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Psychiatric or Psychological Hospitalization or Consultation
Induced abortion and implications for long-term mental health: a cohort study of 1.2 million pregnancies. Auger N, Healy-Profitós J, Ayoub A, Lewin A, Low N. J Psychiatr Res. 2025 Jul;187:304-310. doi: 10.1016/j.jpsychires.2025.05.031. Epub 2025 May 16. PMID: 40408979.
Background: The relationship between induced abortion and long-term mental health is not clear. We assessed whether having an induced abortion was associated with an increase in the long-term risk of mental health hospitalization.
Methods: We carried out a retrospective cohort study of 28,721 induced abortions and 1,228,807 births in hospitals of Quebec, Canada, between 2006 and 2022. The exposure was induced abortion compared with other pregnancies, and the outcome was hospitalization for a psychiatric disorder, substance use disorder, or suicide attempt over time. We followed patients up to 17 years after the end of pregnancy to identify mental health-related hospitalizations. We calculated hazard ratios (HR) and 95 % confidence intervals (CI) for the association between induced abortion and mental health hospitalization, adjusted for pregnancy characteristics.
Results: Rates of mental health-related hospitalization were higher following induced abortions than other pregnancies (104.0 vs. 42.0 per 10,000 person-years). Abortion was associated with hospitalization for psychiatric disorders (HR 1.81, 95 % CI 1.72-1.90), substance use disorders (HR 2.57, 95 % CI 2.41-2.75), and suicide attempts (HR 2.16, 95 % CI 1.91-2.43) compared with other pregnancies. The associations were greater for patients who had preexisting mental illness or were aged less than 25 years at the time of the abortion. Abortion was strongly associated with mental health hospitalization within five years but risks waned over time.
Conclusion: Induced abortion is associated with an increased risk of mental health-related hospitalization in the long term but the association weakens with time.
Note: The supplementary Table S2, compared to live birth, the suicide attempts were twice as likely after an abortion (HR=2.16 95% CI 1.92-2.43)
Association between abortion and mental health hospitalization, excluding stillbirths from the comparison group. Adjusted hazard ratio (HR) and adjusted population attributable risk (PAR).
| Rate per 10,000 person-years | Adjusted HR | Adj PAR | ||
| (95% CI) | (95% CI)a | |||
| Abortion | Live birth | |||
| Any mental health admission | 104.0 (100.2-108.0) | 41.8 (41.5-42.2) | 1.92 (1.83-2.01) | 2.02% |
| Psychiatric disorder | 85.1 (81.7-88.7) | 37.0 (36.6-37.3) | 1.81 (1.73-1.91) | 1.81% |
| Bipolar | 8.7 (7.7-9.9) | 4.3 (4.2-4.5) | 1.45 (1.25-1.68) | 1.01% |
| Depression | 24.7 (22.9-26.6) | 12.1 (11.9-12.3) | 1.65 (1.51-1.80) | 1.43% |
| Anxiety and stress | 54.8 (52.1-57.7) | 23.8 (23.6-24.1) | 1.81 (1.70-1.92) | 1.81% |
| Eating | 2.4 (1.9-3.1) | 0.7 (0.7-0.8) | 2.25 (1.67-3.04) | 2.78% |
| Psychosis | 9.2 (8.1-10.4) | 3.1 (3.0-3.2) | 2.06 (1.78-2.39) | 2.38% |
| Personality | 33.0 (30.9-35.3) | 9.7 (9.5-9.9) | 2.26 (2.08-2.45) | 2.78% |
| Substance use disorder | 56.7 (53.9-59.6) | 14.9 (14.7-15.1) | 2.58 (2.42-2.76) | 3.47% |
| Alcohol | 27.8 (25.9-29.8) | 7.4 (7.2-7.6) | 2.50 (2.28-2.74) | 3.30% |
| Opioids | 6.0 (5.1-7.0) | 1.2 (1.1-1.3) | 3.26 (2.69-3.95) | 4.89% |
| Cannabis | 17.7 (16.2-19.3) | 4.3 (4.2-4.4) | 2.58 (2.30-2.89) | 3.47% |
| Cocaine | 13.6 (12.3-15.1) | 2.5 (2.4-2.5) | 3.47 (3.02-3.98) | 5.31% |
| Stimulant | 15.7 (14.3-17.3) | 3.5 (3.4-3.6) | 2.78 (2.45-3.15) | 3.89% |
| Hallucinogen | 0.8 (0.5-1.2) | 0.1 (0.1-0.1) | 5.19 (2.78-9.67) | 8.66% |
| Sedative | 10.5 (9.3-11.8) | 2.5 (2.4-2.6) | 2.86 (2.46-3.31) | 4.05% |
| Other illicit substance | 0.5 (0.3-0.9) | 0.1 (0.1-0.1) | 5.37 (2.57-11.23) | 9.11% |
