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Abortion and subsequent depressive symptoms: an analysis of the National Longitudinal Study of Adolescent Health

  • A. M. Gomez (a1)

Twenty states currently require that women seeking abortion be counseled on possible psychological responses, with six states stressing negative responses. The majority of research finds that women whose unwanted pregnancies end in abortion do not subsequently have adverse mental health outcomes; scant research examines this relationship for young women.


Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed. Population-averaged lagged logistic and linear regression models were employed to test the relationship between pregnancy resolution outcome and subsequent depressive symptoms, adjusting for prior depressive symptoms, history of traumatic experiences, and sociodemographic covariates. Depressive symptoms were measured using a nine-item version of the Center for Epidemiologic Studies Depression scale. Analyses were conducted among two subsamples of women whose unwanted first pregnancies were resolved in either abortion or live birth: (1) 856 women with an unwanted first pregnancy between Waves 2 and 3; and (2) 438 women with an unwanted first pregnancy between Waves 3 and 4 (unweighted n’s).


In unadjusted and adjusted linear and logistic regression analyses for both subsamples, there was no association between having an abortion after an unwanted first pregnancy and subsequent depressive symptoms. In fully adjusted models, the most recent measure of prior depressive symptoms was consistently associated with subsequent depressive symptoms.


In a nationally representative, longitudinal dataset, there was no evidence that young women who had abortions were at increased risk of subsequent depressive symptoms compared with those who give birth after an unwanted first pregnancy.

