Examining the Association of Antidepressant Prescriptions With First Abortion and First Childbirth | Depressive Disorders | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.206.238.77. Please contact the publisher to request reinstatement.
1.
Major  B, Appelbaum  M, Beckman  L, Dutton  MA, Russo  NF, West  C.  Abortion and mental health: evaluating the evidence.  Am Psychol. 2009;64(9):863-890.PubMedGoogle ScholarCrossref
2.
National Collaborating Centre for Mental Health.  Induced abortion and Mental Health: a Systematic Review of the Mental Health Outcomes of induced Abortion, Including Their Prevalence and Associated Factors. London, UK: Academy of Medical Royal Colleges; 2011.
3.
Munk-Olsen  T, Laursen  TM, Pedersen  CB, Lidegaard  Ø, Mortensen  PB.  Induced first-trimester abortion and risk of mental disorder.  N Engl J Med. 2011;364(4):332-339.PubMedGoogle ScholarCrossref
4.
Munk-Olsen  T, Laursen  TM, Pedersen  CB, Lidegaard  Ø, Mortensen  PB.  First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder.  Arch Gen Psychiatry. 2012;69(2):159-165.PubMedGoogle ScholarCrossref
5.
Steinberg  JR, McCulloch  CE, Adler  NE.  Abortion and mental health: findings from the National Comorbidity Survey-Replication.  Obstet Gynecol. 2014;123(2, pt 1):263-270.PubMedGoogle ScholarCrossref
6.
Biggs  MA, Upadhyay  UD, McCulloch  CE, Foster  DG.  Women’s mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study.  JAMA Psychiatry. 2017;74(2):169-178.PubMedGoogle ScholarCrossref
7.
Coleman  PK.  Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009.  Br J Psychiatry. 2011;199(3):180-186.PubMedGoogle ScholarCrossref
8.
Jones  RK, Kost  K.  Underreporting of induced and spontaneous abortion in the United States.  Stud Fam Plann. 2007;38(3):187-197.PubMedGoogle ScholarCrossref
9.
Cannell  CF, Marquis  KH, Laurent  A.  A summary of studies of interviewing methodology.  Vital Health Stat 2. 1977;69(69):i-viii, 1-78.PubMedGoogle Scholar
10.
Wong  J, Motulsky  A, Eguale  T, Buckeridge  DL, Abrahamowicz  M, Tamblyn  R.  Treatment indications for antidepressants prescribed in primary care in Quebec, Canada, 2006-2015.  JAMA. 2016;315(20):2230-2232.PubMedGoogle ScholarCrossref
11.
Steinberg  JR, Finer  LB.  Examining the association of abortion history and current mental health.  Soc Sci Med. 2011;72(1):72-82.PubMedGoogle ScholarCrossref
12.
Noordam  R, Aarts  N, Verhamme  KM, Sturkenboom  MCM, Stricker  BH, Visser  LE.  Prescription and indication trends of antidepressant drugs in the Netherlands between 1996 and 2012.  Eur J Clin Pharmacol. 2015;71(3):369-375.PubMedGoogle ScholarCrossref
13.
Kildemoes  HW, Sørensen  HT, Hallas  J.  The Danish National Prescription Registry.  Scand J Public Health. 2011;39(7)(suppl):38-41.PubMedGoogle ScholarCrossref
14.
Schmidt  M, Schmidt  SA, Sandegaard  JL, Ehrenstein  V, Pedersen  L, Sørensen  HT.  The Danish National Patient Registry: a review of content, data quality, and research potential.  Clin Epidemiol. 2015;7:449-490.PubMedGoogle ScholarCrossref
15.
 Legalt Provokerede Aborter 2005 (oreløbig opgørelse). Copenhagen, Denmark: Sundhedsstyrelsen; 2006:1-10.
16.
Pedersen  CB.  The Danish Civil Registration System.  Scand J Public Health. 2011;39(7)(suppl):22-25.PubMedGoogle ScholarCrossref
17.
Jerman  J, Jones  RK, Onda  T.  Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008. New York, NY: Guttmacher Institute; 2016. https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014.
18.
Moussavi  S, Chatterji  S, Verdes  E, Tandon  A, Patel  V, Ustun  B.  Depression, chronic diseases, and decrements in health: results from the World Health Surveys.  Lancet. 2007;370(9590):851-858.PubMedGoogle ScholarCrossref
19.
Timmermans  B. The Danish Integrated Database for Labor Market Research: towards demystification for the English speaking audience. DRUID Working Paper No. 10-16. 2010.https://www.researchgate.net/publication/46451548_The_Danish_Integrated_Database_for_Labor_Market_Research_Towards_Demystification_for_the_English_Speaking_Audience.
20.
Mors  O, Perto  GP, Mortensen  PB.  The Danish Psychiatric Central Research Register.  Scand J Public Health. 2011;39(7)(suppl):54-57.PubMedGoogle ScholarCrossref
21.
Charlson  ME, Pompei  P, Ales  KL, MacKenzie  CR.  A new method of classifying prognostic comorbidity in longitudinal studies.  J Chronic Dis. 1987;40(5):373-383.PubMedGoogle ScholarCrossref
22.
Thygesen  SK, Christiansen  CF, Christensen  S, Lash  TL, Sørensen  HT.  The predictive value of ICD-10 diagnostic coding used to assess Charlson Comorbidity Index conditions in the population-based Danish National Registry of Patients.  BMC Med Res Methodol. 2011;11:83-88.PubMedGoogle ScholarCrossref
23.
Fergusson  DM, Horwood  LJ, Boden  JM.  Abortion and mental health disorders: evidence from a 30-year longitudinal study.  Br J Psychiatry. 2008;193(6):444-451.PubMedGoogle ScholarCrossref
24.
Speckhard  AC, Rue  VM.  Postabortion syndrome: an emerging public health concern.  J Soc Issues. 1992;48(3):95-119. doi:10.1111/j.1540-4560.1992.tb00899.xGoogle ScholarCrossref
25.
van Ditzhuijzen  J, Ten Have  M, de Graaf  R, Lugtig  P, van Nijnatten  CHCJ, Vollebergh  WAM.  Incidence and recurrence of common mental disorders after abortion.  J Psychiatr Res. 2017;84:200-206.PubMedGoogle ScholarCrossref
26.
Jones  RK, Frohwirth  L, Moore  AM.  More than poverty: disruptive events among women having abortions in the USA.  J Fam Plann Reprod Health Care. 2013;39(1):36-43.PubMedGoogle ScholarCrossref
27.
Hall  KS, Kusunoki  Y, Gatny  H, Barber  J.  The risk of unintended pregnancy among young women with mental health symptoms.  Soc Sci Med. 2014;100:62-71.PubMedGoogle ScholarCrossref
28.
Munk-Olsen  T, Gasse  C, Laursen  TM.  Prevalence of antidepressant use and contacts with psychiatrists and psychologists in pregnant and postpartum women.  Acta Psychiatr Scand. 2012;125(4):318-324.PubMedGoogle ScholarCrossref
29.
Munk-Olsen  T, Maegbaek  ML, Johannsen  BM,  et al.  Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence.  Transl Psychiatry. 2016;6(10):e919.PubMedGoogle ScholarCrossref
Original Investigation
August 2018