| Suicide attempt | 14.7 (13.3-16.2) | 4.4 (4.3-4.5) | 2.16 (1.92-2.43) | 2.58% |
aHazard ratio for abortion vs live birth, adjusted for age, comorbidity, preexisting mental illness, material deprivation, rural residence, and time period
A Reanalysis of Mental Disorders Risk Following First-Trimester Abortions in Denmark. Reardon DC. Issues Law Med. 2024 Spring;39(1):66-75. PMID: 38771715.
Background: A previous Danish study of monthly and tri-monthly rates of first-time psychiatric contact following first induced abortions reported higher rates compared to first live births but similar rates compared to nine months pre-abortion. Therefore, the researchers concluded abortion has no independent effect on mental health; any differences between psychiatric contacts after abortion and delivery are entirely attributable to pre-existing mental health differences. However, these conclusions are inconsistent with similar studies that used longer time frames. Reanalysis of the published Danish data over slightly longer time frames may reconcile this discordance.
Method: Monthly and tri-monthly data was extracted for reanalysis of cumulative effects over nine- and twelvemonths post-abortion.
Results: Across all psychiatric diagnoses, cumulative average monthly rate of first-time psychiatric contact increased from an odds ratio of 1.12 (95% CI: 1.02 to 1.22) at 9-months to 1.49 (95% CI: 1.37 to 1.63) at 12 months post-abortion as compared to the 9 months pre-abortion rate. At 12 months post-abortion, first-time psychiatric contact was higher across all four diagnostic groupings and highest for personality or behavioral disorders (OR=1.87; 95% CI:1.48 to 2.36) and neurotic, stress related, or somatoform disorders (OR=1.60; 95% CI: 1.41 to 1.81).
Conclusions: Our reanalysis revealed that the Danish data is consistent with the larger body of both record-based and survey- based studies when viewed over periods of observation of at least nine months. Longer periods of observation are necessary to capture both anniversary reactions and the exhaustion of coping mechanisms which may delay observation of post-abortion effects.
Medication and procedural abortions before 13 weeks gestation and risk of psychiatric disorders. Am J Obstet Gynecol. Steinberg JR, Laursen TM, Lidegaard Ø, Munk-Olsen T. 2024 Oct;231(4):437.e1-437.e18. doi: 10.1016/j.ajog.2024.05.025. Epub 2024 May 20. PMID: 38777160.
Background: The proportion of abortions provided by medication in the United States and worldwide has increased greatly since the U.S. Food and Drug Administration approved mifepristone in 2000. While existing research has shown that abortion does not increase risk of mental health problems, no population-based study has examined specifically whether a procedural or medication abortion increases risk of mental health disorders.
Objective: This study examined whether mental health disorders increased in the shorter and longer-term after a medication or procedural abortion.
Study design: Using Danish population registers' data, we conducted a prospective cohort study in which we included 72,424 females born in Denmark between 1980 and 2006, who were ages 12 to 38 during the study period and had a first first-trimester abortion before 13 weeks gestation in 2000 to 2018. Females with no previous psychiatric diagnoses were followed from 1 year before their abortion until their first psychiatric diagnosis, December 31, 2018, emigration from Demark, or death, whichever came first. Risk of any first psychiatric disorder was defined as a recorded psychiatric diagnosis at an in- or out-patient facility from the 1 year after to more than 5 years after a medication or procedural abortion relative to the year beforehand. Results were adjusted for calendar year, age, gestational age, partner status, prior mental and physical health, childbirth history, childhood environment, and parental mental health history.
