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An Explanatory Model to Guide Assessment, Risk and Diagnosis of Psychological Distress after Abortion

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DOI: 10.4236/ojog.2014.415133    3,344 Downloads   3,968 Views   Citations
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ABSTRACT

Background: Emerging data report 30% of women worldwide who obtain elective abortion experience negative and persistent psychological distress afterward. Studies find higher rates of psychological stress, depressive, substance, and anxiety disorders as well as suicidal behaviors, among some populations after abortion as compared to other reproductive events. Of concern, is that currenttheory and practice which promote abortion to relieve the stress of an unwanted pregnancy do not reflect new evidence. Moreover, the controversy on abortion inhibits research and treatment on its impact on women’s mental health. Thus, clinicians do not identify adverse psychological outcomes to abortion leaving many women untreated. Indeed, this knowledge-practice gap among healthcare providers may be the major reason that the incidence of adverse psychological outcomes after abortion continues to rise. Method: This paper proposes a theoretical understanding of psychological distress after abortion based on new data. A bio-psychosocial framework, including a psychological and biological theory, as well as a conceptual model is presented to explain the development of psychological distress after abortion. A comparison of risk factors between postpartum and post-abortion disorders is presented. Conclusion: A new theoretical model of psychological distress after abortion deepens understanding of the range of women’s responses to abortion and promotes evidence based practice. A scientific framework provides a much needed understanding of abortion aftermath as opposed to a political one. By providing assistance to clinicians in the identification, screening, and treatment of psychological disorders after abortion, this thesis aims to close the practice gap, and increase services after abortion to women who need them.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Curley, M. (2014) An Explanatory Model to Guide Assessment, Risk and Diagnosis of Psychological Distress after Abortion. Open Journal of Obstetrics and Gynecology, 4, 944-953. doi: 10.4236/ojog.2014.415133.

References

[1] Bradshaw, Z. and Slade, P. (2003) The Effects of Induced Abortion on Emotional Experiences and Relationships: A Critical Review of the Literature. Clinical Psychology Review, 23, 929-958.
http://dx.doi.org/10.1016/j.cpr.2003.09.001
[2] Fergusson, D., Horwood, J. and Boden, J.M. (2008) Abortion and Mental Health Disorders: Evidence from a 30-Year Longitudinal Study. British Journal of Psychiatry, 193, 444-451.
http://dx.doi.org/10.1192/bjp.bp.108.056499
[3] Dingle, K., Alati, A., et al. (2008) Pregnancy Loss and Psychiatric Disorders in Young Women: An Australian Birth Cohort Study. British Journal of Psychiatry, 193, 455-460.
http://dx.doi.org/10.1192/bjp.bp.108.055079
[4] Pederson, W. (2008) Abortion and Depression: A Population-Based Longitundinal Study of Young Women. Scandinavian Journal of Public Health, 36, 424-428.
http://dx.doi.org/10.1177/1403494807088449
[5] Taft, A.J. and Watson, L.F. (2008) Depression and Termination of Pregnancy in a National Cohort of Young Australian Women: The Confounding Effect of Women Experiencing Violence. BioMedCentral, 8, 75.
[6] Gilchrist, A.C., Hannaford, P.C., Frank, P. and Kay, C.R. (1995) Termination of Pregnancy and Psychiatric Morbidity. The British Journal of Psychiatry, 167, 243-248.
http://dx.doi.org/10.1192/bjp.167.2.243
[7] Gissler, M., Hemminki, E. and Lonnqvist, J. (1996) Suicides after Pregnancy in Finland 1987-1994: Register Linkage Study. BMJ, 313, 1431-1434. http://dx.doi.org/10.1136/bmj.313.7070.1431
[8] Cougle, J., Reardon, D. and Coleman, P. (2005) Generalized Anxiety following Unintended Pregnancies Resolved through Childbirth and Abortion: A Cohort Study National Survey of Family Youth. Journal of Anxiety Disorders, 19, 137-142. http://dx.doi.org/10.1016/j.janxdis.2003.12.003
[9] Reardon, D.C. and Coleman, P.K. (2006) Relative Treatment Rates for Sleep Disorders and Sleep Disturbances Following Abortion and Childbirth: A Prospective Record-Based Study. Sleep, 29, 105-106.
