Miscarriage and abortion are both stressful events, but a study from Norway suggests that abortion may be associated with more long-term psychological distress.
Researchers interviewed 40 women who had miscarriages and 80 women who had abortions and followed them for five years.
Women who had miscarriages suffered more anxiety and depression immediately after the event and six months later. But abortion was associated with more stress and anxiety two years -- and even five years -- after the event.
“The women who had miscarriages were often psychologically traumatized for several months,” researcher Anne Nordal Broen, MD, tells WebMD. “Nightmares and flashbacks were not uncommon, but within half a year most of these mental responses were over and they were managing well.”
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Guilt, Shame Greater
Women who had abortions had fewer problems early on, and Broen says their long-term issues did not approach the level of trauma. But these women were also twice as likely to feel guilt about the event five years later and 60 percent more likely to feel shame, as measured by psychological testing.
At five years, both groups had few intrusive thoughts about the event. But the women who had abortions were seven times as likely to report that they actively avoided thinking about it.
When compared with the general population, women who had abortions had higher anxiety scores at all measured time points -- from 10 days after the pregnancy termination to five years later. Women who had miscarriages had higher than normal anxiety scores at only one of the measured time points -- 10 days after their pregnancy ended.
The findings are published in the December issue of the journal BMC Medicine.
Broen says it is not clear from the study if having an abortion contributed to the higher anxiety scores or if the women who had abortions were more anxious to begin with.
“These women may have had poorer psychiatric health, which would make them more vulnerable,” she says. “But it may also be that they didn’t allow themselves to think about the event and deal with it, and that this contributed to their distress.”
The researchers write that only about half of the women who were asked to be included in the study agreed to participate. There were also notable differences between the two groups of women regarding marital status, number of existing children, and employment, all of which could contribute to the their findings.
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Debate Over Abortion Stress
The debate over the emotional impact of abortion is a contentious one, with pro-choice and anti-abortion advocates not surprisingly having very different views of the issue.
Some people contend that a form of posttraumatic stress is common among women who have had elective abortions. But neither the American Psychological Association nor the American Psychiatric Association officially recognizes such a syndrome.
University of California, San Francisco psychiatry professor Nancy Adler, PhD, conducted some of the first studies on the psychological impact of abortion. She says it would be impossible to do a study that definitively answered the question.
“You would have to assign women with unwanted pregnancies to either have an abortion or give birth, and that would never happen,” she tells WebMD.
“There is no denying that the experience of unwanted pregnancy is very stressful for most women, and so is the decision about what to do about it. But we are not seeing evidence of long-term trauma at the clinical level.”
Yale University psychiatry professor Kimberly Yonkers, MD, agrees. She points out that both groups in the study showed improvements over time in most measures of psychological stress. She also expressed concerns about the study’s small sample size but said one of the study’s strengths was that it followed the women for so long.
“I don’t think it is much of a surprise that there was residual guilt and shame following the voluntary termination of a pregnancy,” she says. “This is not the kind of thing that someone does and never thinks about again. But I don’t believe in postabortion syndrome because I haven’t seen it. And I don’t think these data show it in any way, shape or form.”
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By Salynn Boyles, reviewed by Louise Chang, MD
SOURCES: Broen, A.N. BMC Medicine, Dec. 12, 2005; vol 3; online edition. Anne Nordal Broen, MD, University of Oslo, Oslo, Norway. Nancy Adler, PhD, professor and vice chairwoman, psychiatry, University of California, San Francisco. Kimberly Yonkers, MD, associate professor, department of psychiatry, Yale School of Medicine, New Haven, Conn.
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