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Keywords:

  • abortion;
  • anxiety;
  • depression;
  • mental illness

Abstract

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. References

The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of 36 studies were retrieved, and six of them were excluded for methodological bias. Depression, anxiety disorders (e.g. post-traumatic stress disorder) and substance abuse disorders were the most studied outcome. Abortion versus childbirth: 13 studies showed a clear risk for at least one of the reported mental problems in the abortion group versus childbirth, five papers showed no difference, in particular if women do not consider their experience of fetal loss to be difficult, or if after a fetal reduction the desired fetus survives. Only one paper reported a worse mental outcome for childbearing. Abortion versus unplanned pregnancies ending with childbirth: four studies found a higher risk in the abortion groups and three, no difference. Abortion versus miscarriage: three studies showed a greater risk of mental disorders due to abortion, four found no difference and two found that short-term anxiety and depression were higher in the miscarriage group, while long-term anxiety and depression were present only in the abortion group. In conclusion, fetal loss seems to expose women to a higher risk for mental disorders than childbirth; some studies show that abortion can be considered a more relevant risk factor than miscarriage; more research is needed in this field.

THE POSSIBILITY THAT abortion might have mental consequences has been widely investigated in the last few years.[1] The same concerns apply also to miscarriage;[2] therefore psychological support has been advocated for women who experience a fetal loss, either induced or involuntary.[3, 4] The psychological drawbacks of abortion have been studied in order to offer complete information to the women who hesitate when facing a difficult pregnancy.[5, 6] In the last few years, these studies have become more and more frequent, and a constant update of research evidence in this field is needed. In particular, several studies have compared the mental consequences of abortion (voluntary termination of pregnancy) with those described after a miscarriage (involuntary termination of pregnancy with fetal death). Most studies investigated the possible mental consequences of abortion, maybe because it is worth determining whether this intervention can be an actual help for women's health, and how to prevent its drawbacks, if any. Thus, we performed a review of the scientific literature on the psychological and psychiatric drawbacks of abortion.

Methods

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. References

We performed a search in PubMed and Medscape from the year 1995 to 2011. We used as key words the following: ‘abortion’, ‘mental disorder’, ‘depression’ ‘anxiety’, ‘illicit drugs’ ‘tobacco’, ‘alcohol’. Inclusion criteria were: (i) original studies about mental risks correlated with abortion; (ii) presence of a control group of women, who did not undergo abortion, with similar background features; (iii) clarity and simplicity of design, and reliability of the measures used to assess the outcome; and (iv) correct statistical evaluation to assess the significance of differences between groups. Exclusion criteria: (i) reviews, commentaries, case-reports; and (ii) all studies that did not fulfill the inclusion criteria. We carefully examined each paper, and highlighted several features: age and sample size, type of control group, outcome, tool used to assess the studied outcome, conclusions, major limitations of the study. We performed a further analysis of the 30 studies that fulfilled the inclusion criteria, and divided them into four categories, according to the type of study design: (i) prospective studies with validated assessment tools and adjustment for previous mental illness; (ii) prospective studies with validated assessment tools and no adjustment for previous mental illness; (iii) retrospective studies reporting specific diagnoses; and (iv) retrospective studies reporting only the rates of first-time psychiatric contact.

Results

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. References

We retrieved 36 papers.[7-42] We excluded seven studies: two for absence of a control group,[26, 40] one because the control group was composed of women's partners,[25] one because it did not use a validated questionnaire,[22] one because it compared the consequences of medical and surgical abortion,[42] one because it was a re-elaboration of a previous paper to investigate the causes of the increase of depression in the abortion group,[19] and one because there was no statistical comparison between abortion and childbirth groups.[39]

We retained 30 studies for analysis. Of these, only two assessed adolescent women.[7, 41] Four studies assessed only a possible correlation between abortion and depression;[15, 31, 32, 35] 14, a correlation between abortion and depression along with other outcomes such as anxiety disorders or substance abuse disorders;[9, 12, 16-18, 20, 21, 23, 24, 27, 28, 30, 37, 41] three, a correlation between abortion and anxiety disorders alone;[8, 14, 38] and one, a correlation between abortion and loss of self-esteem alone.[7] Three papers used as outcomes the rates of psychiatric visit or psychiatric treatment taken from databases.[11, 29, 33] Three papers studied illicit drugs, alcohol and smoke use as the only outcome,[11, 13, 34] and in five cases they studied the correlation between abortion and both substance abuse disorder and depression.[12, 16, 17, 28, 30]

