Published in JAMA Psychiatry, results of a cohort study indicate that antidepressant use is higher among women who have had abortions than among women who have not. However, statistical analyses indicate that this correlation is attributable to differences in risk factors for depression within the cohort rather than the incidence of abortion itself.
Researchers identified a cohort of 396,397 women from Danish population registries, noting antidepressant use, abortion incidence, and childbirth rates from medical and civil records. First-time antidepressant prescription redemptions were taken to indicate an episode of depression or anxiety. Researchers calculated incident rate ratios (IRRs) of antidepressant use among women who had an abortion vs women who did not have an abortion and among women who went through childbirth vs women who did not.
Of the total cohort, 30,834 (7.8%) had record of a first-trimester abortion, 85,592 (21.6%) had record of first child birth, and 59,465 (15.0%) had record of first antidepressant use. Among women who had an abortion, 5705 (18.5%) initiated antidepressant use after a first abortion; among women who gave birth, 10,825 (12.7%) initiated antidepressant use after a first child birth.
Relative to the women who had no abortion (IR, 22.5; 95% CI, 22.3-22.7), women’s rate of redeeming antidepressant prescriptions was higher in the year before (IR, 45.7; 95% CI, 43.3-48.3), the year after (IR, 40.5; 95% CI, 39.1-42.0), and more than 5 years after (IR, 36.5; 95% CI, 34.6-38.5) an abortion. However, the rate of new antidepressant use was similar in the year before an abortion (IRR, 1.46; 95% CI, 1.38-1.54) and the year following an abortion (IRR, 1.54; 95% CI, 1.45-1.62), indicating that abortion itself was not a significant influence on antidepressant initiation.
Additionally, the association between abortion and first antidepressant use decreased from the basic model to the fully adjusted model, indicating that other factors were confounding the association. Across all women in the sample, the strongest risk factors for antidepressant use 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).
Although basic statistical models indicated an association between abortion and antidepressant use among women, the relationship was strongly moderated by existing depression risk factors. As such, the notion that abortion harms women’s mental health may be misinformed and should be re-examined according to scientific data such as these.
Steinberg JR, Laursen TM, Adler NE, Gasse C, Agerbo E, Munk-Olsen T. Examining the association of antidepressant prescriptions with first abortion and first childbirth [published online May 30, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.0849