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The Psychological Complications of Therapeutic Abortion

  • G. Zolese (a1) and C. V. R. Blacker (a2)
Abstract

Psychological or psychiatric disturbances occur in association with therapeutic abortions but they seem to be marked, severe, or persistent in only a minority (approximately 10%) of women. These consist mostly of caseness depression and anxiety. Psychoses are very uncommon, being repotted in only 0.003% of cases – most of whom have a history of previous psychiatric illness. Certain groups are especially at risk from adverse psychological sequelae; these include those with a past psychiatric history, younger women, those with poor social support, the multiparous, and those belonging to sociocultural groups antagonistic to abortion. This is not to overlook the fact that, adopting a crisis-resolution framework, subsequent termination of an unwanted pregnancy is itself ‘therapeutic‘. A better understanding of the nature of the risk factors would enable clinicians to identify vulnerable women for whom some form of psychological intervention might be beneficial.

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Adler, N. E. (1976) Sample attrition in studies of psychosocial sequelae of abortion. How great a problem? Journal of Applied Social Psychology, 6, 240259.
Ancill, R., Hilton, S., Carr, T., et al (1986) Screening for antenatal and postnatal depressive symptoms in general practice using a microcomputer-delivered questionnaire. Journal of the Royal College of General Practitioners, 36, 276279.
Arens, P. (1958) Yearbook of Obstetrics and Gynaecology. Chicago: Yearbook Medical Publishers Inc.
Ashton, J. R. (1980) The psychological outcome of induced abortion. British Journal of Obstetrics and Gynaecology, 82, 11151122.
Beard, R. W., Belsey, E., Lal, S., et al (1974) King's Termination Study II: contraceptive practice before and after outpatient termination of pregnancy. British Medical Journal, i, 418421.
Beazley, J. M. & Haeri, A. D. (1971) Termination of pregnancy refused. Lancet, ii, 10591061.
Baetsen, K. L., Rankin, R. E., Fuller, G. B., et al (1985) A comparative MMPI study of abortion-seeking women and those who intend to carry their pregnancies to term. Family Practice Research Journal, 4, 199207.
Blacker, C. V. R. & Clare, A. W. (1987) Depressive disorder in primary care. British Journal of Psychiatry, 150, 737751.
Brekke, B. (1958) Other aspects of the abortion problem. In Abortion in the United States (ed. Caldemane, M.), pp 133136. New York: Harper & Row Publishers Inc.
Brewer, C. (1977) Incidence of post-abortion psychosis: a prospective study. British Medical Journal, i, 476477.
Brody, H., Meikle, S. & Gerritse, R. (1971) Therapeutic abortion: a prospective study. I. American Journal of Obstetrics and Gynecology, 109, 347353.
Brown, G. W. & Harris, T. O. (1978) Social Origins of Depression. London: Tavistock.
Clark, M. M., Forstner, I., Pond, D. A., et al (1968) Sequels of unwanted pregnancy: a follow up of patients referred for psychiatric opinion. Lancet, ii, 501503.
Cooper, P., Gath, D., Rose, N., et al (1982) Psychological sequelae to elective sterilization: a prospective study. British Medical Journal, 284, 461464.
David, H. B. (1985) Post-abortion and postpartum psychiatric hospitalisation. In Abortion: Medical Progress and Social Implications. CIBA Foundation Symposium, 115, 150161.
Davison, K. (1981) Toxic psychosis. British Journal of Hospital Medicine, 26, 530537.
Deutsch, H. (1945) The Psychology of Women: A Psychoanalytic Interpretation. New York: Grune & Stratton Inc.
Donnai, D. & Harris, R. (1981) Attitudes of patients after “genetic” termination of pregnancy. British Medical Journal, 282, 621622.
Drug & Therapeutics Bulletin (1989) Editorial. Drug & Therapeutics Bulletin, 27, 8687.
Dunbar, F. (1967) A psychosomatic approach to abortion and the abortion habit. In Abortion in America (ed. Rosen, H.), pp. 2231. Boston: Beacon Press.
Ebaugh, F. & Heuser, K. D. (1947) Psychiatric aspects of therapeutic abortion. Postgraduate Medicine, 2, 325332.
Ekblad, N. (1955) Induced abortion on psychiatric grounds. Acta Psychiatrica Scandinavica (suppl. 99).