Twenty-eight of the studies that examined psychiatric symptoms used a validated scale, while three examined psychiatric diagnosis from the database from which the data on psychiatric help were collected;[10, 29, 33] and three studies on drug, alcohol or tobacco abuse were done using simple interviews or questionnaires to ascertain the use of these substances and did not investigate for substance abuse disorders.[11, 13, 34]

For a more detailed analysis, Table 1 lists studies according to major outcome (depression, anxiety disorder, substance addiction disorder etc.), and then according to the type of main control groups: common childbearing, miscarriage, and unintended childbearing. Twenty-three studies were prospective,[7-10, 16-18, 20, 21, 23, 24, 27, 30-39, 41] while seven were retrospective (Table 1).[11-15, 28, 29]

Table 1. Synthesis of the retrieved studies
First authorWomen's agePregnancy status compared in the study (no. cases)OutcomesOutcome assessment: time after pregnancyResultsStudy design
  1. †Studies in which abortion is compared with miscarriage. Bold, studies in which abortion is compared with UC. Study design: A, prospective studies with validated assessment tools and adjustment for previous mental illness; B, prospective studies with validated assessment tools and no adjustment for previous mental illness; C, retrospective studies reporting specific diagnoses; D, retrospective studies reporting only the rates of first-time psychiatric contact. A, abortion; C, childbirth; D, depression; FR, fetal reduction; M, miscarriage, N, never pregnant; PC, planned childbirth; Pr, pregnant for the first time; PrC, preterm childbirth; PreA, previous abortion; PreC, previous childbirth; PTSD, post-traumatic stress disorder; SAD, substance abuse disorder; SAR, substance abuse rate; SB, stillbirth; TC, term childbirth; UC, unplanned childbirth.

Main outcome: Depression
Gilchrist, 199520No limitsUC (6151), A (6410)Self-harm psychoses, D, anxietyVariable

Compared with UC, A had no more reported psychiatric disorders

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 A than after C, but rates of psychosis leading to hospital admission were similar.

In women with no previous history of psychiatric illness, deliberate self-harm was more common after A

A
Salvesen, 1997[37]No limitsA (29); M (24)D, anxiety disorder7 weeks, 5 months, 1 yearAnxiety and depression, close to the event are greater in the abortion group, but they are similar after 1 year.A
Broen, 2005[9]18–45A (80), M (40)Stress, quality of life, anxiety, D10 days, 6 months, 2 and 5 years after the eventCompared with the general population, A had significantly higher anxiety scores at all four interviews, while M had significantly higher anxiety scores only at 10-day interview. No significant differences in depression scores.A
Rees, 2007[35]No limitsA (99); M or CB (107); C (629); N (1732); P (146).D1 and 3 years after childbirth/abortionWomen who have an abortion are not at higher risk of depression than those who give birth. The positive association between abortion and depressive symptoms cannot be explained by pre-pregnancy depression.A
Kersting 2007[23]No limitsA (62), C (65)Complicated grief, PTSD, D, anxiety14 days, 6 months and 14 months after the abortion/deliveryCompared with C, A had significantly higher scores in all outcomes.A
Kersting, 2009[24]No limitsA (62), PrC (43), TC (65)D, anxiety and PTSD2 weeks, 6 months and 12 months after the birth/abortionCompared with TC, PrC had higher outcome scores, and A even higherA
McKinney, 1995[27]No limitsC (44), FR (44)D and other mental illnessesVariableCompared with C, in FR if only one fetus dies, outcomes are similar; if all fetuses die, outcomes are worse, both if the loss is voluntary or spontaneous.B
Reardon, 2002[32]14–24 (1st interview)UC (128), A (293)DVariableCompared with UC, A married women, were significantly more likely to be at high risk of clinical depression. The difference was not significant among unmarried women.C
Cougle, 2003[15]14–21 (1st interview)A (131–154); C (877–1197) (the range depends on the no. respondents for each item of the questionnaire).DVariable. Interviewed in 1992Compared with C, after A, greater depression was presentC
Pedersen, 2007[30]12–18 (1st interview)N: (461), C (183), A (76), C&A: (49)D, substance abuseIn 1992, and after 2, 7 and 13 years

Compared with N and C, A and C&A had elevated rates of substance use and D.

