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The Psychological Complications of Therapeutic Abortion

Published online by Cambridge University Press:  02 January 2018

G. Zolese  and
C. V. R. Blacker
G. Zolese*
Affiliation:
Department of Psychological Medicine, St Bartholomew's Hospital, London EC1A 7BE
C. V. R. Blacker
Affiliation:
Royal Cornwall Hospital, Truro
*
∗Correspondence
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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.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 160 , Issue 6 , June 1992 , pp. 742 - 749
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Adler, N. E. (1976) Sample attrition in studies of psychosocial sequelae of abortion. How great a problem? Journal of Applied Social Psychology, 6, 240–259.Google Scholar
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, 276–279.Google Scholar
Arens, P. (1958) Yearbook of Obstetrics and Gynaecology. Chicago: Yearbook Medical Publishers Inc.Google Scholar
Ashton, J. R. (1980) The psychological outcome of induced abortion. British Journal of Obstetrics and Gynaecology, 82, 1115–1122.CrossRefGoogle Scholar
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, 418–421.Google Scholar
Beazley, J. M. & Haeri, A. D. (1971) Termination of pregnancy refused. Lancet, ii, 1059–1061.Google Scholar
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, 199–207.Google Scholar
Blacker, C. V. R. & Clare, A. W. (1987) Depressive disorder in primary care. British Journal of Psychiatry, 150, 737–751.CrossRefGoogle ScholarPubMed
Brekke, B. (1958) Other aspects of the abortion problem. In Abortion in the United States (ed. Caldemane, M.), pp 133–136. New York: Harper & Row Publishers Inc.Google Scholar
Brewer, C. (1977) Incidence of post-abortion psychosis: a prospective study. British Medical Journal, i, 476–477.Google Scholar
Brody, H., Meikle, S. & Gerritse, R. (1971) Therapeutic abortion: a prospective study. I. American Journal of Obstetrics and Gynecology, 109, 347–353.Google Scholar
Brown, G. W. & Harris, T. O. (1978) Social Origins of Depression. London: Tavistock.Google Scholar
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, 501–503.Google Scholar
Cooper, P., Gath, D., Rose, N., et al (1982) Psychological sequelae to elective sterilization: a prospective study. British Medical Journal, 284, 461–464.CrossRefGoogle ScholarPubMed
David, H. B. (1985) Post-abortion and postpartum psychiatric hospitalisation. In Abortion: Medical Progress and Social Implications. CIBA Foundation Symposium, 115, 150–161.Google Scholar
Davison, K. (1981) Toxic psychosis. British Journal of Hospital Medicine, 26, 530–537.Google Scholar
Deutsch, H. (1945) The Psychology of Women: A Psychoanalytic Interpretation. New York: Grune & Stratton Inc.Google Scholar
Donnai, D. & Harris, R. (1981) Attitudes of patients after “genetic” termination of pregnancy. British Medical Journal, 282, 621–622.Google Scholar
Drug & Therapeutics Bulletin (1989) Editorial. Drug & Therapeutics Bulletin, 27, 86–87.Google Scholar
Dunbar, F. (1967) A psychosomatic approach to abortion and the abortion habit. In Abortion in America (ed. Rosen, H.), pp. 22–31. Boston: Beacon Press.Google Scholar
Ebaugh, F. & Heuser, K. D. (1947) Psychiatric aspects of therapeutic abortion. Postgraduate Medicine, 2, 325–332.CrossRefGoogle ScholarPubMed
Ekblad, N. (1955) Induced abortion on psychiatric grounds. Acta Psychiatrica Scandinavica (suppl. 99).Google Scholar
Ewing, J. A. & Rouse, B. A. (1973) Therapeutic abortion and a prior psychiatric history. American Journal of Psychiatry, 130, 37–40.Google Scholar
Eysenck, H. J. & Edwards, S. (1964) The Eysenck Personality Questionnaire. Windsor: NFER/Nelson.Google Scholar
Ford, C. V., Castelnuovo-Tedesco, P. & Long, K. (1971) Abortion: is it a therapeutic procedure in psychiatry? Journal of the American Medical Association, 218, 1173–1178.Google Scholar