Ewing, J. A. & Rouse, B. A. (1973) Therapeutic abortion and a prior psychiatric history. American Journal of Psychiatry, 130, 3740.
Eysenck, H. J. & Edwards, S. (1964) The Eysenck Personality Questionnaire. Windsor: NFER/Nelson.
Ford, C. V., Castelnuovo-Tedesco, P. & Long, K. (1971) Abortion: is it a therapeutic procedure in psychiatry? Journal of the American Medical Association, 218, 11731178.
Forssman, H. & Thuwe, I. (1966) One hundred and twenty children born after application for therapeutic abortion refused. Acta Psychiatrica Scandinavica, 42, 7178.
Frank, P. I., Kay, C. R., Winsgrave, S. J., et al (1985) Induced abortion operations and their early sequelae. Journal of the Royal College of General Practitioners, 35, 175180.
Greer, H. S., Lal, S., Lewis, S. C., et al (1976) Psychological consequences of therapeutic abortion. King's termination study III. British Journal of Psychiatry, 128, 7479.
Hall, M. H. (1990) Changes in the abortion law. British Medical Journal, 301, 11091110.
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Holden, C. (1989) Koop finds abortion evidence “inconclusive”. Science, 243, 730731.
Illsley, R. & Hall, H. M. (1976) Psychosocial aspects of abortion. A review of issues and needed research. Bulletin of the World Health Organization, 53, 83106.
Johnston, M. (1980) Anxiety in surgical patients. Psychological Medicine, 10, 145152.
Kay, C. R. & Frank, P. I. (1981) Characteristics of women recruited to a long-term study of the sequelae of induced abortion. Journal of the Royal College of General Practitioners, 31, 473477.
Kumar, R. (1982) In Motherhood and Mental Illness (eds Brockington, I. F. & Kumar, R.), pp. 71113. New York & London: Academic Press.
Kumar, R. & Robson, K. (1978) Previous induced abortion and antenatal depression in primiparae: preliminary report of a survey of mental health in pregnancy. Psychological Medicine, 8, 711715.
Lask, B. (1975) Short term psychiatric sequelae to therapeutic termination of pregnancy. British Journal of Psychiatry, 126, 173177.
Law, R. F. (1989) Abortion debate. British Medical Journal, 299, 916917.
Lazarus, A. (1985) Psychiatric sequelae of legalized elective first trimester abortion. Journal of Psychosomatic Obstetrics and Gynaecology, 4, 141150.
Lewis, T. L. T. (1980) Legal abortion in England and Wales 1968–1978. British Medical Journal, 280, 295296.
Lidz, T. (1954) Reflections of a psychiatrist. In Therapeutic Abortion (ed. Rosen, H.). New York: Julian Press.
Llewellyn-Jones, D. (1982) Fundamentals of Obstetrics and Gynaecology. London: Faber & Faber.
Llewellyn, S. P. & Pytches, R. (1988) An investigation of anxiety following termination of pregnancy. Journal of Advanced Nursing, 13, 468471.
McCance, C., Olley, P. C. & Edward, V. (1973) Long-term psychiatric follow up. In Experience with Abortion (ed. Horobin, G.), pp. 245300. Cambridge: Cambridge University Press.
McDonald, A. D. (1958) Maternal health and congenital defect: a prospective investigation. New England Journal of Medicine, 11, 477484.
Malforms, K. (1958) The problem of women seeking abortion. In Abortion in the United States (ed. Caldemane, M.), pp. 133135. New York: Harper & Row Publishers Inc.
Margolis, A., Davison, L., Hanson, K., et al (1971) Therapeutic abortion follow up study. American Journal of Obstetrics and Gynecology, 110, 243249.
Matejcek, Z., Dytrych, Z. & Schuller, R. V. (1978) Children from unwanted pregnancies. Acta Psychiatrica Scandinavica, 57, 6790.
Meyerowitz, S., Satloff, A. & Romano, J. (1971) Induced abortion for psychiatric indication. American Journal of Psychiatry, 127, 11531160.
Miller, J. F., Williamson, E. & Glue, J. (1980) Fetal loss after implantation. Lancet, ii, 554556.
Morrison-Friedman, C., Greenspan, R. & Mittleman, F. (1974) The decision-making process and the outcome of therapeutic abortion. American Journal of Psychiatry, 131, 13321337.
Ney, P. (1979) Relationship between abortion and child abuse. Canadian Journal of Psychiatry, 24, 610620.