Results: Females having medication (n=37,155) and procedural abortions (n=35,269) had the same risk of any first psychiatric diagnosis in the year after their abortion relative to the year before their abortion (medication abortion adjusted incidence rate ratio [MaIRR]=1.02, 95% confidence interval [CI]: 0.93-1.12; procedural abortion adjusted incidence rate ratio [PaIRR]=0.94, 95% CI: 0.86-1.02). Moreover, as more time from the abortion passed, the risk of a psychiatric diagnoses decreased relative to the year before their abortion for each abortion method (MaIRR 1-2 years after=0.89, 95% CI: 0.80-0.98; PaIRR 1-2 years after=0.81, 95% CI: 0.88-1.05; MaIRR 2-5 years after=0.77, 95% CI: 0.71-0.84; PaIRR 2-5 years after=0.72, 95% CI: 0.67-0.78; MaIRR 5+ years after=0.58, 95% CI: 0.53-0.63; PaIRR 5+ years after=0.54, 95% CI: 0.50-0.58).
Conclusion: Because the risk of psychiatric diagnoses was the same in the year after relative to the year before a medication and procedural abortion and the risk did not increase as more time after the abortion increased, neither abortion method increased risk of mental health disorders in the shorter or longer-term.
Note: Most notably, the authors of this study chose not to provide any comparison to first psychiatric diagnosis rates of the general population, or women without a history of abortion who had natural pregnancy losses or caried a first pregnancy to term.
Induced First-Trimester Abortion and Risk of Mental Disorder. Trine Munk-Olsen, Ph.D., Thomas Munk Laursen, Ph.D., Carsten B. Pedersen, Dr.Med.Sc., Øjvind Lidegaard, Dr.Med.Sc., and Preben Bo Mortensen, Dr.Med.Sc. N Engl J Med 2011;364:332-9.
- Background:Concern has been expressed about potential harm to women’s mental health in association with having an induced abortion, but it remains unclear whether induced abortion is associated with an increased risk of subsequent psychiatric problems.
- Methods:We conducted a population-based cohort study that involved linking information from the Danish Civil Registration system to the Danish Psychiatric Central Register and the Danish National Register of Patients. The information consisted of data for girls and women with no record of mental disorders during the 1995–2007 period who had a first-trimester induced abortion or a first childbirth during that period. We estimated the rates of first-time psychiatric contact (an inpatient admission or outpatient visit) for any type of mental disorder within the 12 months after the abortion or childbirth as compared with the 9-month period preceding the event.
- Results: The incidence rates of first psychiatric contact per 1000 person-years among girls and women who had a first abortion were 14.6 (95% confidence interval [CI], 13.7 to 15.6) before abortion and 15.2 (95% CI, 14.4 to 16.1) after abortion. The corresponding rates among girls and women who had a first childbirth were 3.9 (95% CI, 3.7 to 4.2) before delivery and 6.7 (95% CI, 6.4 to 7.0) post partum. The relative risk of a psychiatric contact did not differ significantly after abortion as compared with before abortion (P = 0.19) but did increase after childbirth as compared with before childbirth (P<0.001).
- Conclusions: The finding that the incidence rate of psychiatric contact was similar before and after a first-trimester abortion does not support the hypothesis that there is an increased risk of mental disorders after a first-trimester induced abortion.
- Editor's Note: Please see the extended review of this study for a more detailed discussion of the methodological limitations which slanting of the study design.
Psychiatric admissions of low income women following abortion and childbirth. Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Can Med Assoc J. 2003; 168(10):1253-7
- Background: Controversy exists about whether abortion or childbirth is associated with greater psychological risks. We compared psychiatric admission rates of women in time periods from 90 days to 4 years after either abortion or childbirth.
