Papal adviser finds holes in new study on abortion and mental health

Rome, Italy, Jan 29, 2011 / 14:08 pm

A new study concluding that women who have abortions are not at risk for later psychological problems used questionable methodology, comments Dr. Carlo Bellieni, a member of the Pontifical Academy for Life.

The New England Journal of Medicine on Jan. 27 published the study, “Induced First-Trimester Abortion and Risk of Mental Disorder.” The study was compiled by Danish researchers.

It concludes that the possibility of a woman visiting a psychiatrist for the first time before or after having an abortion is nearly equal, while a woman who gives birth is far more likely to seek first-time psychiatric help.

Bellieni, an Italian neonatal doctor who monitors research on bioethical issues, told CNA Jan. 28 that the conclusions of this latest study are misleading.

He criticized the researchers’ methods, saying that “psychiatric first-contact” does not necessarily mean that all women were diagnosed as having a confirmed psychiatric problem.

Regarding sample selection, he noted the authors’ report that the girls and women in the study population, as well as their parents, were classified as having a mental disorder “if they had records of inpatient or outpatient contact at psychiatric facilities in Denmark for any mental disorder.”

According to Bellieni, researchers should have studied only women “who made first-time contact with a mental health professional and received a diagnoses.”

“Going to the psychiatrist doesn't mean they have a mental disorder,” he said. “You can go to the psychiatrist for a million things. Clearly you can have doubts, states of anxiety, sadness, you might not be happy, but that doesn't mean a person has a mental illness.”

For this new study, researchers used medical records of 365,500 Danish women between the years 1995 to 2007. Of these women, 84,620 aborted their pregnancies and 280,930 gave birth. Researchers compared the numbers of those making first-time visits to mental health professionals in the year after their abortion or live birth with those who had sought help up to nine months prior.

The rates of those seeking care following an abortion were no different than in the period preceding the abortion, according to Trine Munk-Olsen and her associates at the National Center for Register-Based Research at Aarhus University, Denmark.

The paper also shows that one percent of women sought help for possible mental disorders in the nine months before the abortion, while 1.5 percent did so in the 12 months that followed.

On the other hand, 0.3 percent of women who gave live birth visited a psychiatrist for the first time in the nine months before birth compared to an average of 0.7 percent in the year that followed. More detailed analysis showed a sharp spike of “risk of first contact” with psychiatrists from these women in the time just after the baby was born.

Using these numbers researchers reported that women show no greater risk of psychological disorders after an abortion while women who give birth do.

“The risk of a psychiatric contact did not differ significantly before and after abortion, but the risk after childbirth was significantly greater than the risk before childbirth,” the study announced.

Dr. Bellieni said these conclusions seem to contradict some of the results of the study. In his view, the study's authors should have discussed the one-and-a-half times increase in the number of first psychiatric visits among women who had abortions.

He also pointed out that while the study discloses the difference in levels of first contact between the two groups, it does not highlight and discuss the reasons women who abort seek psychiatric help at more than two times the rate of the women who give live birth.

It also does not account for women who “hid” their abortions and did not seek help, he added.

There is a stigma to seeking psychiatric help following an abortion in countries where the procedure is legal, noted the doctor.

“You have no right to complain about sickness after an abortion, they say, because it is a 'right' and a 'normal thing,’” he said. “So to say that you are sick after an abortion is heresy in a Western country."

The study does acknowledge the possibility that women who had had abortions and not sought help may have been underestimated in its results.

In addition, while studying “first-time” contact with mental health professionals, researchers excluded those women who may have had prior contact or on-going mental health care.

Bellieni said these categories of women should have been included in the study’s sample population. The authors themselves recognize this limit to their study.

While the results tout the near-equal “risk of psychiatric contact” in women who seek help before and after the abortion, he said that there are more interesting patterns for study in the data.

Women who had abortions, for example, sought help at nearly the same rate for the entire 21 months included in the study, including the six-month period before their pregnancy.

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The study was based on the premise that abortions were carried out within the first 12 weeks of pregnancy.

“I can understand that women who will seek abortions go [to a psychiatrist] when they learn they are pregnant, but it is obscure why they begin going in the few months before they knew,” Bellieni continued.

“It is unusual that healthy women, who had no previously recorded psychiatric visits, might seek help before the occurrence of the ‘traumatic event’ - in this case learning of a pregnancy.

“The authors should have explained this point,” Bellieni said.

There are other aspects that merit further examination in this regard, according to the doctor.

It is important to highlight that the rate of women who gave birth and sought “first contact” with mental health professionals, while spiking in the month after birth, decreased by at least one-half in the two months that followed.

Bellieni explained the numbers: “We all know that after a childbirth there is a depression. It is very common: post-partum depression. It is clear — but it ceases, it decreases with time while depression after abortion may not.”

He cited a 2005 paper published by the journal BMC Medicine that studied psychological responses of women who had miscarriages and those who had abortions up to five years after the event. It found that women how had miscarried responded with higher “anxiety scores” in the first six months, while women who aborted demonstrated prolonged psychological ailments.

Bellieni noted that researchers for the just-published Danish study also did not explore another particularly noteworthy finding in their study.

Women who sought first-time psychiatric help following an abortion were 1.5 times more likely to be diagnosed for possible personality and behavior disorders than in the year prior to having the abortion, he said.

While the just-published Danish study has gained high visibility for being published in the prestigious New England Journal of Medicine, Bellieni said, “it deserves more careful discussion.”

“We have to consider it with respect, of course. But together with the respect we also have to make our critiques,” he added.