Huang and colleagues, affiliated with the Anhui Medical College in China, just published a sophisticated large scale study in the Bulletin of Clinical Psychopharmacology entitled “The Impact of Prior Abortion on Anxiety and Depression Symptoms during a Subsequent Pregnancy: Data From a Population-Based Cohort Study."
Data were derived from the Anhui Birth Defects and Child Development Cohort Study and the sample consisted of 6,887 women, 3,264 (47.6%) of whom had experienced at least one abortion.
Results indicated that women with a history of induced abortion a year or more prior, were 49% more likely to experience depression and 114% more likely to experience anxiety in the 1st trimester of a subsequent pregnancy, when compared to women who had not experienced an induced abortion. These results were obtained after controlling for maternal education, income, place of residence, and BMI scores.
When a prior abortion had occurred within the past year, women experienced a 97% increased risk for experiencing anxiety during the 1st trimester after the above controls were instituted. Further, when assessed during the 2nd trimester, a prior induced abortion occurring less than a year earlier was related to a 64% greater risk of depression after instituting controls.
Finally, the results revealed that women with a history of spontaneous abortion were not at a greater risk for anxiety or depression in the 1st or 2nd trimester of a subsequent pregnancy, when compared to women without a history of spontaneous abortion. These results were obtained when the prior loss occurred within one year and when it occurred over a year before the current pregnancy.
There are several take home messages from this study:
1)This study adds to the rapidly accumulating world literature on abortion and mental health. Even in a culture wherein abortion is widespread and is mandated by the government after women give birth once, the magnitude of psychological risks are comparable to those identified in other parts of the world (e.g., Australia, New Zealand, Norway, South Africa, US).
2)The 1st trimester of a later pregnancy may be the most difficult time for women, who have experienced an induced abortion, since the majority of abortions occur early in pregnancy. This is disconcerting because all the major body structures are formed during the 1st trimester and stress hormones may potentially harm the developing fetus.
3)The psychological experience of abortion is more likely to be associated with long-term psychological distress than spontaneous abortion. Similar results were derived from studies conducted by Dr. Anne Broen in Norway. As noted by this Chinese research team, “The social, moral, and psychological context of an induced abortion may be more complicated than that of that of a spontaneous abortion, and may result in different psychological experiences.
Huang, Z., Hao, J., Su, P. et al. (2012). The impact of prior abortion on anxiety and depression symptoms during a subsequent pregnancy: Data from a population-based cohort study in China. Bulletin of Clinical Psychopharmacology, 22.