January 28, 2011

Abortion and Mental Health

     

And the beat goes on. Another "study" purporting to show that having an abortion does not increase the chances of subsequent mental health problems. In fact, the latest, which appears in today's New England Journal of Medicine, allows reporters such as the Associated Press's Alicia Chang to write, "Having an abortion does not increase the risk of mental health problems, but having a baby does, one of the largest studies to compare the aftermath of both decisions suggests. The research by Danish scientists further debunks the notion that terminating a pregnancy can trigger mental illness and shows postpartum depression to be much more of a factor."

Over at Part Three, Professor Priscilla Coleman debunks the conclusions reached by researchers Munk-Olsen, Laursen, Pedersen, and colleagues in a study titled, "Induced First-Trimester Abortion and Risk of Mental Disorder." You'd never know it from either the study itself or news accounts, but there has been "a tidal wave of sound published data on the emotional consequences of abortion," as Dr. Coleman wrote last year. "Over 30 studies have been published in just the last five years and they add to a body of literature comprised of hundreds of studies published in major medicine and psychology journals throughout the world."

Just three points to keep in mind.

First, research was partially funded by the Susan Thompson Buffett Foundation, which supports pro-abortion organizations and their "projects." As Prof. Michael New noted today, "[T]his summer, an article in The New York Times Magazine indicated that two new programs designed to train and encourage young physicians to perform abortions were funded, in part, by the Susan Thompson Buffet Foundation" [www.nationalreview.com/corner/258205/more-misleading-research-about-mental-health-consequences-abortion-michael-j-new].

If NRLC funded a study, do you think it would be trumpeted as unbiased and even-handed?

Second, the go-to guy for comments was Robert Blum, "an expert on reproductive health at the Johns Hopkins Bloomberg School of Public Health." Oh, by the way, he just happens to be the former president of the pro-abortion Guttmacher Institute.

Blume told NPR that "This is an extremely, extremely well done study," and that "There is no evidence that abortion predisposes a woman to psychiatric and mental health problems." Reporter Nancy Shute tells us that Blum "would like to say goodbye to the political buzz words." Blum adds definitively, "There is no post-abortion trauma, post-abortion syndrome, or anything of the like."

No way, no how. What a surprise.

Third, there are and will be recurrent waves of research, alleging there is no emotional aftermath to abortion. But resistance to this pretend consensus is growing and is not limited to pro-lifers. Let me offer the conclusion of an analysis Dr. Coleman wrote last year (http://www.nrlc.org/News_and_Views/Nov10/nv111210part2.html)

"The evidence is accumulating despite socio-political agendas to keep the truth out of the academic journals and ultimately from women to insure that the big business of abortion continues unimpeded. …And I am not alone in my opinion that abortion has a devastating aftermath for women. These conclusions have been voiced by prominent researchers in Great Britain, Norway, New Zealand, Australia, South Africa, the U.S., and elsewhere. As a group of researchers, who in 2008 had published nearly 50 peer-reviewed articles indicating abortion is associated with negative psychological outcomes, six colleagues and I sent a petition letter to the American Psychological Association (APA) criticizing their methods and conclusions as described in their Task Force Report on Abortion and Mental Health. It is noteworthy that Dr. Major chaired the task force.

"Any interpretation of the available research that does not acknowledge the strong evidence now available in the professional literature represents a conscious choice to ignore basic principles of scientific integrity. The human fallout to such a choice by the APA and like-minded colleagues is misinformed professionals, millions of women struggling in isolation to make sense of a past abortion, thousands who will seek an abortion today without the benefit of known risks, and millions who will make this often life altering decision tomorrow without the basic right of informed consent, which is routinely extended for all other elective surgeries in the U.S."

Danish researchers Munk-Olsen, Laursen, Pedersen, and colleagues will publish a study tomorrow in the New England Journal of Medicine, addressing the risk of mental health disorders in women who have a first-trimester abortion and those who experience a first childbirth.

The researchers focus on the fact that there is not a statistically significant difference in first-time inpatient admissions and outpatient psychiatric visits before and after an abortion, concluding that it is unlikely that the abortion procedure causes mental health problems. However there are some major problems with this conclusion.

First, the measure of pre-abortion mental health is likely high (more than 3 times greater than prior to birth, 14.6% vs. 3.9%), because many of the women were probably in the midst of abortion decision-making when they experienced their first psychiatric visit. This high rate of pre-abortion mental health problems is construed to indicate that women who choose abortion will often experience mental health problems based on factors other than the procedure.

In fact, the women in the sample are quite unlikely to fall into this "vulnerable" category since none of the women included in the study had any history of psychological diagnoses prior to 9 months before the abortion. These researchers used a window of 0-9 months to measure pre-abortion mental health; however, the assessment should instead have been before the pregnancies were detected. The data do indicate that rates of mental health problems are significantly higher after abortion compared to after childbirth (15.2% vs. 6.7%) and compared to not having been pregnant (8.2%).

The bottom line is the fact that they found comparable rates before and after abortion does not negate a possible causal link between abortion and mental health. This is true because many women were likely disturbed to the point of seeking help, because they were pregnant and contemplating an abortion or had already chosen one and were awaiting the procedure. There are numerous published studies indicating high levels of stress among women facing an unplanned pregnancy and considering an abortion.

Second, the authors note in the beginning of their article that previous studies lack controls for third variables, but the only third variables they consider are age and parity. There are no controls for pregnancy wantedness, coercion by others to abort, marital status, income, education, exposure to violence and other traumas, etc. Many studies have been deemed inadequate based on only one of these variables not being accounted for (see APA Task Force Report, 2008), yet the study design was considered adequate to merit publication in the NEJM.

Third, all women who had psychiatric histories more than 9 months prior to the abortion were not included in the study. There are many studies showing that these women are at heightened risk for post-abortion mental health problems. In this study, the researchers have narrowed the participant pool to only the healthiest of women and there are high rates before and after abortion…imagine if all women had been included! Women who experience repeat abortions are likewise not considered at all and they are more likely to be at risk for mental health problems post-dating the procedure.

Fourth, the results follow women for only one year post-abortion or childbirth and there is plenty of evidence suggesting that the negative effects of abortion may not surface for several years. There is also data indicating that women are most likely to experience postpartum psychological problems soon after birth with the benefits of motherhood often manifesting later than the first year wherein many life-style adjustments are necessary.

A more appropriate analytic strategy would have been to include all women experiencing an abortion, a birth, or no pregnancy and then compare pre and post-pregnancy mental health visits with statistic al controls for all psychiatric visits pre-dating conception and all other relevant third variables described above. I am confident that the data would then be quite consistent with the dozens of studies published in recent years in high impact journals indicating that abortion increases risk for a variety of mental health problems.

Even without appropriate improvements to the design, the data reported does indicate increased rates of particular diagnoses at specific points in the first year. Relative risk for psychiatrics visits involving neurotic, stress-related, or somatoform disorders was 47% and 37% higher post-abortion compared to pre-abortion at 2 and 3 months respectively. In addition, psychiatric contact for personality or behavioral disorders was 56%, 45%, 31%, and 55% higher at 3, 4-6, 7-9, and 10-12 months respectively.

Contact: Dave Andrusko, Priscilla Coleman, Ph.D.
Source: National Right to Life