Forssman, H. & Thuwe, I. (1966) One hundred and twenty children born after application for therapeutic abortion refused. Acta Psychiatrica Scandinavica, 42, 71–78.CrossRefGoogle ScholarPubMed
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, 175–180.Google Scholar
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, 74–79.Google Scholar
Hall, M. H. (1990) Changes in the abortion law. British Medical Journal, 301, 1109–1110.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.Google Scholar
Holden, C. (1989) Koop finds abortion evidence “inconclusive”. Science, 243, 730–731.Google Scholar
Illsley, R. & Hall, H. M. (1976) Psychosocial aspects of abortion. A review of issues and needed research. Bulletin of the World Health Organization, 53, 83–106.Google Scholar
Johnston, M. (1980) Anxiety in surgical patients. Psychological Medicine, 10, 145–152.CrossRefGoogle ScholarPubMed
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, 473–477.Google Scholar
Kumar, R. (1982) In Motherhood and Mental Illness (eds Brockington, I. F. & Kumar, R.), pp. 71–113. New York & London: Academic Press.Google Scholar
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, 711–715.CrossRefGoogle ScholarPubMed
Lask, B. (1975) Short term psychiatric sequelae to therapeutic termination of pregnancy. British Journal of Psychiatry, 126, 173–177.Google Scholar
Law, R. F. (1989) Abortion debate. British Medical Journal, 299, 916–917.CrossRefGoogle ScholarPubMed
Lazarus, A. (1985) Psychiatric sequelae of legalized elective first trimester abortion. Journal of Psychosomatic Obstetrics and Gynaecology, 4, 141–150.CrossRefGoogle Scholar
Lewis, T. L. T. (1980) Legal abortion in England and Wales 1968–1978. British Medical Journal, 280, 295–296.Google Scholar
Lidz, T. (1954) Reflections of a psychiatrist. In Therapeutic Abortion (ed. Rosen, H.). New York: Julian Press.Google Scholar
Llewellyn-Jones, D. (1982) Fundamentals of Obstetrics and Gynaecology. London: Faber & Faber.Google Scholar
Llewellyn, S. P. & Pytches, R. (1988) An investigation of anxiety following termination of pregnancy. Journal of Advanced Nursing, 13, 468–471.Google Scholar
McCance, C., Olley, P. C. & Edward, V. (1973) Long-term psychiatric follow up. In Experience with Abortion (ed. Horobin, G.), pp. 245–300. Cambridge: Cambridge University Press.Google Scholar
McDonald, A. D. (1958) Maternal health and congenital defect: a prospective investigation. New England Journal of Medicine, 11, 477–484.Google Scholar
Malforms, K. (1958) The problem of women seeking abortion. In Abortion in the United States (ed. Caldemane, M.), pp. 133–135. New York: Harper & Row Publishers Inc.Google Scholar
Margolis, A., Davison, L., Hanson, K., et al (1971) Therapeutic abortion follow up study. American Journal of Obstetrics and Gynecology, 110, 243–249.Google Scholar
Matejcek, Z., Dytrych, Z. & Schuller, R. V. (1978) Children from unwanted pregnancies. Acta Psychiatrica Scandinavica, 57, 67–90.Google Scholar
Meyerowitz, S., Satloff, A. & Romano, J. (1971) Induced abortion for psychiatric indication. American Journal of Psychiatry, 127, 1153–1160.Google Scholar
Miller, J. F., Williamson, E. & Glue, J. (1980) Fetal loss after implantation. Lancet, ii, 554–556.Google Scholar
Morrison-Friedman, C., Greenspan, R. & Mittleman, F. (1974) The decision-making process and the outcome of therapeutic abortion. American Journal of Psychiatry, 131, 1332–1337.Google Scholar
Ney, P. (1979) Relationship between abortion and child abuse. Canadian Journal of Psychiatry, 24, 610–620.Google Scholar
Niswander, K. & Paterson, R. (1967) Psychological reaction to therapeutic abortion I: subjective patient response. Obstetrics and Gynecology, 29, 702–706.Google Scholar