- Methods: We used California Medicaid (Medi-Cal) records of women aged 13–49 years at the time of either abortion or childbirth during 1989. Only women who had no psychiatric admissions or pregnancy events during the year before the target pregnancy event were included (n = 56 741). Psychiatric admissions were examined using logistic regression analyses, controlling for age and months of eligibility for Medi-Cal services.
- Results: Overall, women who had had an abortion had a significantly higher relative risk of psychiatric admission compared with women who had delivered for every time period examined. Significant differences by major diagnostic categories were found for adjustment reactions (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1–4.1), single-episode (OR 1.9, 95% CI 1.3–2.9) and recurrent depressive psychosis (OR 2.1, 95% CI 1.3–3.5), and bipolar disorder (OR 3.0, 95% CI 1.5–6.0). Significant differences were also observed when the results were stratified by age.
- Interpretation: Subsequent psychiatric admissions are more common among low-income women who have an induced abortion than among those who carry a pregnancy to term, both in the short and longer term.
NOTES:
- Tables showing when the psychiatric hospitalization occurred illustrate a marked peak closer to the time of the pregnancy event, providing support for a causal interpretation.
- Using the same population, the authors also examined outpatient treatment for psychiatric disorders and also found higher rates of outpatient treatment following abortion. See next entry below
- The abortion group had 160% more total in-patient mental health claims than the birth group. Percentages equaled 120%, 90%, 110%, 60%, and 50% for the first 180 days, one year, two years, three years, and four years respectively.
- Across the four years, the abortion group had 70% more in-patient mental health claims than the birth group. Percentages equaled 90%, 110%, and 200% for depressive psychosis, single episode, depressive psychosis, recurrent episode, and bipolar disorder, respectfully
State-funded abortions vs. deliveries: A comparison of outpatient mental health claims over five years. Coleman PK, Reardon DC, Rue VM, Cougle JR. American Journal of Orthopsychiatry, 2002; 72(1):141–52.
- (Abstract) In this record-based study, rates of 1st-time outpatient mental health treatment for 4 years following an abortion or a birth among women (aged 13-49 yrs) receiving medical assistance through the state of California were compared. After controlling for preexisting psychological difficulties, age, months of eligibility, and the number of pregnancies, the rate of care was 17% higher for the abortion group (n = 14,297) in comparison with the birth group (n = 40,122). Within 90 days after the pregnancy, the abortion group had 63% more claims than the birth group, with the percentages equaling 42%, 30%, and 16% for 180 days, 1 year, and 2 years, respectively. Additional comparisons between the abortion and birth groups were conducted on the basis of claims for specific types of disorders and age.
Report of the Committee on the Abortion Law, RF Badgley et al, (Ottawa:Supply and Services, 1977) pp. 313-321
- A Saskatchewan, Canada study found that postabortion women had "mental disorders" 40.8% more often than postpartum women. An Alberta, Canada study found that among women who had abortions, 24% made visits to psychiatrists compared to 3% in the general population.
'[http://www.scribd.com/doc/132704966/Virginia-DMAS-analysis-of-health-claims-following-abortion-and-childbirth Virginia DMAS analysis of health claims following abortion and childbirth. Nelson J. Department of Medical Assistance Services. Richmond, VA. March 21, 1997. Reply to request by Delegate Bob Marshall.
- This was an exploratory investigation by the Virginia Department of Medical Assistance Services (DMAS) to compare health claims of women who aborted and women who had normal births. The study examined medicaid claims paid by DMAS over a three year period for 122 women who had a first live birth and 122 women with a first abortion.
- In this study population, women who had abortions had statistically significant 62% percent increase in subsequent mental health claims (43% higher costs), and a 12% increase in claims (53% higher costs) for treatments resulting from accidents. They were 275% more likely to undergo a subsequent clinical psychiatric evaluation and 206% more likely to receive individual medical psychotherapy, and were 720% more likely to receive pharmacologic management in association with minimal psychotherapy.