[10] Reardon, D.C. and Ney, P.G. (2000) Abortion and Subsequent Substance Abuse. American Journal of Drug and Alcohol Abuse, 26, 61-75. http://dx.doi.org/10.1081/ADA-100100591
[11] Curley, M. and Johnston, C. (2013) The Characteristics and Severity of Psychological Distress after Abortion among University Students. Journal of Behavioral and Health Service and Research, 40, 279-293. http://dx.doi.org/10.1007/s11414-013-9328-0
[12] Hamana, L., Rausch, S., Sperlich, M. and Defever, E. (2010) Previous Experience of Spontaneous Abortion or Elective Abortion and Risk for Post Traumatic Stress and Depression during Subsequent Pregnancy. Depression and Anxiety, 27, 699-707.
[13] van Emmerik, A.P., Kamphuis, J.H. and Emmelkamp, P.M. (2008) Prevalence and Prediction of Re-Experiencing and Avoidance after Elective Surgical Abortion: A Prospective Study. Clinical Psychology and Psychotherapy, 15, 378385.
[14] Rue, V., Coleman, P., Rue, J. and Reardon, D. (2004) Induced Abortion and Traumatic Stress: A Preliminary Comparison of American and Russian Women. Medical Science Monitor, 10, SR5-SR16.
[15] Zulcic-Nakic, V., Pajevic, I., Hasanovic, M. and Pavlovic, S. (2012) Psychological Problems Sequelae in Adolescents after Artificial Abortion. Journal of Pediatric and Adolescent Gynecology, 25, 241-247. http://dx.doi.org/10.1016/j.jpag.2011.12.072
[16] Coleman, P.K. (2011) Abortion and Mental Health: Quantitative Synthesis and Analysis of Research Published 19952009. The British Journal of Psychiatry, 199, 180-186.
http://dx.doi.org/10.1192/bjp.bp.110.077230
[17] Coleman, P.K., Coyle, C.T., Shuping, M. and Rue, V.M. (2009) Induced Abortion and Anxiety, Mood, and Substance Abuse Disorders: Isolating the Effects of Abortion in the National Comorbidity Survey. Journal of Psychiatric Research, 43, 770-776. http://dx.doi.org/10.1016/j.jpsychires.2008.10.009
[18] Broen, A., Moum, T., Bodtker, A. and Ekeberg, O. (2005) The Course of Mental Health after Miscarriage and Induced Abortion: A Longitudinal, Five-Year Follow-Up Study. BMC Medicine, 3, 18. http://dx.doi.org/10.1186/1741-7015-3-18
[19] Speckhard, A.C. and Rue, V.M. (1992) Post Abortion Syndrome: An Emerging Public Health Concern. Journal of Social Issues, 48, 95-119. http://dx.doi.org/10.1111/j.1540-4560.1992.tb00899.x
[20] Ekblad, M. (1955) Induced Abortion on Psychiatric Grounds: A Follow-Up Study of 479 Women. Acta Psychiatrica Neurologica Scandinavia Supplement, 99, 1-238.
[21] Charles, V., Polis, C., Sridhara, S. and Blum, R. (2008) Abortion and Long-Term Mental Health Outcomes: A Systematic Review of the Evidence. Contraception, 78, 436-450.
http://dx.doi.org/10.1016/j.contraception.2008.07.005
[22] Robinson, G., Stotland, N., Russo, N., Lang, J. and Occhiogrosso, M. (2009) Is There an “Abortion Trauma Syndrome”? Critiqueing the Evidence. Harvard Review of Psychiatry, 17, 268-269. http://dx.doi.org/10.1080/10673220903149119
[23] American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, APA, Arlington.
