British Medical Journal Study Publishes Highly Flawed Study Designed to Refute Link between Abortion and Depression
BY NRL News Staff

In late October the web site of the British Medical Journal (BMJ) posted a study by Sarah Schmiege and Nancy Russo which purported to show that there was no association between abortion and depression. Although the conclusions were reported uncritically in newspapers, a closer look reveals that the study is rife with flaws and weaknesses in design, presentation, and discussion. Moreover, its conclusions are not in line with most recent research that reveals that abortion is associated with negative aftereffects for women.

When National Right to Life News asked Priscilla Coleman, associate professor of human development and family studies at Bowling Green State University, to comment on "Depression and unwanted first pregnancy: longitudinal cohort study," she began by pointing out that Schmiege and Russo re-analyzed the same National Longitudinal Survey of Youth data used in a 2002 BMJ paper written by David Reardon and Jesse Cougle. Whereas Schmiege and Russo argued that "[w]ell designed studies have not found that abortion contributes to an increased risk of depression," Reardon and Cougle found that when compared to an unintended pregnancy carried to term, there was a 92% greater risk of depression in women who aborted a first pregnancy.

As Reardon pointed out in a letter to the BMJ, the "uninformed readers may wrongly infer from the authors' presentation that our NLSY [National Longitudinal Survey of Youth] study is the only study linking abortion to depression. In fact, it was simply the first study to compare women who have had abortions to a control group of women who have carried unintended pregnancies to term."

Dr. Coleman, who has published widely on the psychology of abortion, agreed, noting that the re-analysis used different criteria to decide which participants to include in the study and lacked controls for key variables associated with the choice to abort. Consequently "Depression and unwanted first pregnancy: longitudinal cohort study" makes very little sense scientifically.

Schmiege and Russo chose to exclude women who said they had at some point wanted their pregnancy before deciding to abort. This is very significant.
Research by Hunsfeldt and colleagues (1995) suggests that 44% of women who abort experience doubts prior to the procedure. Eliminating women from the study who had at some juncture wanted their pregnancies biases the results, since a wealth of data indicates that women who are ambivalent about the decision to abort are at a higher risk for post-abortion mental health problems.

The researchers in effect removed a large group of vulnerable women. Thus their results do not speak to the typical woman choosing abortion--only to those who claim to have had no doubts about their choice.

Another major problem with the design is that the investigators included in the control group women who carried their first baby to term but later had an abortion! There are several problems with this, including some evidence that women who abort after having delivered a live child are at greater risk of emotional difficulties compared to women without children.

Moreover, results of the Reardon and Cougle study were stratified by marital status. The association between abortion and depression was only apparent in women married at the time of the depression assessment. By lumping married and non-married women together, Schmiege and Russo succeeded in obscuring the effect.

Further, the researchers neglected to control for variables identified by Reardon and Cougle as associated with the choice to abort (income, education, race, and psychological state).

As noted, Schmiege and Russo claim that "well-designed studies have not found that abortion contributes to an increased risk of depression." Yet in another place in the same article they state, "Some women who undergo abortion will also experience clinical levels of depression."
How do they reconcile these two statements? By arguing that "other research has found that pre-existing mental health is the more important predictor of mental health after pregnancy regardless of how the pregnancy is resolved."

Is abortion associated with depression or not?

In six out of the 12 studies published by Dr. Coleman and her colleagues, controls were instituted to take into account pre-existing psychological health. Abortion was still associated with a variety of mental health problems.

In actuality there are at least 10 studies, published in excellent journals, that show that an abortion is associated with an increased risk of depression.
Finally, in two recently published studies a history of having an abortion was found to be associated with a 34% increased risk for generalized anxiety disorder (Cougle, Reardon, and Coleman 2005) and a 100% greater risk of using marijuana (Reardon, Coleman, and Cougle 2004). Moreover, women with a history of abortion also engaged in more frequent drinking than those who carried an unintended pregnancy to term (Reardon, Coleman, and Cougle 2004).

Dr. Coleman said she was not surprised that the Schmiege and Russo paper made it through the peer-review process.

"This is typical of how research on this topic has proceeded over the last few decades, with scientific standards relaxed for studies with politically correct results and intense scrutiny applied to studies revealing negative effects of abortion on women," she said.

"In the end, however, the truth is in the data. When objective academics and health care professionals examine the entire literature, what they see is solid, difficult-to-refute evidence that shows associations between abortion and compromised well-being."

Dr. Coleman noted that studies like this that show abortion is not harmful to women not only have an easier time getting through the peer-review process, but then once published, the results are communicated by virtually every major news service. This stands in stark contrast to the media response to the 12 studies published by Dr. Coleman and her colleagues in major peer-reviewed scientific journals over the last three years. These studies indicate that abortion increases risk of anxiety, depression, substance use, and even parenting problems.

"We are lucky if one major news service interviews us, and if they do, they always include an opposing perspective concerning our findings," she said. "When Reuters, MedlinePlus, and the Henry Kaiser Family Foundation, among others, publicize findings like the Schmiege and Russo paper, we are rarely called upon to give balance to the research report."

Sadly, women are the victims, she said, "because they are encouraged to make a decision about their pregnancy based upon misleading information."

References
Cougle, J., and D. C. Reardon. 2002. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: A cohort study. British Medical Journal 324:151–52.
Cougle, J., D. C. Reardon, and P. K. Coleman. 2005. Generalized anxiety associated with unintended pregnancy: A cohort study of the 1995 National Survey of Family Growth. Journal of Anxiety Disorders 19:137–42.
Hunsfeldt, C., S. K. Hansen, A. Lyngberg, M. Noddebo, and B. Pettersson. 1995. Ambivalence among women applying for abortion. Acta Obstetricia et Gynecologica Scandinavica 74:813–17.
Reardon, D. C., P. K. Coleman, and J. Cougle. 2004. Substance use associated with unintended pregnancy outcomes in the National Longitudinal Survey of Youth. American Journal of Drug and Alcohol Abuse 30:369–83.