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Another Flawed Study on
Abortion-Mental Health Link
Part Three of Four By Priscilla Coleman, Ph.D. Editor's note. Last night Professor Coleman provided pro-life sources with an analysis of a study by Danish researchers that appeared today in the prestigious New England Journal of Medicine. We've reprinted her trenchant comments below, along with additional comments and commentary in Part One. Coleman is a Professor of Human Development and Family Studies at Bowling Green State University. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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. |
