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Abortion does not increase a woman’s risk of attempting suicide

Increased risk of suicide in women who have abortions is linked to pre-existing mental health conditions

Ingrid Torjesen

Wednesday, 20 November 2019

Undergoing an abortion does not increase women’s risk of suicide according to the results of a 17-year-long observational study* including more than half a million Danish women published in The Lancet Psychiatry journal.

The study is the first to compare the risk of women attempting suicide before and after an abortion, and it found that although women who had abortions had a higher risk of first-time non-fatal suicide attempts, that this cannot be attributed to the abortion itself. Instead, pre-existing mental health problems (which were more common in women having abortions than in women not having abortions) were associated with the increased risk of attempted suicide, the study found.

“The view that having an abortion leads to suicidal thoughts, plans, or even suicide attempts has been used to inform abortion policies in some regions of the world, particularly laws requiring women seeking the procedure be informed of this view,” said lead author Dr Julia R. Steinberg from the University of Maryland, College Park, USA. “The evidence from our study does not support this notion.”

The study examined data from 523,380 Danish women aged 18 to 36 years and the risk of non-fatal suicide attempts associated with a first abortion between January 2000 and December 2016. Only data related to non-fatal suicide attempts and first first-trimester abortions, not multiple abortions nor abortions beyond the first trimester, were considered.

Of the women included in the study, 9% (48,990/523,380 women) had at least one first-trimester abortion and 2% (10,216/523,380 women) had a suicide attempt during the 17-year study period.

For the women who had an abortion, there were similar unadjusted rates of suicide attempts in the year before and after the abortion – 8.9 attempts in every 1,000 women in the year before an abortion, and 8.6 attempts in every 1,000 women in the year after the abortion.  Over time, the unadjusted rate of suicide attempts decreased to 4.6 attempts in every 1,000 women per year between one to five years after an abortion, and to 2.2 in every 1,000 women per year after five or more years – similar to the rate of 2 per 1,000 women per year for women who did not have an abortion during the study period.

“Five years after an abortion, the unadjusted rate of first-time suicide attempts reduces to the same rate as in women who have not had an abortion, countering the notion of ‘post-abortion syndrome’, in which it is hypothesised that the effects are not experienced until a long time afterwards,” said Dr Steinberg.

The strongest risk factors for attempting suicide were having previous contact with a psychiatric service, previous use of antidepressant medication, previous use of antianxiety medication and previous use of antipsychotic medication.

“Our findings suggest that when a woman is seeking advice and care surrounding an abortion, it could be appropriate to screen for mental health issues in order to pick up on pre-existing problems and to prevent future ones occurring,” said co-author Dr Trine Munk-Olsen from Aarhus University, Denmark.

The researchers noted that not all women with mental health problems may seek help, therefore, the effect of previous mental health problems may be underestimated.

*Steinberg JR, Laursen TM, Adler NE, et al. The association between first abortion and first-time non-fatal suicide attempt: a longitudinal cohort study of Danish population registries. The Lancet Psychiatry. Published: November 19, 2019. DOI: 10.1016/S2215-0366(19)30400-6

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