Abortion and mental health: Evaluating the evidence.

The authors evaluated empirical research addressing the relationship between induced abortion and women's mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in women's responses following abortion. This article reflects and updates the report of the American Psychological Association Task Force on Mental Health and Abortion (2008). Major methodological problems pervaded most of the research reviewed. The most rigorous studies indicated that within the United States, the relative risk of mental health problems among adult women who have a single, legal, first-trimester abortion of an unwanted pregnancy is no greater than the risk among women who deliver an unwanted pregnancy. Evidence did not support the claim that observed associations between abortion and mental health problems are caused by abortion per se as opposed to other preexisting and co-occurring risk factors. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however. It is important that women's varied experiences of abortion be recognized, validated, and understood.

Is there an "abortion trauma syndrome"? Critiquing the evidence.

The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an "abortion trauma syndrome" or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.

Call to action: Reducing interpersonal violence across the lifespan.

On September 12-13, 2008, more than 40 representatives from national professional organizations, grass roots organizations, governmental agencies, policy organizations, and advocacy movements gathered together in San Diego, California, as part of the Think Tank on Reducing Interpersonal Violence Across the Lifespan: Connecting Agendas. Working as a whole and in small groups, the think tank identified major gaps and issues facing the field of interpersonal violence prevention and began to develop a blueprint for integrating action across types of violence and types of populations, as well as integrating research, practice, and policy across the lifespan. Recognizing the need for a mechanism to facilitate communication and integrative collaboration in research, practice, and policy activities across diverse domains of interests and populations, the organizations committed to work together formed the National Partnership to Prevent Interpersonal Violence Across the Lifespan. The 2010 conference will bring together researchers, practitioners, policymakers, advocates, consumers, and funders in a series of plenary sessions, workshops, and poster sessions to present cutting-edge examples of integrative work aimed at transforming approaches to the prevention of interpersonal violence. Interpersonal violence is an intransigent problem with widespread and long-lasting direct and indirect effects. Rates of intimate partner violence (IPV), sexual assault, and childhood physical and sexual abuse around the world remain unacceptably high (CDC, 2006; see also http://www.cdc.gov/ncipc). Although the rippling effects of interpersonal violence have yet to be fully understood and documented, it is known that outcomes of violence encompass death, injury, and a wide range of physical, sexual, reproductive, and mental health problems. This special section of the American Journal of Orthopsychiatry encourages support for the call to action by the National Partnership to Prevent Interpersonal Violence Across the Lifespan.

Gender-based violence: concepts, methods, and findings.

The United Nations has identified gender-based violence against women as a global health and development issue, and a host of policies, public education, and action programs aimed at reducing gender-based violence have been undertaken around the world. This article highlights new conceptualizations, methodological issues, and selected research findings that can inform such activities. In addition to describing recent research findings that document relationships between gender, power, sexuality, and intimate violence cross-nationally, it identifies cultural factors, including linkages between sex and violence through media images that may increase women's risk for violence, and profiles a host of negative physical, mental, and behavioral health outcomes associated with victimization including unwanted pregnancy and abortion. More research is needed to identify the causes, dynamics, and outcomes of gender-based violence, including media effects, and to articulate how different forms of such violence vary in outcomes depending on cultural context.

Depression and unwanted first pregnancy: longitudinal cohort study.

OBJECTIVE: To examine the outcomes of an unwanted first pregnancy (abortion v live delivery) and risk of depression and to explain discrepancies with previous research that used the same dataset. DESIGN: Longitudinal cohort study. SETTING: Nationally representative sample of US men and women aged 14-24 in 1979. PARTICIPANTS: 1247 women in the US national longitudinal survey of youth who aborted or delivered an unwanted first pregnancy. MAIN OUTCOME MEASURES: Clinical cut-off and continuous scores on a 1992 measure of the Center for Epidemiological Studies depression scale. RESULTS: Terminating compared with delivering an unwanted first pregnancy was not directly related to risk of clinically significant depression (odds ratio 1.19, 95% confidence interval 0.85 to 1.66). No evidence was found of a relation between pregnancy outcome and depression in analyses of subgroups known to vary in under-reporting of abortion. In analyses of the characteristics of non-respondents, refusal to provide information on abortion did not explain the lack of detecting a relation between abortion and mental health. The abortion group had a significantly higher mean education and income and lower total family size, all of which were associated with a lower risk of depression. CONCLUSIONS: Evidence that choosing to terminate rather than deliver an unwanted first pregnancy puts women at higher risk of depression is inconclusive. Discrepancies between current findings and those of previous research using the same dataset primarily reflect differences in coding of a first pregnancy.

Controlling birth: science, politics, and public policy.

Reproductive technologies raise a host of social and legal issues that challenge basic values and create intense controversy. If researchers wish to inform public policies related to reproductive technologies, they must understand how the scientific enterprise is being manipulated and research findings are being misrepresented to justify a particular social agenda and restrict access to contraception and abortion. To counter these distortions, scientists must defend the science advisory process, be involved in dissemination of their research findings beyond simply publication in scientific journals, and actively work to ensure that the findings are not misrepresented to the public.

Psychology, population, and reproductive behavior.

This special section on international perspectives in psychology focuses on population issues and reproductive behavior across national and cultural boundaries, emphasizing the responsibility of psychologists and colleagues in related disciplines to generate and communicate culturally mindful findings likely to shape public health policy and improve human well-being. After considering the historical and policy context, it highlights internationally collaborative research projects in the Czech Republic, Egypt, Mexico, and the United States that address reproductive behavior, women's roles and status, responsible parenthood, and abortion legislation in terms of cultural context, gender equity, the needs of adolescents, and public health policy. The articles illustrate the importance of the cultural context within which psychological research is conducted and how psychology can be informed by international perspectives.