Psychological Responses of Women After First-Trimester Abortion | Depressive Disorders | JAMA Psychiatry | JAMA Network
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Not Available, Roe v Wade, 410 US 113(1973);
Henshaw  SK Characteristics of US women having abortions, 1982-1983. Henshaw  SKVan Vort  Jeds Abortion Services in the United States, Each State and Metropolitan Area 1984-1985; New York, NY Alan Guttmacher Institute1987;Google Scholar
Henshaw  SKKoonin  LMSmith  JC Characteristics of US women having abortions, 1987.  Fam Plann Perspect. 1991;2375- 81Google ScholarCrossref
Tietze  CForrest  JDHenshaw  SK United States of America. Sachdev  Ped International Handbook on Abortion Westport, Conn Greenwood Press1988;474- 483Google Scholar
Wilmoth  GHdeAlteriis  MBussell  D Prevalence of psychological risks following legal abortion in the US: limits of the evidence.  J Soc Issues. 1992;4837- 66Google ScholarCrossref
Not Available, Surgeon General's Report: The Public Health Effects of Abortion, 101st Cong, 1st Sess (1989) (testimony of C. E. Koop).
Blumenthal  SJ Psychiatric consequences of abortion: overview. Stotland  NLed Psychiatric Aspects of Abortion Washington, DC American Psychiatric Press Inc1991;17- 38Google Scholar
Speckhard  ARue  VM Postabortion syndrome: an emerging public health concern.  J Soc Issues. 1992;4895- 120Google ScholarCrossref
Speckhard  A Psycho-Social Stress Following Abortion.  Kansas City, Mo Sheed & Ward1987;
Rue  VSpeckhard  ARogers  JFranz  W The Psychological Aftermath of Abortion: A White Paper.  Washington, DC US Dept of Health and Human Services1987;
Reardon  DC Aborted Women: Silent No More.  Chicago, Ill Loyola University Press1987;
Adler  NEDavid  HPMajor  BNRoth  SHRusso  NFWyatt  GE Psychological responses after abortion.  Science. 1990;24841- 43Google ScholarCrossref
Adler  NEDavid  HPMajor  BNRoth  SHRusso  NFWyatt  GE Psychological factors in abortion: a review.  Am Psychol. 1992;471194- 1204Google ScholarCrossref
Dagg  PK The psychological sequelae of therapeutic abortion—denied and completed.  Am J Psychiatry. 1991;148578- 585Google Scholar
Zolese  GBlacker  CV The psychological complications of therapeutic abortion.  Br J Psychiatry. 1992;160742- 749Google ScholarCrossref
Shusterman  L Predicting the psychological consequences of abortion.  Soc Sci Med [Med Psychol Med Sociol]. 1979;13A683- 689Google ScholarCrossref
Koop  CE A measured response: Koop on abortion.  Fam Plann Perspect. 1989;2131- 32Google ScholarCrossref
Adler  N Emotional responses of women following therapeutic abortion.  Am J Orthopsychiatry. 1975;45446- 454Google ScholarCrossref
Major  BMueller  PHildebrandt  K Attributions, expectations, and coping with abortion.  J Pers Soc Psychol. 1985;48585- 599Google ScholarCrossref
Mueller  PMajor  B Self-blame, self-efficacy, and adjustment to abortion.  J Pers Soc Psychol. 1989;571059- 1068Google ScholarCrossref
Zabin  LSHirsch  MBEmerson  MR When urban adolescents choose abortion: effects on education, psychological status, and subsequent pregnancy.  Fam Plann Perspect. 1989;21248- 255Google ScholarCrossref
Tietze  CHenshaw  SK Induced Abortion: A World Review: 1986. 6th ed. New York, NY Alan Guttmacher Institute1986;
Henshaw  SKKost  K Abortion patients in 1994-1995: characteristics and contraceptive use.  Fam Plann Perspect. 1996;28140- 147Google ScholarCrossref
Derogatis  LRMelisaratos  N The Brief Symptom Inventory: an introductory report.  Psychol Med. 1983;13595- 605Google ScholarCrossref
Robins  LNHelzer  JECroughan  JRatcliff  KS National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity.  Arch Gen Psychiatry. 1981;38381- 389Google ScholarCrossref
Rosenberg  M Society and the Adolescent Self-Image.  Princeton, NJ Princeton University Press1965;
Taylor  SEBrown  JD Illusion and well-being: a social psychological perspective on mental health.  Psychol Bull. 1988;103193- 210Google ScholarCrossref
Cozzarelli  C Personality and self-efficacy as predictors of coping with abortion.  J Pers Soc Psychol. 1993;651224- 1236Google ScholarCrossref
Watson  CGJuba  MPManifold  VKucala  TAnderson  PED The PTSD interview: rationale, description, reliability, and concurrent validity of a DSM-III-based technique.  J Clin Psychol. 1991;47179- 188Google ScholarCrossref
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.  Washington, DC American Psychiatric Association1987;
Russo  NFZierk  KL Abortion, childbearing, and women's well-being.  Professional Psychol Res Pract. 1992;23269- 280Google ScholarCrossref
Gilchrist  ACHannaford  PCFrank  PKay  CR Termination of pregnancy and psychiatric morbidity.  Br J Psychiatry. 1995;167243- 248Google ScholarCrossref
Athanasiou  ROppel  WMichaelson  LUnger  TYager  M Psychiatric sequelae to term birth and induced early and late abortion: a longitudinal study.  Fam Plann Perspect. 1973;5227- 231Google ScholarCrossref
Freeman  EWRickels  K Early Childbearing: Perspectives of Black Adolescents on Pregnancy, Abortion, and Contraception.  Newbury Park, Calif Sage Publications1993;
David  HPRasmussen  NKHolst  E Postpartum and postabortion psychotic reactions.  Fam Plann Perspect. 1981;1388- 92Google ScholarCrossref
Blazer  DGKessler  RCMcGonagle  KASwartz  MS The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey.  Am J Psychiatry. 1994;151979- 986Google Scholar
Kessler  RCSonnega  ABromet  EHughes  MNelson  CB Post-traumatic stress disorder in the National Comorbidity Survey.  Arch Gen Psychiatry. 1995;521048- 1060Google ScholarCrossref
Major  BCozzarelli  C Psychosocial predictors of adjustment to abortion.  J Soc Issues. 1992;48121- 142Google ScholarCrossref
Major  BZubek  JCooper  MLCozzarelli  CRichards  C Mixed messages: social conflict and social support for adjustment to abortion.  J Pers Soc Psychol. 1997;721349- 1363Google ScholarCrossref
Major  BRichards  CCooper  MLCozzarelli  CZubek  J Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion.  J Pers Soc Psychol. 1998;74735- 752Google ScholarCrossref
Cozzarelli  CSumer  NMajor  B Mental models of attachment and coping with abortion.  J Pers Soc Psychol. 1998;74453- 467Google ScholarCrossref
Major  BCozzarelli  CSciacchitano  AMCooper  MLTesta  MMueller  PM Perceived social support, self-efficacy, and adjustment to abortion.  J Pers Soc Psychol. 1990;59452- 463Google ScholarCrossref
Cozzarelli  CMajor  B The psychological effects of anti-abortion picketing on women who seek abortions. Beckman  LJHarvey  SMeds Abortion in the United States: Psychological, Social, and Political Issues. Washington, DC American Psychological Association1998;81- 104Google Scholar
Cozzarelli  CMajor  B The effects of anti-abortion demonstrators and pro-choice escorts on women's psychological responses to abortion.  J Soc Clin Psychol. 1994;13404- 427Google ScholarCrossref
Major  BGramzow  RH Abortion as stigma: cognitive and emotional implications of concealment.  J Pers Soc Psychol. 1999;77735- 745Google ScholarCrossref
Sobol  MPDaly  KJ The adoption alternative for pregnant adolescents: decision making, consequences, and policy implications.  J Soc Issues. 1992;48143- 161Google ScholarCrossref
Lydon  JDunkel-Schetter  CCohan  CLPierce  T Pregnancy decision making as a significant life event: a commitment approach.  J Pers Soc Psychol. 1996;71141- 151Google ScholarCrossref
Original Article
August 2000

