Induced abortion and mental health

Sir, We thank Dr. Reardon for his interest and comments (1) on our article (2). The relation between induced abortion and mental health continues to be a topic of great interest and discussion. Induced abortion is associated with an overall increased risk of psychiatric morbidity, a low socioeconomic status, and other adverse conditions affecting well-being and quality of life. However, as stated by the American Psychological Association, induced abortion itself cannot be seen as a cause of mental health problems (3). The increased risk of psychiatric morbidity in women undergoing induced abortion can be noticed already before the abortion, as seen in a large registry-based study in Denmark (4) as well as in our recent study concerning teenagers undergoing an induced abortion in Finland (5). So, it seems that in the case of an unintended pregnancy, the prevalence of psychiatric morbidity does not differ between women who decided to carry the pregnancy to term and women who chose abortion (5). The participants of our present study were recruited and randomized after referral to hospital because of an unintended pregnancy that they wished to terminate. In the study, the first time-point of collecting data on the level of anxiety or quality of life was baseline at the first hospital visit immediately before the termination. A history of previously medically diagnosed mental health problems as reported by the women themselves has been mentioned in our paper. However, we did not have access to the actual diagnoses for the reported mental disorders. Furthermore, we reported all the scales we used and all the data we had for the study. Thus, we could only compare the subjectively experienced and reported levels of anxiety and quality of life when presenting for induced abortion with the scores collected during the follow ups. Based on these results, we concluded that the distress at the time of the abortion subsided rather rapidly. In no way did our conclusions claim that abortion per se would have therapeutic effects. An important finding of our study was that despite the rapid overall amelioration of anxiety and quality of life after abortion, a high proportion (up to 40%) of women continued to report marked levels of anxiety during the follow up. High levels of baseline anxiety, a self-reported history of psychiatric morbidity, and smoking were risk factors for this continuation of elevated levels of anxiety and low levels of quality of life. Thus, it suggests that this group of women might benefit from attention to and efforts for mental health promotion measures after abortion as part of good practice and care.