Five-Year Study Finds No Link Between Abortion, Suicide

Women who have abortions are not at increased risk of suicidal ideation or suicide, according to a study published May 24 in AJP in Advance.

The results echo previous literature reviews on the psychological effects of abortion and studies on the effects of abortion on suicidal ideation, wrote M. Antonia Biggs, Ph.D., and colleagues at the University of California, San Francisco. “Policies requiring that women be warned that they are at increased risk of becoming suicidal if they choose abortion are not evidence based,” they concluded.

“We apparently have to keep proving the same thing that’s been clear for a long time: that terminating a pregnancy doesn’t increase your risk of suicide, substance abuse, or other adverse mental health outcomes,” said Nada Stotland, M.D., M.P.H., a former APA president and a specialist in reproductive psychiatry in Chicago, who reviewed the study at the request of Psychiatric News.

Twenty states require women to receive pre-abortion counseling about the psychological consequences of abortion, and eight of those states detail only negative psychological effects (Kansas, Louisiana, Michigan, Nebraska, North Carolina, South Dakota, Texas, and West Virginia), according to the Guttmacher Institute. These states detail serious short- and long-term consequences of abortion including sexual dysfunction, depression, flashbacks, sleep disturbances, grief, anxiety, and nightmares. In two of these states, Texas and West Virginia, women are specifically warned that having an abortion increases their risk of suicidal thoughts or actions.

Stotland said such laws “require doctors to violate their Hippocratic Oath by putting them in the impossible position of misinforming their patients. This is contradictory to everything medicine is about and doesn’t occur in any other area of medicine.”

APA strongly opposes legislation that intrudes into the privacy of physician-patient communications and that is aimed at discouraging pregnant women from exercising their constitutional right to make their own reproductive choices, according to a position statement approved by the Board of Trustees in December 2013.

For the study, Biggs and colleagues re-examined the data from their previous Turnaway study, for which nearly 1,000 women were recruited from 30 U.S. abortion facilities from 2008 through 2010. Women who received late-term abortions (within two weeks of a facility’s gestational age limit) were compared with women who were denied an abortion because they were over the facility’s gestational age limit. For comparison, the study also included a group who obtained a first-trimester abortion.

Women were interviewed by telephone one week after their abortion visit, then every six months for five years. During each interview, women completed various assessments, including two suicidal ideation scales.

Researchers found rates of suicidal ideation were low among all the groups studied, when compared with women in other studies of pregnant and postpartum women. “For women having an abortion, we found that the proportion with any [suicidal ideation] symptoms did not increase, but rather decreased over the five-year time period,” Biggs and colleagues wrote. “We also found no effect of receiving compared with being denied an abortion on either of our two suicidal ideation measures at any time point, dispelling the notion that abortion increases women’s risk for suicidal ideation over time.”

While having an abortion was not associated with suicidal ideation, the researchers did find other factors that raised women’s risk of suicidality: being Hispanic or Latina, being subject to intimate partner violence or sexual assault, problem alcohol use, and a history of anxiety or depression.

Ultimately, Biggs said, the study is a testament to the resiliency of the women studied. “At least with regard to their mental health, the women were doing quite well.”

The study was funded in part by grants from the Wallace Alexander Gerbode Foundation, the David and Lucile Packard Foundation, and the William and Flora Hewlett Foundation. ■