A women who lived with the father of the aborted fetus were not at increased risk.

C
Dingle, 2008[16]21N (943), C (97), A (101), M (82)Substance abuse, DVariableCompared with N and C, A and M had higher scores in all parameters than the other two groupsC
Fergusson, 2008[17]16–30 (1st interview)A (153), M (138), UC (52) PC (197)D, anxiety, suicide ideation, substance abuseVariableCompared with UC and PC, A and M have higher risks in all outcomes, with A having higher risk than MC
Pedersen, 2008[31]12–15 (1st interview).A (125), C (232)DVariableWomen who undergo an A in their 20s, had increased rates of depression at age 27.C
Coleman, 2009[12]15–54A (399), C (650)Panic disorder, panic attacks, PTSD, agoraphobia, mood, bipolar disorder, mania, D, and SADVariableCompared with C, A was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, D), and SADC
Mota, 2010[28]>18A (452) C (2839)D, anxiety panic attacks, PTSD, social phobia, SAD, suicidal ideation, eating disordersVariableCompared with C, all outcomes but eating disorders were higher in A.C
Warren, 2010[41]TeenagersC (220); A (69)D, self-esteem1 and 5 yearsAdolescents who have an abortion do not appear to be at elevated risk for D or low self-esteem in the short term or up to 5 years after the abortionC
Hamama, 2010[21]No limitsA (199), M (184) C (1176)D and PTSDDuring subsequent pregnancyCompared with C, A and M have higher depression and PTSD, only if fetal loss is lived as ‘hard times’.C
Main outcome: Anxiety disorders
Gilchrist, 1995[20]No limitsUC (6151), A (6410)Self-harm psychoses, D, anxiety disordersVariable

Compared with UC, A had no more reported psychiatric disorder.

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 A than after C, but rates of psychosis leading to hospital admission were similar.

In women with no previous history of psychiatric illness, deliberate self-harm was more common after A

A
Salvesen, 1997[37]No limitsA (29); M (24)D, anxiety disorder7 weeks, 5 months, 1 yearAnxiety and depression are greater in the abortion group, close to the event, but similar after 1 year.A
Broen 2004[8]18–45A (80), M (40)PTSD10 days, 6 months, and 2 years after the miscarriage or induced abortionCompared with M, A was followed by minor short-term PTSD. In the long term, PTSD was higher in the A group.A
Broen, 2005[9]18–45A (80), M (40)Stress, quality of life, anxiety disorders, depression10 days, 6 months, 2 and 5 years after the eventCompared with the general population, A women had significantly higher anxiety scores at all four interviews, while M women had higher anxiety scores only at 10-day interview.A
Kersting 2007[23]No limitsA (62), C(65)Complicated grief, D, anxiety disorders14 days, 6 months and 14 months after the abortion/deliveryCompared with C, A had significantly higher scores in all outcomesA
Kersting, 2009[24]No limitsA (62) PrC (43), TC (65)D, anxiety disorders2 weeks, 6 months and 12 months after the birth/abortionCompared with C, Pr had higher rates of the investigated outcomes, and A even higherA
Salvesen 1997[37]No limitsA(24), M (27)Anxiety disorders, PTSDJust after abortion/miscarriage, and after 4 weeks, 7 weeks and 1 year.Compared wit M, A was not followed by different outcomesB
Hamama, 2010[21]No limitsA(199), M (184), C (1176)D and PTSDDuring subsequent pregnancyCompared with C, A and M had higher D and PTSDB
Cougle 2005[14]15–44UC (1813); A (1033)Anxiety disordersVariableCompared with UC, A had significantly higher rates of subsequent generalized anxiety when controlling for race and age
Fergusson, 2008[17]16–30A (153), M (138), UC (52) PC (197)Depression, anxiety disorders, suicide ideation, SADVariableCompared with UC and PC, A and M had higher risks for all outcomes, with A having higher risk than M.C
Steinberg, 2008[38]15–44

(a) A (1244) UC (5470)

(b) A (273), C (1549)

Anxiety symptomsVariable

(a) Compared with UC, anxiety was greater in the abortion group, but the difference disappeared if anxiety previous to birth/abortion was considered as a confounding factor

(b) Compared with C, anxiety was not greater after A.

