Psychiatric or Psychological Hospitalization or Consultation
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Psychiatric or Psychological Hospitalization or Consultation
Induced First-Trimester Abortion and Risk of Mental Disorder. Trine Munk-Olsen, Ph.D., Thomas Munk Laursen, Ph.D., Carsten B. Pedersen, Dr.Med.Sc., Øjvind Lidegaard, Dr.Med.Sc., and Preben Bo Mortensen, Dr.Med.Sc. N Engl J Med 2011;364:332-9.
- Background:Concern has been expressed about potential harm to women’s mental health in association with having an induced abortion, but it remains unclear whether induced abortion is associated with an increased risk of subsequent psychiatric problems.
- Methods:We conducted a population-based cohort study that involved linking information from the Danish Civil Registration system to the Danish Psychiatric Central Register and the Danish National Register of Patients. The information consisted of data for girls and women with no record of mental disorders during the 1995–2007 period who had a first-trimester induced abortion or a first childbirth during that period. We estimated the rates of first-time psychiatric contact (an inpatient admission or outpatient visit) for any type of mental disorder within the 12 months after the abortion or childbirth as compared with the 9-month period preceding the event.
- Results:
The incidence rates of first psychiatric contact per 1000 person-years among girls and women who had a first abortion were 14.6 (95% confidence interval [CI], 13.7 to 15.6) before abortion and 15.2 (95% CI, 14.4 to 16.1) after abortion. The corresponding rates among girls and women who had a first childbirth were 3.9 (95% CI, 3.7 to 4.2) before delivery and 6.7 (95% CI, 6.4 to 7.0) post partum. The relative risk of a psychiatric contact did not differ significantly after abortion as compared with before abortion (P = 0.19) but did increase after childbirth as compared with before childbirth (P<0.001).
- Conclusions: The finding that the incidence rate of psychiatric contact was similar before and after a first-trimester abortion does not support the hypothesis that there is an increased risk of mental disorders after a first-trimester induced abortion.
- Editor's Note: Please see the extended review of this study for a more detailed discussion of the methodological limitations which slanting of the study design.
Psychiatric admissions of low income women following abortion and childbirth. Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Can Med Assoc J. 2003; 168(10):1253-7
- Background: Controversy exists about whether abortion or childbirth is associated with greater psychological risks. We compared psychiatric admission rates of women in time periods from 90 days to 4 years after either abortion or childbirth.
- Methods: We used California Medicaid (Medi-Cal) records of women aged 13–49 years at the time of either abortion or childbirth during 1989. Only women who had no psychiatric admissions or pregnancy events during the year before the target pregnancy event were included (n = 56 741). Psychiatric admissions were examined using logistic regression analyses, controlling for age and months of eligibility for Medi-Cal services.
- Results: Overall, women who had had an abortion had a significantly higher relative risk of psychiatric admission compared with women who had delivered for every time period examined. Significant differences by major diagnostic categories were found for adjustment reactions (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1–4.1), single-episode (OR 1.9, 95% CI 1.3–2.9) and recurrent depressive psychosis (OR 2.1, 95% CI 1.3–3.5), and bipolar disorder (OR 3.0, 95% CI 1.5–6.0). Significant differences were also observed when the results were stratified by age.
- Interpretation: Subsequent psychiatric admissions are more common among low-income women who have an induced abortion than among those who carry a pregnancy to term, both in the short and longer term.
NOTES:
- Tables showing when the psychiatric hospitalization occurred illustrate a marked peak closer to the time of the pregnancy event, providing support for a causal interpretation.
- Using the same population, the authors also examined outpatient treatment for psychiatric disorders and also found higher rates of outpatient treatment following abortion. See next entry below
- The abortion group had 160% more total in-patient mental health claims than the birth group. Percentages equaled 120%, 90%, 110%, 60%, and 50% for the first 180 days, one year, two years, three years, and four years respectively.
- Across the four years, the abortion group had 70% more in-patient mental health claims than the birth group. Percentages equaled 90%, 110%, and 200% for depressive psychosis, single episode, depressive psychosis, recurrent episode, and bipolar disorder, respectfully
State-funded abortions vs. deliveries: A comparison of outpatient mental health claims over five years. Coleman PK, Reardon DC, Rue VM, Cougle JR. American Journal of Orthopsychiatry, 2002; 72(1):141–52.
- (Abstract) In this record-based study, rates of 1st-time outpatient mental health treatment for 4 years following an abortion or a birth among women (aged 13-49 yrs) receiving medical assistance through the state of California were compared. After controlling for preexisting psychological difficulties, age, months of eligibility, and the number of pregnancies, the rate of care was 17% higher for the abortion group (n = 14,297) in comparison with the birth group (n = 40,122). Within 90 days after the pregnancy, the abortion group had 63% more claims than the birth group, with the percentages equaling 42%, 30%, and 16% for 180 days, 1 year, and 2 years, respectively. Additional comparisons between the abortion and birth groups were conducted on the basis of claims for specific types of disorders and age.
Report of the Committee on the Abortion Law, RF Badgley et al, (Ottawa:Supply and Services, 1977) pp. 313-321
- A Saskatchewan, Canada study found that postabortion women had "mental disorders" 40.8% more often than postpartum women. An Alberta, Canada study found that among women who had abortions, 24% made visits to psychiatrists compared to 3% in the general population.