Corresponding author
Address for correspondence: A. M. Gomez, Ph.D., Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, 120 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA. (Email:
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Arnett JJ (2000). Emerging adulthood: a theory of development from the late teens through the twenties. American Psychologist 55, 469480.
Arnett JJ, Žukauskienė R, Sugimura K (2014). The new life stage of emerging adulthood at ages 18–29 years: implications for mental health. Lancet Psychiatry 1, 569576.
Biggs M, Upadhyay UD, Mcculloch CE, Foster DG (2017). Women's mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study. JAMA Psychiatry 74, 169178.
Biggs MA, Rowland B, Mcculloch CE, Foster DG (2016). Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study. BMJ Open 6, e009698.
Chantala K, Tabor J (2010). National Longitudinal Study of Adolescent Health: Strategies to Perform a Design-Based Analysis Using the Add Health Data. Carolina Population Center, University of North Carolina at Chapel Hill: Chapel Hill, NC.
Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders 82, 217225.
Charles VE, Polis CB, Sridhara SK, Blum RW (2008). Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception 78, 436450.
Cockrill K, Upadhyay UD, Turan J, Foster DG (2013). The stigma of having an abortion: development of a scale and characteristics of women experiencing abortion stigma. Perspectives on Sexual and Reproductive Health 45, 7988.
Coleman PK (2006). Resolution of unwanted pregnancy during adolescence through abortion versus childbirth: individual and family predictors and psychological consequences. Journal of Youth and Adolescence 35, 903911.
Coleman PK (2011). Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009. British Journal of Psychiatry 199, 180186.
Coleman PK, Coyle CT, Shuping M, Rue VM (2009). Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the National Comorbidity Survey. Journal of Psychiatric Research 43, 770776.
Coleman PK, Reardon DC, Rue VM, Cougle J (2002). A history of induced abortion in relation to substance use during subsequent pregnancies carried to term. American Journal of Obstetrics & Gynecology 187, 16731678.
Cougle JR, Reardon DC, Coleman PK (2003). Depression associated with abortion and childbirth: a long-term analysis of the NLSY cohort. Medical Science Monitor 9, CR105CR112.
Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the adverse childhood experiences study. JAMA 286, 30893096.
Erikson EH, Erikson JM (1998). The Life Cycle Completed (Extended Version) . W.W. Norton & Company: New York, NY.
Finer LB, Zolna MR (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine 374, 843852.
Frisco ML, Houle JN, Lippert AM (2013). Weight change and depression among US young women during the transition to adulthood. American Journal of Epidemiology 178, 2230.
Goldacre B, Lee W (2012). Abortion and mental health: guidelines for proper scientific conduct ignored. British Journal of Psychiatry 200, 7777.
Goodman E (1999). The role of socioeconomic status gradients in explaining differences in US adolescents’ health. American Journal of Public Health 89, 15221528.
Gotlib IH, Lewinsohn PM, Seeley JR (1995). Symptoms versus a diagnosis of depression: differences in psychosocial functioning. Journal of Consulting and Clinical Psychology 63, 90100.
Grzywacz JG, Hovey JD, Seligman LD, Arcury TA, Quandt SA (2006). Evaluating short-form versions of the CES-D for measuring depressive symptoms among immigrants from Mexico. Hispanic Journal of Behavioral Sciences 28, 404424.
Guttmacher Institute (2017 a). Counseling and Waiting Periods for Abortion. ( Accessed 2 May 2017.
Guttmacher Institute (2017 b). Parental Involvement in Minors’ Abortions. ( Accessed 25 April 2017.
Hall KS, Richards JL, Harris KM (2017). Social disparities in the relationship between depression and unintended pregnancy during adolescence and young adulthood. Journal of Adolescent Health 60, 688697.
Harris KM (2013). The Add Health Study: Design and Accomplishments. Carolina Population Center, University of North Carolina at Chapel Hill: Chapel Hill, NC.
Harris LF, Roberts SC, Biggs MA, Rocca CH, Foster DG (2014). Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study. BMC Women's Health 14, 111.
Herrenkohl TI, Hong S, Klika JB, Herrenkohl RC, Russo MJ (2013). Developmental impacts of child abuse and neglect related to adult mental health, substance use, and physical health. Journal of Family Violence 28, 191199.
Jagannathan R (2001). Relying on surveys to understand abortion behavior: some cautionary evidence. American Journal of Public Health 91, 18251831.
Jerman J, Jones RK, Onda T (2016). Characteristics of US Abortion Patients in 2014 and Changes Since 2008. Guttmacher Institute: New York, NY.
Jones RK, Kost K (2007). Underreporting of induced and spontaneous abortion in the United States: an analysis of the 2002 National Survey of Family Growth. Studies in Family Planning 38, 187197.
Kendall T, Bird V, Cantwell R, Taylor C (2012). To meta-analyse or not to meta-analyse: abortion, birth and mental health. British Journal of Psychiatry 200, 1214.
Kessler RC, Birnbaum H, Demler O, Falloon IRH, Gagnon E, Guyer M, Howes MJ, Kendler KS, Shi L, Walters E, Wu EQ (2005). The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biological Psychiatry 58, 668676.