C
Mota, 2010[28]>18A (452), C (2839)D, anxiety disorders, panic attacks, PTSD, social phobia, SAD, suicidal ideation, eating disordersVariableCompared with C, A was followed by higher outcome rates, with the exception of eating disordersC
Main outcome: Substance abuse disorders
Coleman, 2002[11]15–44

From the National Pregnancy and Health Survey

(a) C with PreA (74), C with PreC (531)

(b) C with PreA (74) C with no previous pregnancies (664)

SARJust after childbirthCompared with PreC or Pr, A was followed by higher SAR rates.C
Reardon, 2004[34]14–21 (1st interview)UC (535), A (213), N (1144)SAR4 years after birth/abortion Interviews every 2 years since 1979 to 1984Compared with UC and N, A was followed by higher risk of presenting SARC
Coleman, 2005[13]No limitsC (1020). In previous pregnancies they had experienced M (404), A (426), and SB (401)SARJust after delivery/abortionCompared with previous M and SB, previous A was followed by greater risk of SAR in the present pregnancy.C
Pedersen, 2007[30]12–18 (1st interview)N (461), C (183), A (76), C&A (49)D, SADIn 1992, and after 2, 7 and 13 years

Compared with N and C, A and C&A had greater rates of SAD and D.

A women who lived with the father of the aborted fetus were not at increased risk.

C
Dingle, 2008[16]21N (943), C (97), A (101), M (82)SAD, DVariableCompared with N and C, A and M were followed by worse D and SADC
Fergusson, 2008[17]30A (153), M (138), UC (52) PC (197)D, anxiety disorder, suicidal ideation, SADVariableCompared with UC, M was followed by higher outcome scores for all outcomes, and A by even higher scoresC
Coleman, 2009[12]15–54A (399), C (2650)Panic disorder, panic attacks, PTSD, Agoraphobia, mood, bipolar disorder, mania, D, and SADVariableCompared with C, A was followed by higher outcome scoresC
Mota, 2010[28]>18A (452) C (2839)D, anxiety disorder, panic attacks, PTSD, social phobia, SAD, suicidal ideation, eating disordersVariableCompared with C, A was followed by higher outcome rates, with the exception of eating disordersC
Main outcome: Miscellaneous
Bailey, 2001[7]<18M (51), A (75), UC (176), PC (96)Self-esteemThe teens in prenatal care were interviewed four times: at their first prenatal visit (before discharge in the case of abortion), at approx. 35 weeks of gestation, at 45 days postpartum/abortion, and at 1 year postpartum/abortion.

A and UC and PC: increase in self-esteem after 1 year.

The level of self-esteem was far higher in girls who have given birth; its increase rate is faster in those who have aborted.

M: lower self-esteem than A after 1 year

B
Coleman, 2002[10]14–49A(14,297); C (40,122)Rates of 1st-time outpatient mental health treatmentAfter 180 days, 1 year, 2 years, 4 years from the eventCompared with C, A had 63% more claims within 90 days after the pregnancy; this difference decreased with time.C
Fergusson, 2009[18]16–30

(a) A (104) immediate reactions to A;

(b) A (532) long-term reactions to A

Feelings towards their abortion; anxiety disorderVariableAbortion was associated with high rates of both positive and negative emotional reactions; risks of subsequent mental health problems increased with the extent of the negative emotional reactions reported by the woman.C
Reardon, 2003[33] C (41 442), A (15 299)Rates of first-time psychiatric contact (also classified for D or psychoses)In the following 4 yearsCompared with C, A women had more first-time psychiatric admissionD
Munk-Olsen, 2011[29]No limitsA (84,620), C (280,930)Rates of first-time psychiatric contactWithin the 12 months after the abortion or childbirth as compared with the 9-month period before the event.Compared with C, A had a lower increase in first-time psychiatric contact. Personality difficulties increase after A, but not after C.D