'[http://www.scribd.com/doc/132704966/Virginia-DMAS-analysis-of-health-claims-following-abortion-and-childbirth Virginia DMAS analysis of health claims following abortion and childbirth. Nelson J. Department of Medical Assistance Services. Richmond, VA. March 21, 1997. Reply to request by Delegate Bob Marshall.
- This was an exploratory investigation by the Virginia Department of Medical Assistance Services (DMAS) to compare health claims of women who aborted and women who had normal births. The study examined medicaid claims paid by DMAS over a three year period for 122 women who had a first live birth and 122 women with a first abortion.
- In this study population, women who had abortions had statistically significant 62% percent increase in subsequent mental health claims (43% higher costs), and a 12% increase in claims (53% higher costs) for treatments resulting from accidents. They were 275% more likely to undergo a subsequent clinical psychiatric evaluation and 206% more likely to receive individual medical psychotherapy, and were 720% more likely to receive pharmacologic management in association with minimal psychotherapy.
"Health Services Utilization After Induced Abortion in Ontario: A Comparison Between Community Clinics and Hospitals," T Ostbye et al, Am J Medical Quality 16(3):99-106, 2001
- In Canada, a study of Ontario Health Insurance Plan claims in 1995 found that women who were three months postabortion from hospital day surgery had a rate of hospitalization for psychiatric problems of 5.2 per 1000 vs. 1.1 per 1000 for age matched controls without induced abortions. Three month postabortion women who had abortions at a community clinic had a rate of hospitalization for psychiatric problems of 1.9 per 1000 vs. 0.60 per 1000 for age-matched controls who did not have induced abortions. The incidence of postabortion psychiatric hospitalization was significantly higher if there had been preabortion hospitalization for psychiatric problems, preabortion emergency room consultation, or preabortion hospital admissions. Ed. Note: Flaws in the available data and study design limit the value of this study.
"Postabortion or Postpartum Psychotic Reactions," H David et al, Family Planning Perspectives 13(2): 892, 1981
- A Danish register linkage study over a three month period found that the rate of psychiatric hospital admissions was 18.4 per 10,000 postabortion women, 12.0 pr 10,000 postpartum women, and 7.5 per 10,000 women of childbearing age generally.
"Risk of Admission to Psychiatric Institutions among Danish Women Who Experienced Induced Abortion: An Analysis Based on A National Record Linkage," Ronald Somers, Dissertation Abstracts Int'l, Public Health 2621-B, 1979
- The age-adjusted incidence of psychiatric hospitalization was 3.42%, 4.06%, and 6.0% for women with one, two, and three induced abortions respectively compared with 2.56%, 1.97% and 2.15% for women with one, two and three live births respectively. The age- adjusted percentage of psychiatric hospitalization for aborting women was 1.49% for married women, 2.38%for single women, 4.21% for separated women, and 5.16% for divorced women. Aborting women under 30 years of age exhibited higher overall and diagnosis specific psychiatric hospital admission rates than women of this age in general. Teenagers who had abortions had 2.9 times the rate of psychiatric hospital admissions compared to teenage women in general. The highest rate of psychiatric hospital admissions was 9.45% among women age 35-39 with more than one abortion during the study period.
"State-funded abortions vs. deliveries: A comparison of subsequent mental health claims over 6 years," PK Coleman and D Reardon, Poster session presented at the American Psychological Society 12th Annual Convention, Miami, FL, June, 2000
- In a study of California women who received state funded medical care and who either had an abortion or gave birth in 1989, postabortion women were more than twice as likely to have from two to nine treatments for mental health as women who carried to term.
"Psychosocial Characteristics of Psychiatric Inpatients with Reproductive Losses," T Thomas et al, Journal of Health Care for the Poor and Underserved 7(1):15, 1996
- Postabortion women were more likely to require psychiatric hospitalization, have been subjected to sexual abuse, and be diagnosed for psychoactive substance abuse disorder compared to childless women.
"Past Trauma and Present Functioning of Patients Attending a Women's Psychiatric Clinic," EFM Borins and PJ Forsythe, Am J Psychiatry 142(4):460, 1985
- In a Canadian study of women attending a hospital based women's psychiatric clinic, a past abortion correlated significantly with three or more trauma factors.
Proceedings of the Conference on Psycho-Social Factors in Transnational Planning, W Pasini and J Kellerhals, (Washington D.C.: American Institute for Research, 1970) p.44
- A three fold increase in previous psychiatric consultations was found in women seeking repeat abortions compared to maternity patients.
Family planning needs and STD risk behaviours of female psychiatric out-patients. J H Coverdale , S H Turbott , H Roberts The British Journal of Psychiatry Jul 1997, 171 (1) 69-72; DOI: 10.1192/bjp.171.1.69
- METHOD Sixty-six female out-patients with major psychiatric disorders, including schizophrenia, bipolar disorder and mood disorders, completed a semi-structured interview (response rate = 63%) and were individually matched for age and ethnicity with 66 women who had never been treated for psychiatric illness. They answered questions on child-rearing and on their methods of contraception in relation to their attitudes towards pregnancy, as well as on their risk for STDs.
- RESULTS Compared with controls, the female patients reported having had significantly more induced abortions. 17 patients (39.5%) and 8 controls (13.8%) had had one or more induced abortions (p 0.01).