Leppälahti S, Heikinheimo O, Kalliala I, Santalahti P, Gissler M (2016). Is underage abortion associated with adverse outcomes in early adulthood? A longitudinal birth cohort study up to 25 years of age. Human Reproduction 31, 21422149.
Levinson DJ (1986). A conception of adult development. American Psychologist 41, 313.
Lipsky S, Caetano R, Roy-Byrne P (2009). Racial and ethnic disparities in police-reported intimate partner violence and risk of hospitalization among women. Women's Health Issues 19, 109118.
Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C (2009). Abortion and mental health: evaluating the evidence. American Psychologist 64, 863.
Major B, Cozzarelli C, Cooper ML, Zubek J, Richards C, Wilhite M, Gramzow RH (2000). Psychological responses of women after first-trimester abortion. Archives of General Psychiatry 57, 777784.
Nkansah-Amankra S, Tettey G (2015). Association between depressive symptoms in adolescence and birth outcomes in early adulthood using a population-based sample. Preventive Medicine Reports 2, 371378.
Pope LM, Adler NE, Tschann JM (2001). Postabortion psychological adjustment: are minors at increased risk? Journal of Adolescent Health 29, 211.
Primack BA, Swanier B, Georgiopoulos AM, Land SR, Fine MJ (2009). Association between media use in adolescence and depression in young adulthood: a longitudinal study. Archives of General Psychiatry 66, 181188.
Radloff LS (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.
Reardon DC, Coleman PK, Cougle JR (2004). Substance use associated with unintended pregnancy outcomes in the National Longitudinal Survey of Youth. American Journal of Drug and Alcohol Abuse 30, 369383.
Robinson GE, Stotland NL, Russo NF, Lang JA, Occhiogrosso M (2009). Is there an ‘abortion trauma syndrome’? Critiquing the evidence. Harvard Review of Psychiatry 17, 268290.
Romero L, Pazol K, Warner L, Cox S, Kroelinger C, Besera G, Brittain A, Fuller TR, Koumans E, Barfield W (2016). Reduced disparities in birth rates among teens aged 15–19 years—United States, 2006–2007 and 2013–2014. Morbidity and Mortality Weekly Report 65, 409414.
Rue VM, Coleman PK, Rue JJ, Reardon DC (2004). Induced abortion and traumatic stress: a preliminary comparison of American and Russian women. Medical Science Monitor 10, SR5SR16.
Rushton JL, Forcier M, Schectman RM (2002). Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. Journal of the American Academy of Child and Adolescent Psychiatry 41, 199205.
Russo NF, Zierk KL (1992). Abortion, childbearing, and women's well-being. Professional Psychology: Research and Practice 23, 269.
Santelli J, Rochat R, Hatfield-Timajchy K, Gilbert BC, Curtis K, Cabral R, Hirsch JS, Schieve L (2003). The measurement and meaning of unintended pregnancy. Perspectives on Sexual and Reproductive Health 35, 94101.
Schmiege S, Russo NF (2005). Depression and unwanted first pregnancy: longitudinal cohort study. British Medical Journal 331, 1303.
Shrier LA, Harris SK, Sternberg M, Beardslee WR (2001). Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Preventive Medicine 33, 179189.
Slopen N, Shonkoff JP, Albert MA, Yoshikawa H, Jacobs A, Stoltz R, Williams DR (2016). Racial disparities in child adversity in the U.S.: interactions with family immigration history and income. American Journal of Preventive Medicine 50, 4756.
Spriggs AL, Halpern CT (2008). Sexual debut timing and depressive symptoms in emerging adulthood. Journal of Youth and Adolescence 37, 10851096.
Steinberg JR, Becker D, Henderson JT (2011). Does the outcome of a first pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the National Comorbidity Survey. American Journal of Orthopsychiatry 81, 193201.
Steinberg JR, Finer LB (2011). Examining the association of abortion history and current mental health: a reanalysis of the National Comorbidity Survey using a common-risk-factors model. Social Science & Medicine 72, 7282.
Steinberg JR, Finer LB (2012). Coleman, Coyle, Shuping, and Rue make false statements and draw erroneous conclusions in analyses of abortion and mental health using the National Comorbidity Survey. Journal of Psychiatric Research 46, 407408.
Steinberg JR, Mcculloch CE, Adler NE (2014). Abortion and mental health: findings from the National Comorbidity Survey-Replication. Obstetrics & Gynecology 123, 263270.
Steinberg JR, Russo NF (2008). Abortion and anxiety: what's the relationship? Social Science & Medicine 67, 238252.
Steinberg JR, Russo NF (2009). Evaluating research on abortion and mental health. Contraception 80, 500503.
Steinberg JR, Trussell J, Hall KS, Guthrie K (2012). Fatal flaws in a recent meta-analysis on abortion and mental health. Contraception 86, 430437.
Swallen KC, Reither EN, Haas SA, Meier AM (2005). Overweight, obesity, and health-related quality of life among adolescents: the National Longitudinal Study of Adolescent Health. Pediatrics 115, 340347.
Van Ditzhuijzen J, Ten Have M, De Graaf R, Van Nijnatten CHCJ, Vollebergh WAM (2017). Correlates of common mental disorders among Dutch women who have had an abortion: a longitudinal cohort study. Perspectives on Sexual and Reproductive Health 49, 123131.
Warren JT, Harvey SM, Henderson JT (2010). Do depression and low self-esteem follow abortion among adolescents? Evidence from a national study. Perspectives on Sexual and Reproductive Health 42, 230235.
Zabin LS, Hirsch MB, Emerson MR (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives 21, 248255.
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