In most studies, the group of women who had abortion was compared with women who had given birth, without considering the intention of being pregnant,[10-12, 15-17, 21, 23, 24, 27, 28, 30, 31, 35, 38] and in others with women who had miscarried[8, 9, 13, 16, 17, 21, 36] or who had had unintended pregnancies that had led to delivery.[14, 17, 20, 32, 34] Two studies compared women who had delivered a baby, with those with fetal reduction.[27, 40]

Abortion versus childbirth

Thirteen studies supported the presence of a risk of mental disorder (Table 1) in the groups of women who had had an abortion versus those who gave birth.[10-12, 15-17, 19, 23, 24, 28, 30, 31, 33] Only five papers showed no risk in the abortion group:[18, 21, 27, 35, 41] in particular if women do not consider their experience of fetal loss to be difficult,[21] or unless all fetuses die in a fetal reduction aimed to eliminate only one fetus,[27] but in the presence of negative emotional reactions, the subsequent negative effects of abortion on mental health were more frequent.[18] One study noted a lower increase in first psychiatric contact after abortion than after childbirth.[29] One study that evaluated self-esteem after abortion produced mixed findings.[7]

Abortion versus unplanned pregnancy

When comparing abortion and unplanned pregnancies that ended in delivery, four studies found a higher risk for loss of self-esteem, anxiety disorders, depression, suicide ideation, and substance abuse disorder or substance abuse rate in the abortion groups,[7, 14, 17, 34] and two no difference;[20, 38] in one case, results were indicative of a prevalence of depression in the case of abortion only in the case of married women.[32]

Abortion versus miscarriage

Three studies that compared abortion and miscarriage found greater risk of subsequent loss of self-esteem, substance abuse or depression, anxiety disorder, suicide ideation and – above all – substance abuse disorder after an abortion,[7, 13, 17] three found no differences,[16, 21, 37] while two noted apparently discordant results (short-term post-traumatic stress disorder [PTSD] and depression are higher in the miscarriage group, while long-term PTSD and depression are present only in the abortion group).[8, 9]

Classification of these results according to study design is given in Table 2; in particular, all studies on the relationship between drug abuse and abortion are retrospective, while those for the other possible consequences include both prospective and retrospective studies.

Table 2. Studies comparing mental consequences of abortion with other pregnancy outcomes
Comparison with:Results of the comparisons (1,x,2,†)
1 (n) [Study type]x (n) [Study type]2 (n) [Study type] (n) [Study type]
  1. 1, studies reporting a higher risk for mental illness in the case of abortion; x, studies reporting similar risk for mental illness in the case of another outcome (childbirth, unplanned childbirth or miscarriage); 2, studies reporting a higher risk for mental illness in the case of another outcome (childbirth, unplanned childbirth or miscarriage); †, studies reporting that some mental illness are more frequent for abortion and others for the other outcome (childbirth, unplanned childbirth or miscarriage). A, prospective studies with validated assessment tools and adjustment for previous mental illness; B, prospective studies with validated assessment tools and no adjustment for previous mental illness; C, retrospective studies reporting specific diagnoses; D, retrospective studies reporting only the rates of first-time psychiatric contact.

Childbirth(13) [2A, 10C, 1D ](5) [2A, 1B, 2C](1) [D](1) [B]
Unplanned childbirth(4) [1B, 3C ](2) [1A, 1C] (1) [C]
Miscarriage(3) [1B, 2C](4) [1B, 2C] (2) [A]

The rates of the single outcomes in the various groups of women should be outlined; in some studies rates are not available, and this makes this analysis difficult, but there is a general convergence of the data.

