The Psychological Effects of First Trimester Abortion

Citation: Major, B., Cozzarelli, C., Cooper, M. C., Zubek, J., Richards, C., Wilhite, M., & Gramzow, R. H. (2000). Psychological responses of women after first-trimester abortion. Archives of General Psychiatry, 57, 777-784.

Introduction: Clinical case studies of women who seek counseling or therapy after abortion are cited by antichoice proponents as evidence for the existence of a post-abortion syndrome characterized by severe stress and depression. In contrast, studies using sound research designs and random samples of women receiving abortions show few short-term negative psychological effects. This study's objectives were to examine mental health outcomes and appraisal of the abortion 2 years post-abortion, examine changes over time in outcomes, and identify predictors of outcome.

Methods: Women receiving a first-trimester abortion at one of 3 sites were asked to participate in a longitudinal study. Of eligible women, 85% agreed to participate and half (50%) of those initially enrolled in the study were followed for 2 years. These 442 women were assessed 4 times: 1 hour before the abortion and 1 hour, 1month and 2 years after the abortion. The women completed questionnaires measuring depression (the Brief Symptom Inventory) and self esteem (a short version of the Rosenberg Self-Esteem Inventory) both before and after the abortion. After the abortion they were also questioned about current mood, history of depression (an adapted version of the Diagnostic Interview Schedule), post-traumatic stress disorder (PTSD, using an adapted version of a PTSD interview designed for Vietnam War veterans), satisfaction with their abortion decision and appraisal of post-abortion harm. Data were analyzed using analysis of variance, correlation and multiple regression.

Results: At 2 year follow-up 70-75% of the women were satisfied with the abortion, would decide to have the abortion again and attributed more positive than negative outcomes to it. Eighty percent were not depressed; 1% (6 women) evidenced PTSD. Self-esteem increased and depression declined post-abortion. Negative emotions increased and satisfaction with the abortion decision decreased over time. The women in this study (mean age, 24; range, 14-40) were no more likely to show clinical depression and less likely to evidence PTSD than national samples of women of similar ages in the U.S. Precursors of negative psychological outcomes at 2 years included history of clinical depression, younger age and greater numbers of children preabortion.

Evaluation: Consistent with previous research, this study provides strong support for the minimal adverse psychological effects of abortion. Its use of standardized instruments and a 2-year follow up period overcomes limitations of many previous studies. Equally valuable is its investigation of risk factors for negative psychological outcomes. This research does not show that prior psychological problems are made worse by abortion, but rather that these prior problems do not disappear. The predictive value of history of depression and the considerable percentage of women (16%) who were dissatisfied with their decision 2 years after abortion suggest the need for better preabortion screening and counseling. Although the 50% attrition is of concern, the authors painstakingly show that women lost to follow-up did not differ on demographic or psychological characteristics from those who completed the study. Other limitations, noted by the authors, include under-representation of Hispanic women and failure to compare psychological risk of abortion to that of alternatives. Nevertheless, this study significantly advances research on the long-term psychological effects of abortion.