[24] WHO Organization (1990) International Classification of Diseases. 9th Revision, WHO, Geneva.
[25] Kuhn, T.S. (1977) Second Thoughts on Paradigms. In: Kuhn, T.S., Ed., The Essential Tension: Selected Studies in Scientific Tradition and Change, University of Chicago Press, Chicago, 293-320.
[26] Maslow, A.H. (1943) A Theory of Human Motivation. Psychological Review, 50, 370-396.
http://dx.doi.org/10.1037/h0054346
[27] Sichel, D. (2003) Neurohormonal Aspects of Postpartum Depression and Psychosis. In: Spinelli, M.G., Ed., Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill, American Psychiatric Publishing & APA, Washington DC, 61-80.
[28] McEwen, B.S. (2003) Mood Disorders and Allostatic Load. Biological Psychiatry, 54, 200-207. http://dx.doi.org/10.1016/S0006-3223(03)00177-X
[29] Kirschbaum, C., Kudielka, B.M., Gaab, J., Schommer, N.C. and Hellhammer, D.H. (1999) Impact of Gender, Menstrual Cycle Phase, and Oral Contraceptives on the Activity of the Hypothalamus-Pituitary-Adrenal Axis. Psychosomatic Medicine, 61, 154-162. http://dx.doi.org/10.1097/00006842-199903000-00006
[30] McEwen, B.S. (1998) Stress, Adaptation, and Disease: Allostasis and Allostatic Load. Annals of the New York Academy of Sciences, 840, 33-44. http://dx.doi.org/10.1111/j.1749-6632.1998.tb09546.x
[31] McEwen, B.S. and Wingfield, J.C. (2010) What’s in a Name? Integrating Homeostasis, Allostasis and Stress. Hormones and Behavior, 57, 105-111. http://dx.doi.org/10.1016/j.yhbeh.2009.09.011
[32] Obel, C., Hedegaard, M., Henriksen, T.B., Secher, N.J., Olsen, J. and Levine, S. (2005) Stress and Salivary Cortisol during Pregnancy. Psychoneuroendocrinology, 30, 647-656.
http://dx.doi.org/10.1016/j.psyneuen.2004.11.006
[33] Tu, M.T., Lupien, S.J. and Walker, C.D. (2005) Measuring Stress Responses in Postpartum Mothers: Perspectives from Studies in Human and Animal Populations. Stress, 8, 19-34.
http://dx.doi.org/10.1080/10253890500103806
[34] Talge, N., Neal, C. and Glover, V. (2007) Antenatal Maternal Stress and Long-Term Effects on Child Neurodevelopment: How and Why. Journal of Child Psychology and Psychiatry, 48, 245-261. http://dx.doi.org/10.1111/j.1469-7610.2006.01714.x
[35] Young, E.A., Tolman, R., Witkowski, K. and Kaplan, G. (2004) Salivary Cortisol and Posttraumatic Stress Disorder in a Low-Income Community Sample of Women. Biological Psychiatry, 55, 621-626. http://dx.doi.org/10.1016/j.biopsych.2003.09.009
[36] Glynn, L.M., Davis, E.P. and Sandman, C.A. (2013) New Insights into the Role of Perinatal HPA-Axis Dysregulation in Postpartum Depression. Neuropeptides, 47, 363-370.
