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Comment & Response
June 2017

Mental Health Outcomes After Having or Being Denied an Abortion—Reply

Author Affiliations
  • 1Advancing New Standards in Reproductive Health, University of California–San Francisco
JAMA Psychiatry. 2017;74(6):654. doi:10.1001/jamapsychiatry.2017.0800

In Reply We thank Curley and Thornton as well as Erdek for their comments on our article.1 Curley and Thornton accurately argue that pregnancy decision making and wantedness is influenced by an array of psychosocial factors (eg, material resources and social support). They also stress the importance of following up the women who must continue their pregnancy. However, the purpose of our article1 was not to identify factors associated with change in pregnancy wantedness over time, but rather to assess the effects of having and being denied an abortion on women’s psychological well-being. Acknowledging that psychosocial factors could confound the relationship between the abortion experience and psychological outcomes, we controlled for many of the factors they mentioned. We also agree that some women who dropped out of the study “may have experienced a stress response associated with the abortion.” A series of sensitivity analyses to test for bias demonstrated that women with a history of mental health problems—considered at highest risk of experiencing future mental health issues—were not more likely to be lost to follow-up, nor was there differential loss to follow-up by study group through 4.5 years, mitigating concerns of bias.

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