Psychological Responses of Women After First-Trimester Abortion

Author Affiliations

From the Department of Psychology, University of California, Santa Barbara (Drs Major, Richards, and Wilhite), Kansas State University, Manhattan (Dr Cozzarelli), and University of Missouri, Columbia (Dr Cooper) Department of Organization and Human Resources, School of Management, State University of New York at Buffalo (Dr Zubek); and the Department of Psychology, University of Southampton, Southampton, England (Dr Gramzow).

Arch Gen Psychiatry. 2000;57(8):777-784. doi:10.1001/archpsyc.57.8.777

Background  Controversy exists over psychological risks associated with abortion. The objectives of this study were to examine women's emotions, evaluations, and mental health after an abortion, as well as changes over time in these responses and their predictors.

Methods  Women arriving at 1 of 3 sites for an abortion of a first-trimester unintended pregnancy were randomly approached to participate in a longitudinal study with 4 assessments—1 hour before the abortion, and 1 hour, 1 month, and 2 years after the abortion. Eight hundred eighty-two (85%) of 1043 eligible women approached agreed; 442 (50%) of 882 were followed for 2 years. Preabortion and postabortion depression and self-esteem, postabortion emotions, decision satisfaction, perceived harm and benefit, and posttraumatic stress disorder were assessed. Demographic variables and prior mental health were examined as predictors of postabortion psychological responses.

Results  Two years postabortion, 301 (72%) of 418 women were satisfied with their decision; 306 (69%) of 441 said they would have the abortion again; 315 (72%) of 440 reported more benefit than harm from their abortion; and 308 (80%) of 386 were not depressed. Six (1%) of 442 reported posttraumatic stress disorder. Depression decreased and self-esteem increased from preabortion to postabortion, but negative emotions increased and decision satisfaction decreased over time. Prepregnancy history of depression was a risk factor for depression, lower self-esteem, and more negative abortion-specific outcomes 2 years postabortion. Younger age and having more children preabortion also predicted more negative abortion evaluations.

Conclusions  Most women do not experience psychological problems or regret their abortion 2 years postabortion, but some do. Those who do tend to be women with a prior history of depression.