Examining the Association of Antidepressant Prescriptions With First Abortion and First Childbirth

Author Affiliations
  • 1Department of Family Science, University of Maryland, College Park
  • 2Centre for Integrated Register-Based Research (CIRRAU), National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
  • 3Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
  • 4National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
  • 5Department of Psychiatry, University of California, San Francisco
JAMA Psychiatry. 2018;75(8):828-834. doi:10.1001/jamapsychiatry.2018.0849
Key Points

Question  Is first-trimester first abortion associated with an increase in women’s risk of first-time antidepressant use?

Findings  In this cohort study of 396 397 women born in Denmark between January 1, 1980, and December 31, 1994, women who had a first abortion had a higher risk of first-time antidepressant use compared with women who did not have an abortion. However, for women who had a first abortion, the risk was the same in the year before and the year after the abortion and decreased as time from the abortion increased.

Meaning  Having a first abortion is not associated with an increase in a woman’s risk of first-time antidepressant use.

Abstract

Importance  The repercussions of abortion for mental health have been used to justify state policies that limit access to abortion in the United States. Much earlier research has relied on self-report of abortion or mental health conditions or on convenience samples. This study uses data that rely on neither.

Objective  To examine whether first-trimester first abortion or first childbirth is associated with an increase in women’s initiation of a first-time prescription for an antidepressant.

Design, Setting, and Participants  This study linked data and identified a cohort of women from Danish population registries who were born in Denmark between January 1, 1980, and December 30, 1994. Overall, 396 397 women were included in this study; of these women, 30 834 had a first-trimester first abortion and 85 592 had a first childbirth.

Main Outcomes and Measure  First-time antidepressant prescription redemptions were determined and used as indication of an episode of depression or anxiety, and incident rate ratios (IRRs) were calculated comparing women who had an abortion vs women who did not have an abortion and women who had a childbirth vs women who did not have a childbirth.

Results  Of 396 397 women whose data were analyzed, 17 294 (4.4%) had a record of at least 1 first-trimester abortion and no children, 72 052 (18.2%) had at least 1 childbirth and no abortions, 13 540 (3.4%) had at least 1 abortion and 1 childbirth, and 293 511 (74.1%) had neither an abortion nor a childbirth. A total of 59 465 (15.0%) had a record of first antidepressant use. In the basic and fully adjusted models, relative to women who had not had an abortion, women who had a first abortion had a higher risk of first-time antidepressant use. However, the fully adjusted IRRs that compared women who had an abortion with women who did not have an abortion were not statistically different in the year before the abortion (IRR, 1.46; 95% CI, 1.38-1.54) and the year after the abortion (IRR, 1.54; 95% CI, 1.45-1.62) (P = .10) and decreased as time from the abortion increased (1-5 years: IRR, 1.24; 95% CI, 1.19-1.29; >5 years: IRR, 1.12; 95% CI, 1.05-1.18). The fully adjusted IRRs that compared women who gave birth with women who did not give birth were lower in the year before childbirth (IRR, 0.47; 95% CI, 0.43-0.50) compared with the year after childbirth (IRR, 0.93; 95% CI, 0.88-0.98) (P < .001) and increased as time from the childbirth increased (1-5 years: IRR, 1.52; 95% CI, 1.47-1.56; >5 years: IRR, 1.99; 95% CI, 1.91-2.09). Across all women in the sample, the strongest risk factors associated with antidepressant use in the fully adjusted model were having a previous psychiatric contact (IRR, 3.70; 95% CI, 3.62-3.78), having previously obtained an antianxiety medication (IRR, 3.03; 95% CI, 2.99-3.10), and having previously obtained antipsychotic medication (IRR, 1.88; 95% CI, 1.81-1.96).

Conclusions and Relevance  Women who have abortions are more likely to use antidepressants compared with women who do not have abortions. However, additional aforementioned findings from this study support the conclusion that increased use of antidepressants is not attributable to having had an abortion but to differences in risk factors for depression. Thus, policies based on the notion that abortion harms women's mental health may be misinformed.

×