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To meta-analyse or not to meta-analyse: abortion, birth and mental health

  • Tim Kendall (a1), Victoria Bird (a2), Roch Cantwell (a3) and Clare Taylor (a4)
Summary

Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.

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Copyright
Corresponding author
Tim Kendall, Sheffield Health and Social Care (NHS) Foundation Trust, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK. Email: tim.kendall@shsc.nhs.uk
Footnotes
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Declaration of interest

T.M., V.B., R.C. and C.T. have been funded by the Academy of Medical Royal Colleges (AoMRC) to undertake a review of mental health and abortion. R.C. is Chair of the expert reference group for the AoMRC, and is Chair of the Section of Perinatal Psychiatry of the Royal College of Psychiatrists.

Footnotes
References
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1 Sedgh, G, Henshaw, S, Singh, S, Ahman, E, Shah, IH. Induced abortion: estimated rates and trends worldwide. Lancet 2007; 370: 1338–45.
2 Coleman, PK. Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009. Br J Psychiatry 2011; 199: 180–6.
3 Howard, LM, Rowe, M, Trevillion, K, Khalifeh, H, Munk-Olsen, T. Abortion and mental health: guidelines for proper scientific conduct ignored (letter). Br J Psychiatry 2012; 200: 74.
4 Lagro-Janssen, T, van Weel, C, Lo Fo Wong, S. Abortion and mental health: guidelines for proper scientific conduct ignored (letter). Br J Psychiatry 2012; 200: 78.
5 Robinson, GE, Stotland, NL, Nadelson, CC. Abortion and mental health: guidelines for proper scientific conduct ignored (letter). Br J Psychiatry 2012; 200: 78.
6 Goldacre, B, Lee, W. Abortion and mental health: guidelines for proper scientific conduct ignored (letter). Br J Psychiatry 2012; 200: 77.
7 Fergusson, DM, Horwood, LJ, Boden, JM. A further meta-analysis (e-letter). Br J Psychiatry 2011; 5 October (http://bjp.rcpsych.org/content/199/3/180.full/reply).
8 Major, B, Appelbaum, M, Beckman, L, Dutton, MA, Russo, NF, West, C. Report on the APA Task Force on Mental Health and Abortion. APA, 2008.
9 Charles, VE, Polis, CB, Sridhara, SK, Blum, RW. Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception 2008; 78: 436–50.
10 Major, B, Appelbaum, M, Beckman, L, Dutton, MA, Russo, NF, West, C. Abortion and mental health: evaluating the evidence. Am Psychol 2009; 64: 863–90.
11 National Collaborating Centre for Mental Health (2011) Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including their Prevalence and Associated Factors. Academy of Medical Royal Colleges (http://www.nccmh.org.uk/consultations_abortion.html).
12 Steinberg, J, Russo, N. Abortion and anxiety: what's the relationship? Soc Sci Med 2008; 6: 238–52.
13 Cougle, JR, Reardon, DC, Coleman, PK. Generalized anxiety following unintended pregnancies resolved through childbirth and abortion: a cohort study of the 1995 National Survey of Family Growth. J Anxiety Disord 2005; 19: 137–42.
14 Gilchrist, AC, Hannaford, PC, Frank, P, Kay, CR. Termination of pregnancy and psychiatric morbidity. Br J Psychiatry 1995; 167: 243–8.
15 Fergusson, DM, Horwood, LJ, Boden, JM. Abortion and mental health disorders: evidence from a 30-year longitudinal study. Br J Psychiatry 2008; 193: 444–51.
16 Dwyer, JM, Jackson, T. Unwanted pregnancy, mental health and abortion: untangling the evidence. Aust N Z Health Policy 2008; 29: 2.
17 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: 332–9.
18 World Health Organization. Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality, 2000 (4th edn). WHO, 2004.
19 House of Commons (2009) Parliamentary Debates (Hansard). Wednesday 15 July 2009. Volume 496, No. 112. House of Commons.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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To meta-analyse or not to meta-analyse: abortion, birth and mental health

  • Tim Kendall (a1), Victoria Bird (a2), Roch Cantwell (a3) and Clare Taylor (a4)
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