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Abortion does not drive depression risk

Tristan Manalac
12 Jun 2018

Women who receive abortions appear to be significantly more likely to use antidepressants, although this pattern of use has less to do with the termination of pregnancy than with other risk factors for depression, according to a recent study.

The study included 396,397 women of whom 4.4 percent (n=17,294) had at least one first-trimester abortion and no children, while 3.4 percent (n=13,540) had at least one abortion and one childbirth. Antidepressant use was reported in 59,465 participants (15 percent). [JAMA Psychiatry 2018;doi:10.1001/jamapsychiatry.2018.0849]

Notably, while women who had undergone abortions were significantly more likely to fill antidepressant prescriptions than those who had not had the operation (adjusted incidence rate ratio [IRR], 1.54; 95 percent CI, 1.38–1.54), this risk was not statistically different from that observed during the year prior to abortion (adjusted IRR, 1.54; 1.45–1.62).

Moreover, this difference in risk decreased with increasing time elapsed since the operation (>1–5 years after abortion: adjusted IRR, 1.24; 1.19–1.29; >5 years after abortion: adjusted IRR, 1.12; 1.05–1.18).

Across all participants, the risk factors most strongly associated with filling an antidepressant prescription were a history of psychiatric contact (adjusted IRR, 3.70; 3.62–3.78), past receipt of antianxiety medications (adjusted IRR, 3.03; 2.96–3.10) and prior prescriptions for antipsychotic medications (adjusted IRR, 1.88; 1.18–1.24).

“[T]he strongest risk factors for first-time antidepressant use were indicators of earlier mental health problems,” said researchers. “Taking all of these results together, it is possible that mental health problems may lead women to have unintended pregnancies and abortions.”

According to researchers, the lack of significant difference between the risk of antidepressant initiation in the year prior to and after abortion provides further evidence that abortion is not linked to depression and possibly other mental health problems.

“[I]f having an abortion is causally related to depression, one would expect a higher rate of first antidepressant use after the procedure than before the procedure,” they argued, adding that the drop in rates of antidepressant use also proves that there are no lagged and delayed mental health consequences of abortion.

Accessing the Danish National Parent Registry, researchers identified all women who had received induced first-trimester abortions. The participants’ mental health histories and antidepressant use were determined by accessing the Danish Psychiatric Central Registry and the National Prescription Registry. 

Overall, the findings suggest that “compared with women who do not have an abortion, women who have an abortion may be at higher risk of depression after undergoing the procedure because they were at higher risk to begin with,” said researchers.

“Consequently, policies based on the notion that having an abortion harms women’s mental health may be misinformed,” they added.

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