abortion and mental health problems, which is subject to both faulty memory and social desirability in reporting,” wrote Dr. Steinberg of the University of Maryland, College Park, and her coauthors. Using data on abortion, childbirth, and antidepressants from the Danish population registries, which were collected over time, avoided that limitation.
Of the 396,397 women, 17,294 (4.4%) had at least one first-trimester abortion and no children, 72,052 (18.2%) had no abortions and at least one childbirth, 13,540 (3.4%) had at least one abortion and at least one childbirth, and 293,511 (74.1%) had neither an abortion nor a childbirth.
Of 30,834 women who had an abortion and filled at least one antidepressant prescription, 5,705 (18.5%) initiated antidepressant use after a first abortion. Of 85,592 women who gave birth and filled at least one antidepressant prescription, 10,825 (12.7%) initiated antidepressant use after a first childbirth.
The researchers were limited to 2-month increments of incidence rates for patient confidentiality reasons.
While women who had an abortion were more likely than women who had not to obtain an antidepressant prescription, “the rate of new antidepressant use was the same in the year before and year after and decreased with increasing time after the abortion,” the researchers wrote. “ after the abortion.”
The strongest risk factors for initiating antidepressant use were indicators for earlier mental health problems, such as a previous psychiatric contact. The authors speculated that mental health problems may lead women to have unintended pregnancies and therefore abortions, as Kelli Stidham Hall, PhD, and associates discussed (Soc Sci Med. 2014 Jan;0:62-71).
The combination of the absence of a postprocedure increase in antidepressant use, the gradual decrease in their use over time, and the lack of statistical significance of the incidence rate ratios when adjusted for risk factors led Dr. Steinberg and her coauthors to conclude that “compared with women who do not have an abortion, women who have an abortion may be at higher risk of depression after undergoing the procedure because they were at higher risk to begin with.”
Dr. Steinberg disclosed that she has served as a scientific expert on the topic of abortion and mental health in legal cases and has consulted for the Center for Reproductive Rights and Planned Parenthood Federation of America. The study was supported by grants from the Society of Family Planning, the American Foundation for Suicide Prevention, and the Lundbeck Foundation Initiative for Integrative Psychiatric Research.
SOURCE: Steinberg JR et al. JAMA Psychiatry. 2018 May 30. doi: 10.1001/jamapsychiatry.2018.0849.
FROM JAMA PSYCHIATRY