Niswander, K. & Paterson, R. (1967) Psychological reaction to therapeutic abortion I: subjective patient response. Obstetrics and Gynecology, 29, 702706.
Niswander, K., Singer, J. & Singer, M. (1972) Psychological reaction to therapeutic abortion II: objective response. American Journal of Obstetrics and Gynecology, 114, 2933.
OPCS (1987) Legal Abortions: 1986. OPCS Monitor, 9 June, 1987. London: Office of Population Censuses and Surveys.
Osofsky, J. & Osofsky, H. (1972) The psychological reactions of patients to legalized abortion. American Journal of Orthopsychiatry, 42, 4860.
Pare, C. M. B. & Raven, H. (1970) Follow up of patients referred for termination. Lancet, i, 635638.
Pasini, W. & Kellerhals, J. (1970) Proceedings of the Conference on Psychosocial Factors in Transnational Family Planning Research, pp. 4454. Washington: American Institute for Research.
Patt, S. L., Rappaport, R. G. & Barglow, P. (1969) Follow up of therapeutic abortion. Archives of General Psychiatry, 20, 408411.
Payne, E. C., Kravitz, A. R., Notaman, M. T., et al (1976) Outcome following therapeutic abortion. Archives of General Psychiatry, 33, 725733.
Peck, A. & Marcus, H. (1966) Psychiatric sequelae of therapeutic interruption of pregnancy. Journal of Nervous and Mental Disease, 143, 417425.
Perez-Reyes, M. & Falk, R. (1973) Follow up after therapeutic abortion in early adolescence. American Journal of Psychiatry, 28, 120126.
Rogers, J. L., Stoms, G. B. & Phifer, J. L. (1989) Psychological impact of abortion: methodological and outcome summary of empirical research between 1966–1988. Health Care for Women International, 10, 347376.
Romans-Clarkson, S. E. (1989) Psychological sequelae of therapeutic abortion. Australian and New Zealand Journal of Psychiatry, 23, 555565.
Rosenthal, M. B. & Rothschild, E. (1975) Some psychological considerations in adolescent pregnancy and abortion. Advances in Planned Parenthood, 9, 6069.
Savage, W. & Paterson, I. (1984) In Contemporary Gynaecology (ed. Chamberlain, G.), pp. 220243. London: Butterworths.
Schneider, S. M. & Thompson, D. S. (1975) Repeat aborters. American Journal of Obstetrics and Gynecology, 126, 316320.
Siegfried, S. (1951) Psychiatrische Untersuchungen uber die Folgen der kuenstlichen Senwangerschaftsunterbrechung. Schweizer Archiv fur Neurologie und Psychiatric, 67, 365388.
Simon, N. M. & Senturia, A. G. (1966) Psychiatric sequelae of abortion: review of the literature 1935–1964. Archives of General Psychiatry, 15, 378389.
Simon, N. M., Senturia, A. G. & Rothman, D. (1967) Psychiatric illness following therapeutic abortion. American Journal of Psychiatry, 130, 3740.
Tanner, L. M. (1971) In-hospital care and post-hospital follow-up. Clinical Obstetrics and Gynecology, 14, 1278.
Todd, N. A. (1972) Follow-up of patients recommended for therapeutic abortion. British Journal of Psychiatry, 120, 645646.
Visram, S. A. (1972) A Follow-up Study of 95 Women Who Were Refused Abortion on Psychiatric Grounds, pp. 561563. Psychosomatic Medicine in Obstetrics and Gynaecology, 3rd congress. Basel: Karger.
Wallerstein, J., Kurtz, P. & Bar-Din, M. (1972) Psychological sequelae of therapeutic abortion in young unmarried women. Archives of General Psychiatry, 27, 828832.
Waiters, W. W. (1980) Mental health consequences of abortion and refused abortion. Canadian Journal of Psychiatry, 25, 6873.
Weston, F. (1973) Psychiatric sequelae of legal abortion in South Australia. Medical Journal of Australia, i, 350354.
Whitelaw, R. G. (1979) 10–year survey of 485 sterilizations. British Medical Journal, i, 3235.
Whittington, H. (1970) Evaluation of therapeutic abortion as an element of preventive psychiatry. American Journal of Psychiatry, 126, 12241229.
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The Psychological Complications of Therapeutic Abortion

  • G. Zolese (a1) and C. V. R. Blacker (a2)
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