Do abortions cause depression?
According to research recently published in JAMA Psychiatry, having an abortion does not increase a woman’s risk for depression. While the study found that women who have abortions are more likely to use antidepressants than women who do not have abortions, the research found that taking the drugs was likely attributable to differences in risk factors for depression rather than the abortion itself.
The study analyzed data on all Danish women born between 1980 and 1994. Women who had an antidepressant prescribed before the study period began and women who had a childbirth before age 18 were excluded. A total of 396,397 women were included. Of these participants, 17294 (4.4%) had a record of at least 1 first-trimester abortion and no children, 72052 (18.2%) had at least 1 childbirth and no abortion, 13540 (3.4%) had at least 1 abortion and 1 childbirth, and 293,511 (74.1%) had neither an abortion nor a childbirth. Of the total participant group, 59465 (15.0%) women redeemed at least 1 antidepressant prescription. Of the total number of women who had an abortion, 5705 (18.5%) initiated antidepressant use after a first abortion. Among the 85592 women who gave birth, 10825 (12.7%) initiated antidepressant use after a first childbirth.
The researchers used statistical analyses and survival analyses to further examine the data. Statistical analysis was used to more closely examine the incidence rates (IRs) of first-time antidepressant users in the year before and year after an abortion or childbirth. Using survival analyses, they looked at the risk of redeeming antidepressant medication associated with a first abortion vs. no abortion and a first childbirth vs. no childbirth. Relative to the 365,563 women who had no abortion (IR, 22.5, 95% CI, 22.3-22.7), in women who had an abortion, the rate of redeeming antidepressant prescriptions was higher in the year before (IR, 45.7; 95% CI, 43.3-48.3), the year after (IR, 49.6; 95% CI, 47.1-52.3), more than 1-5 years after (IR 40.5; 95% CI, 39.1-42.0) and more than 5 years after (IR, 36.5; 95% CI, 34.6-38.5) the procedure. Relative to the 310,805 women who had no childbirth (IR, 22.6%, 95% CI 22.4-22.8), in women who gave birth, the unadjusted rate of redeeming antidepressant prescriptions was lower during the year before having a child (IR, 11.1; 95% CI 10.3-11.9), similar during the year after (IR, 22.1; 95% CI 10.3-11.9), and it increased with more time after 1 year from childbirth ( > 1 to 5 years after childbirth: IR, 36.0; 95% CI, 35.1-36.9; > 5 years after childbirth: IR, 49.7; 95% CI, 47.8-51.6).
In survival analyses, the researchers found that, compared to women with no childbirth, women who gave birth had a lower risk of first-time antidepressant use in the year before childbirth (basic model: IRR, 0.52; 95% CI, 0.49-0.56; fully adjusted model: IRR, 0.47; 95%CI, 0.43-0.50) and they had a slightly higher risk in the basic adjusted model (IRR, 1.06; 95% CI, 1.01-1.12). However, this group had a lower risk in the fully adjusted model in the year after childbirth (IRR,0.93; 95% CI, 0.88-0.98). Childbirth increased women’s likelihood of using antidepressants following 1 year after childbirth (for > 1 to 5 years, basic model: IRR, 1.82; 95% CI, 1.77-1.87; for >1 to 5 years, fully adjusted model: IRR, 1.52; 95%CI, 1.47-1.56; for >5 years, basic model: IRR, 2.81; 95% CI, 2.68-2.94; and for > 5 years, fully adjusted model: IRR, 1.99; 95% CI, 1.91-2.09). Across all women in the sample (N = 396,397), the strongest risk factors associated with antidepressant use in the fully adjusted model were having a previous psychiatric contact (IRR, 3.70; 95% CI, 3.62-3.78), having previously obtained an antianxiety medication (IRR, 3.03; 95% CI, 2.99-3.10), and having previously obtained antipsychotic medication (IRR, 1.88; 95% CI, 1.81-1.96).
The researchers also looked at first- time antidepressant use in the year before and the year following an abortion and following childbirth. They found that rates of antidepressant use were stable during the year before and year after an abortion with a decrease immediately preceding and just after the procedure. Antidepressant sue was lower during pregnancy than it was just before pregnancy or after childbirth. Compared with the eleventh and twelfth month before an abortion, there was less likelihood of first-time antidepressant use in the month before and month after an abortion and no other significant difference in likelihood of use during the other 24 observed months.
The researchers believe that while their findings illustrate an increased use of antidepressants among women who had an abortion compared to women who did not have one, the data suggest that the increased rate had less to do with the abortion and more to do with other risk factors for depression. They point to the findings that increased risk of depression did not change from the year before an abortion to the year after as proof. They also consider the finding that depression risk decreased as more time elapsed following the abortion as additional proof.
The authors note a few limitations to the study. Because their study was based on existing research, they did not have access beyond the month and year of childbirth due to confidentiality policies and had to examine IRs and incidence rate ratios in 2-month increments. They also point out that they did not have access to the reason for the antidepressant prescriptions. While more research is necessary to learn if these results can be generalized to other contexts, i.e. where access to abortion is legally restricted or access to antidepressants is limited, they believe the initial results suggest that policies based on the notion that abortion harms women’s mental health may be misinformed.