Clinical depression is present in 17% of women who give birth to a living baby and in 26% of those who abort.[15] Depression and bipolar disorder were present in 43.2% of women who miscarried, in 45.5% of those who had an abortion, in 28.7% of those who gave birth and in 25.1% of never pregnant women.[16] A minority of studies did not find a significant difference between abortion and live birth, but one gave only risk ratios;[20] only in the study on fetal reduction, did the authors give depression rates: 15% after fetal reduction and 15% in the control group who gave birth to a healthy baby,[27] but fetal reduction is a special type of abortion, because it is balanced by the birth of the surviving fetus. Women enrolled in that study, whose selective reduction provoked the death of all fetuses, had a depression rate of 75%, while those who aborted (control group) had a depression rate of 60%.

With regard to anxiety, one study showed that 10 days after the event, 47.5% of the women who had a miscarriage had high Impact of Event Scale scores, compared with 30% for women who had an induced abortion.[9] The corresponding values after 2 years were 2.6% and 18.1%, respectively. Another study that compared term childbirth and abortion found that after 14 months, relevant psychiatric diagnoses were present in 0% and in 16.7% of women, respectively.[23] Cougle et al. found clinical anxiety in 10.1% of unintended pregnancies, versus 13.7% in the abortion group (P < 0.005).[14]

Drug dependence

Dingle et al. reported that the rate of various dependences (including alcohol and nicotine) was 21–34% in the case of abortion, 17–31% in the case of miscarriage, and 6.3–26% in the case of childbirth.[16] These data agree with the other analyzed studies on dependence.

Discussion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. References

The studies analyzed here show that abortion is a risk factor for subsequent mental illness when compared with childbirth; data show that even when compared with the other two possible outcomes (miscarriage or the birth of an unplanned baby) the risk is greater or similar. Even miscarriage is a risk factor for subsequent mental illness, although the evidence for this risk has not been investigated so widely and seems lower than for abortion. Some consequences can be drawn.

The first is that fetal loss is traumatic. It is a risk factor for mental illness – both in the case of abortion and in miscarriage – and its impact on a woman's life can erroneously be underestimated. Most studies show that abortion has a greater impact on women's mental health than childbearing; all remaining studies show similar mental consequences and only one seems to have noted a worse outcome for childbearing. Even the birth of an unplanned child is often traumatic, but abortion seems to be even more traumatic, or similar with regard to the psychological outcomes; this should be taken into account when counseling women scared by a non-desired pregnancy. Making their choices, women should be clearly informed. It is true that health is more than ‘mental health’; nevertheless, mental health and the risks to it after an abortion cannot be disregarded, in counseling women.

These data show that a greater involvement of the national health system in clinical follow up of women who have had a fetal loss is desirable: miscarriage and elective abortion can have negative mental consequences and this should be taken into account, to follow up women who have had a fetal loss. In particular, elective abortion is one of the most common medical interventions in the world: 1.29 million were performed in the USA in 2008.[43] Thus it is important to monitor mothers who have undergone abortion, to prevent negative mental consequences: although the discussion in this field is limited to ethics and morality, we emphasize that there is also a serious public health problem. The discussion in this field does not currently trespass on the moral boundaries;[44, 45] now, it is important to consider the hypothesis that abortion is an independent risk factor for mental health, and carry out more research accordingly.

We encourage further research in this field. Only a few of the retrieved studies were prospective; ruled out confounding elements in data analysis; or used validated assessment tools. In contrast, most studies used data taken from big databases on female health, and this is a weak point of these studies, because confounding factors cannot be eliminated, because health assessment is performed at very different times from the event, and because causes of abortion are not explored.

The main restriction on the ability to arrive at a conclusion about the mental risks of abortion, is the scarcity and the heterogeneity of the studies. Different outcomes are studied (depression, anxiety disorders and substance abuse disorders, and several psychological symptoms), different scales or questionnaires have been used to measure them, and different age groups have been analyzed, making difficult any comparison and any conclusion, although a correlation between abortion and subsequent risks for mental health seems realistic.

Further research is needed in this field, and it necessitates large longitudinal, prospective studies assessing the numerous contextual variables and potential confounders associated with having an elective abortion, and mental health status. Future research is needed to shed light on the mechanisms linking abortion to various disorders and to decipher the characteristics of women most prone to developing a particular mental health problem.

Acknowledgment

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. References

The authors declare that they have no conflicts of interest.

References

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. References