摘要：Objectives. We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion. Methods. We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility’s gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals. Results. The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits. Conclusions. Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term. There has been much interest in understanding the effects of abortion, one of the most commonly performed surgical procedures, 1,2 on women’s mental health outcomes. Leading reviews on this topic have found no evidence of mental health harm from an abortion, 3–6 with the exception of 1 review 7 which has been critically refuted. 5,8–11 These reviews have called for more research of women seeking abortion beyond the first trimester, longitudinal studies, studies that control for preexisting mental health conditions, and studies that compare women who have had an abortion to women who want an abortion but are unable to get one. 3–5 Most of the few longitudinal studies available have been conducted outside of the United States. A Danish population-based cohort study assessed the onset of a first psychiatric event before and up to 12 months after a first-trimester abortion and found no increased risk of mental disorders after abortion. 12 A Norwegian study followed 120 women for 5 years and compared the psychological response of women who had first-trimester abortions to women who had miscarriages, 13 finding no differences in depression or anxiety between the 2 groups. 13 Fergusson et al. published a series of articles based on a longitudinal study conducted in New Zealand that suggested that abortion is associated with an increased risk of mental health problems. 14,15 These studies, however, have a number of shortcomings that have been discussed elsewhere and may not be generalizable to the US setting. 4 One of the few longitudinal US studies is a secondary analysis of the National Comorbidity Survey that compared the mental health outcomes of women who obtained abortions to women who gave birth. 16 In this study, the predictive effect of abortion on mental health conditions disappeared when analyses controlled for mental health history. 16 In this article, we report on the first 3 years of a 5-year longitudinal study, the Turnaway Study, which was specifically designed to examine the psychological consequences of undergoing or being denied an abortion in the United States. Previous findings from the Turnaway Study have demonstrated that most women seeking abortions for financial-, timing-, or partner-related reasons 17 commonly express feelings of relief after the abortion and feel that abortion was the right decision. 18 The mental health symptom trajectories of women who sought an abortion differed little from those who were denied one; however, both improved over time. 19 Our previous analysis 19 assessed self-reported mental health symptoms at 5 discrete points in time over 2 years (potentially missing symptoms of anxiety and depression that may have occurred in between interview dates or after 2 years), and it did not assess women’s severity of symptoms or other circumstances that may have led to a clinical diagnosis of depression or anxiety. This study further contributes to the literature by assessing diagnoses of new depression and anxiety disorders that may have occurred in women at any point up to 3 years after having sought an abortion.
