Gilchrist

Abstract

Gilchrist AC, Hannaford PC, Frank P, Kay CR. Termination of pregnancy and psychiatric morbidity. Br J Psychiatry. 1995;167:243-248.

BACKGROUND. We investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy.

METHOD. This was a prospective cohort study of 13,261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321).

RESULTS. Rates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3-0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95% CI 1.1-2.6), or who were refused a termination (RR 2.9, 95% CI 1.3-6.3).

CONCLUSIONS. The findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found.

Strengths

1. It was prospective with a large sample size
2. affirmed that women with prior psychiatric problems are worse off postabortion
3. affirmed that women with no prior psychiatric history, had significantly higher risks of deliberate self harm (though this was also elevated for women refused abortion)
4. affirmed that women with the most fragile mental health, i.e., psychosis, were worse off postabortion
5. the study used four comparison groups

1. no termination
2. termination
3. requested termination and changed mind
4. requested termination but were refused

Weaknesses

1. General Practitioners evaluated the patients, and are thus less likely to accurately diagnose psychiatric disorders (“underrecognition of and an imprecise diagnosis of psychiatric disorder” p. 247)
2. No standardized measures for mental health diagnoses were employed
3. By the end of the study, 66% sample attrition was reported for women who terminated their pregnancies
4. The GPs who participated in this catchment study were volunteers and no attempt was made to control for selection bias
5. Data re prior psychiatric history was conveyed by the local GP whose patients’ health records were likely incomplete due to lack of record linkage
6. Insufficient power to detect significant differences between those women who requested a termination and changed their minds, and those who were refused abortion