Niswander, K., Singer, J. & Singer, M. (1972) Psychological reaction to therapeutic abortion II: objective response. American Journal of Obstetrics and Gynecology, 114, 29–33.Google Scholar
OPCS (1987) Legal Abortions: 1986. OPCS Monitor, 9 June, 1987. London: Office of Population Censuses and Surveys.Google Scholar
Osofsky, J. & Osofsky, H. (1972) The psychological reactions of patients to legalized abortion. American Journal of Orthopsychiatry, 42, 48–60.Google Scholar
Pare, C. M. B. & Raven, H. (1970) Follow up of patients referred for termination. Lancet, i, 635–638.Google Scholar
Pasini, W. & Kellerhals, J. (1970) Proceedings of the Conference on Psychosocial Factors in Transnational Family Planning Research, pp. 44–54. Washington: American Institute for Research.Google Scholar
Patt, S. L., Rappaport, R. G. & Barglow, P. (1969) Follow up of therapeutic abortion. Archives of General Psychiatry, 20, 408–411.Google Scholar
Payne, E. C., Kravitz, A. R., Notaman, M. T., et al (1976) Outcome following therapeutic abortion. Archives of General Psychiatry, 33, 725–733.Google Scholar
Peck, A. & Marcus, H. (1966) Psychiatric sequelae of therapeutic interruption of pregnancy. Journal of Nervous and Mental Disease, 143, 417–425.Google Scholar
Perez-Reyes, M. & Falk, R. (1973) Follow up after therapeutic abortion in early adolescence. American Journal of Psychiatry, 28, 120–126.Google Scholar
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, 347–376.Google Scholar
Romans-Clarkson, S. E. (1989) Psychological sequelae of therapeutic abortion. Australian and New Zealand Journal of Psychiatry, 23, 555–565.CrossRefGoogle Scholar
Rosenthal, M. B. & Rothschild, E. (1975) Some psychological considerations in adolescent pregnancy and abortion. Advances in Planned Parenthood, 9, 60–69.Google Scholar
Savage, W. & Paterson, I. (1984) In Contemporary Gynaecology (ed. Chamberlain, G.), pp. 220–243. London: Butterworths.Google Scholar
Schneider, S. M. & Thompson, D. S. (1975) Repeat aborters. American Journal of Obstetrics and Gynecology, 126, 316–320.Google Scholar
Siegfried, S. (1951) Psychiatrische Untersuchungen uber die Folgen der kuenstlichen Senwangerschaftsunterbrechung. Schweizer Archiv fur Neurologie und Psychiatric, 67, 365–388.Google Scholar
Simon, N. M. & Senturia, A. G. (1966) Psychiatric sequelae of abortion: review of the literature 1935–1964. Archives of General Psychiatry, 15, 378–389.Google Scholar
Simon, N. M., Senturia, A. G. & Rothman, D. (1967) Psychiatric illness following therapeutic abortion. American Journal of Psychiatry, 130, 37–40.Google Scholar
Tanner, L. M. (1971) In-hospital care and post-hospital follow-up. Clinical Obstetrics and Gynecology, 14, 1278.Google Scholar
Todd, N. A. (1972) Follow-up of patients recommended for therapeutic abortion. British Journal of Psychiatry, 120, 645–646.Google Scholar
Visram, S. A. (1972) A Follow-up Study of 95 Women Who Were Refused Abortion on Psychiatric Grounds, pp. 561–563. Psychosomatic Medicine in Obstetrics and Gynaecology, 3rd congress. Basel: Karger.Google Scholar
Wallerstein, J., Kurtz, P. & Bar-Din, M. (1972) Psychological sequelae of therapeutic abortion in young unmarried women. Archives of General Psychiatry, 27, 828–832.CrossRefGoogle ScholarPubMed
Waiters, W. W. (1980) Mental health consequences of abortion and refused abortion. Canadian Journal of Psychiatry, 25, 68–73.Google Scholar
Weston, F. (1973) Psychiatric sequelae of legal abortion in South Australia. Medical Journal of Australia, i, 350–354.Google Scholar
Whitelaw, R. G. (1979) 10–year survey of 485 sterilizations. British Medical Journal, i, 32–35.Google Scholar
Whittington, H. (1970) Evaluation of therapeutic abortion as an element of preventive psychiatry. American Journal of Psychiatry, 126, 1224–1229.Google Scholar
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