Abortion and anxiety: What's the relationship?

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Abstract

Using data from the United States National Survey of Family Growth (NSFG) and the National Comorbidity Survey (NCS), we conducted secondary data analyses to examine the relationship of abortion, including multiple abortions, to anxiety after first pregnancy outcome in two studies. First, when analyzing the NSFG, we found that pre-pregnancy anxiety symptoms, rape history, age at first pregnancy outcome (abortion vs. delivery), race, marital status, income, education, subsequent abortions, and subsequent deliveries accounted for a significant association initially found between first pregnancy outcome and experiencing subsequent anxiety symptoms. We then tested the relationship of abortion to clinically diagnosed generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social anxiety disorder, using NCS data. Contrary to findings from our analyses of the NSFG, in the NCS analyses we did not find a significant relationship between first pregnancy outcome and subsequent rates of GAD, social anxiety, or PTSD. However, multiple abortions were found to be associated with much higher rates of PTSD and social anxiety; this relationship was largely explained by pre-pregnancy mental health disorders and their association with higher rates of violence. Researchers and clinicians need to learn more about the relations of violence exposure, mental health, and pregnancy outcome to avoid attributing poor mental health solely to pregnancy outcomes.

Section snippets

Abortion and anxiety

Several studies have examined the relationship between abortion and anxiety in samples of patients (for a review see Bradshaw & Slade, 2003) as well as non-patients (Cougle et al., 2005, Fergusson et al., 2006). Although some women do experience post-abortion anxiety, the prevalence of post-abortion anxiety is low, and generally lower than that found pre-abortion. For instance, Lowenstein et al. (2006) found that women's anxiety significantly declined after having an abortion. In a review of

Violence, unintended pregnancy, and anxiety

A substantial body of research has established that the rates of violence in the lives of women who have unintended pregnancies – whether or not those pregnancies end in abortion – are higher than rates for other women (Campbell, Pugh, Campbell, & Visscher 1995; Coker, 2007, Dietz et al., 2000, Fisher et al., 2005, Gazmararian et al., 1995, Gazmararian et al., 2000, Gissler et al., 2004, Glander et al., 1998, Goodwin et al., 2000, Pallitto et al., 2005, Russo and Denious, 1998, Russo and

Violence and specific anxiety disorders

Previous studies of post-abortion mental health outcomes have not separately and specifically assessed clinically diagnosed anxiety disorders (Cougle et al., 2005, Major et al., 2000, Russo and Denious, 2001). Thus, we test whether abortion leads to clinically diagnosed anxiety disorders. Based on previous research and theory regarding the causes of specific anxiety disorders (e.g., fear of public embarrassment – social anxiety; violence – PTSD), we tested whether first pregnancy outcome was

The case of multiple abortions

Most sexually active women are at risk for having an unintended pregnancy, with the risk for more than one such pregnancies increasing over her lifetime. However, researchers have found that the more severe the adversity in childhood, the greater the likelihood of unintended pregnancy (Dietz et al., 2000, Roosa et al., 1997). Further, there is evidence that a history of childhood physical or sexual abuse is associated with repeat abortion, which is an indicator of repeated unintended pregnancy (

Research goals and approach

Our primary goal was to examine the relation of anxiety after first pregnancy outcome (abortion vs. delivery) controlling for pre-pregnancy anxiety, violence exposure, and other relevant covariates. Further, in investigating the relations of pre-pregnancy anxiety, violence, and abortion to post-pregnancy anxiety, we examined whether these relations differed with type of anxiety disorder. We also examined the interrelations among having repeat abortions, violence exposure, and anxiety disorders

Study 1: the National Survey of Family Growth (NSFG)

Study 1 involved two sets of analyses for two different samples of women. The first sample consisted of women who had unintended first pregnancies ending in abortion or delivery of a live birth, and they provide a basis for comparison with findings from Cougle et al. (2005) as well as other studies that examined the relation of unintended first pregnancy outcome to mental health variables (e.g., Reardon and Cougle, 2002, Schmiege and Russo, 2005). The second sample consisted of all women who

Study 2: the National Comorbidity Survey (NCS)

In some ways, the NCS is a more appropriate data set than the NSFG for investigating questions about the relation of pregnancy outcome to mental health. First, in contrast to the NSFG, in the NCS the variables constructed are more closely and accurately based on psychiatric diagnoses of clinical disorders (i.e., the DSM-III-R). Second, in the NCS, variables are constructed for several anxiety diagnoses based on the DSM-III-R, allowing separate analyses for generalized anxiety disorder (GAD or

General discussion

In both the NSFG and the NCS, two samples that are representative of the United States, we found that women who have abortions on their first pregnancy are more likely to experience violence in their lives, congruent with other research finding an association between violence and abortion (e.g., Coker, 2007, Garcia-Moreno et al., 2005, Russo and Denious, 2001). The results also provide additional documentation of the association between violence exposure and anxiety outcomes in the lives of

Conclusion

The body of findings reported here suggests that the associations between abortion and anxiety reported previously in the literature (Cougle et al., 2005, Fergusson et al., 2006) may be explained by the fact that in previous research the outcome variable was not a specific clinical anxiety diagnosis, pre-pregnancy anxiety was not controlled, or that women who have unintended pregnancies have higher rates of violence exposure in their lives than women who have intended pregnancies. More

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