"Health Services Utilization After Induced Abortion in Ontario: A Comparison Between Community Clinics and Hospitals," T Ostbye et al, Am J Medical Quality 16(3):99-106, 2001
- In Canada, a study of Ontario Health Insurance Plan claims in 1995 found that women who were three months postabortion from hospital day surgery had a rate of hospitalization for psychiatric problems of 5.2 per 1000 vs. 1.1 per 1000 for age matched controls without induced abortions. Three month postabortion women who had abortions at a community clinic had a rate of hospitalization for psychiatric problems of 1.9 per 1000 vs. 0.60 per 1000 for age-matched controls who did not have induced abortions. The incidence of postabortion psychiatric hospitalization was significantly higher if there had been preabortion hospitalization for psychiatric problems, preabortion emergency room consultation, or preabortion hospital admissions. Ed. Note: Flaws in the available data and study design limit the value of this study.
"Postabortion or Postpartum Psychotic Reactions," H David et al, Family Planning Perspectives 13(2): 892, 1981
- A Danish register linkage study over a three month period found that the rate of psychiatric hospital admissions was 18.4 per 10,000 postabortion women, 12.0 pr 10,000 postpartum women, and 7.5 per 10,000 women of childbearing age generally.
"Risk of Admission to Psychiatric Institutions among Danish Women Who Experienced Induced Abortion: An Analysis Based on A National Record Linkage," Ronald Somers, Dissertation Abstracts Int'l, Public Health 2621-B, 1979
- The age-adjusted incidence of psychiatric hospitalization was 3.42%, 4.06%, and 6.0% for women with one, two, and three induced abortions respectively compared with 2.56%, 1.97% and 2.15% for women with one, two and three live births respectively. The age- adjusted percentage of psychiatric hospitalization for aborting women was 1.49% for married women, 2.38%for single women, 4.21% for separated women, and 5.16% for divorced women. Aborting women under 30 years of age exhibited higher overall and diagnosis specific psychiatric hospital admission rates than women of this age in general. Teenagers who had abortions had 2.9 times the rate of psychiatric hospital admissions compared to teenage women in general. The highest rate of psychiatric hospital admissions was 9.45% among women age 35-39 with more than one abortion during the study period.
"State-funded abortions vs. deliveries: A comparison of subsequent mental health claims over 6 years," PK Coleman and D Reardon, Poster session presented at the American Psychological Society 12th Annual Convention, Miami, FL, June, 2000
- In a study of California women who received state funded medical care and who either had an abortion or gave birth in 1989, postabortion women were more than twice as likely to have from two to nine treatments for mental health as women who carried to term.
"Psychosocial Characteristics of Psychiatric Inpatients with Reproductive Losses," T Thomas et al, Journal of Health Care for the Poor and Underserved 7(1):15, 1996
- Postabortion women were more likely to require psychiatric hospitalization, have been subjected to sexual abuse, and be diagnosed for psychoactive substance abuse disorder compared to childless women.
"Past Trauma and Present Functioning of Patients Attending a Women's Psychiatric Clinic," EFM Borins and PJ Forsythe, Am J Psychiatry 142(4):460, 1985
- In a Canadian study of women attending a hospital based women's psychiatric clinic, a past abortion correlated significantly with three or more trauma factors.
Proceedings of the Conference on Psycho-Social Factors in Transnational Planning, W Pasini and J Kellerhals, (Washington D.C.: American Institute for Research, 1970) p.44
- A three fold increase in previous psychiatric consultations was found in women seeking repeat abortions compared to maternity patients.
Family planning needs and STD risk behaviours of female psychiatric out-patients. J H Coverdale , S H Turbott , H Roberts The British Journal of Psychiatry Jul 1997, 171 (1) 69-72; DOI: 10.1192/bjp.171.1.69
- METHOD Sixty-six female out-patients with major psychiatric disorders, including schizophrenia, bipolar disorder and mood disorders, completed a semi-structured interview (response rate = 63%) and were individually matched for age and ethnicity with 66 women who had never been treated for psychiatric illness. They answered questions on child-rearing and on their methods of contraception in relation to their attitudes towards pregnancy, as well as on their risk for STDs.
- RESULTS Compared with controls, the female patients reported having had significantly more induced abortions. 17 patients (39.5%) and 8 controls (13.8%) had had one or more induced abortions (p 0.01).