http://dx.doi.org/10.1016/j.npep.2013.10.007
[37] Jung, C., Ho, J.T., Torpy, D.J., Rogers, A., Dooque, M., Lewis, J.G., et al. (2011) A Longitudinal Study of Plasma and Urinary Cortisol in Pregnancy and Postpartum. Journal of Endrocrinology & Metabolism, 96, 1533-1540. http://dx.doi.org/10.1210/jc.2010-2395
[38] Handley, S.L., Dunn, T.L., Waldron, G. and Baker, J.M. (1980) Tryptophan, Cortisol and Puerperal Mood. British Journal of Psychiatry, 136, 498-508. http://dx.doi.org/10.1192/bjp.136.5.498
[39] Ehlert, U., Patalla, U., Kirschbaum, E., Piedemont, E. and Hellhammer, D.H. (1990) Postpartum Blues: Salivary Cortisol and Psychological Factors. Journal of Psychosomatic Research, 34, 319-325. http://dx.doi.org/10.1016/0022-3999(90)90088-L
[40] Pedersen, C.A., Stern, R.A., Pate, J., Senger, M.A., Bowes, W.A. and Mason, G.A. (1993) Thyroid and Adrenal Measures during Late Pregnancy and the Puerperium in Women Who Have Been Major Depressed or Who Become Dysphoric Postpartum. Journal of Affective Disorders, 29, 201-211. http://dx.doi.org/10.1016/0165-0327(93)90034-H
[41] Mehta, D., Newport, D.J., Frishman, G., Kraus, L., Rex-Haffner, M., Ritchies, J.C., Lori, A., Knight, B.T., et al. (2014) Early Predictive Biomarkers for Postpartum Depression Point to a Role for Estrogen Receptor Signaling. Psychological Medicine, Epub Ahead of Print.
[42] Davidson, B.J., Murray, R.D., Challis, J.R. and Valenzuela, G.J. (1987) Estrogen, Progesterone, Prolactin, Prostaglandin E2, Prostaglandin F2α, 13,14-Dihydro-15-Keto-Prostaglandin F2α, and 6-Keto-Prostaglandin F1α Gradients across the Uterus in Women in Labor and Not in Labor. American Journal of Obstetrics and Gynecology, 157, 54-58. http://dx.doi.org/10.1016/S0002-9378(87)80345-9
[43] Lofgren, M. and Backstromxy, T. (1990) Serum Concentrations of Progesterone and 5α-Pregnane-3,20-Dione during Lr and Early Post Partum. Acta Obstetricia et Gynecologica Scandinavica, 69, 123-126. http://dx.doi.org/10.3109/00016349009006156
[44] Doornbos, B., Fokkema, D.S., Molhoek, M., Tanke, M.A., Postema, F. and Korf, J. (2009) Abrupt Rather than Gradual Hormonal Changes Induce Postpartum Blues-Like Behavior in Rats. Life Science, 84, 69-74. http://dx.doi.org/10.1016/j.lfs.2008.10.014
[45] Kumar, R. and Robson, K. (1978) Previous Induced Abortion and Ante-Natal Depression in Primiparae: Preliminary Report of a Survey of Mental Health in Pregnancy. Psychological Medicine, 8, 711-715. http://dx.doi.org/10.1017/S0033291700018912
[46] Spinelli, M.G. (1999) Prevention of Postpartum Mood Disorders. In: Postpartum Mood Disorders, American Psychiatric Association, Arlington, 217-235.
[47] Miller, L.J. (2003) Denial of Pregnancy. In: Spinelli, M.G., Ed., Infanticide: Psychosocial and Legal Perspectives on Mother Who Kill, American Psychiatric Publishing, Washington DC, 81-104.
[48] Mota, N., Burnett, M. and Sareen, J. (2010) Associations between Abortion, Mental Disorders, and Suicidal Behavior in a Nationally Representative Sample. The Canadian Journal of Psychiatry, 55, 239-247.
[49] Franz, W. and Reardon, D. (1992) Differential Aspects of Abortion on Adolescence. Adolescence, 105, 160-172.
[50] Major, B. and Gramzow, R.H. (1999) Abortion as Stigma: Cognitive and Emotional Implications of Concealment. Journal of Personality and Social Psychology, 77, 735-745.
http://dx.doi.org/10.1037/0022-3514.77.4.735
[51] David, P., Rasmusen, N. and Holdt, E. (1980) Postpartum and Postabortion Psychotic Reactions. Family Planning Perspectives, 13, 88-91. http://dx.doi.org/10.2307/2134703
[52] Horowitz, M.J. (2001) Stress Response Syndromes. J. Aronson, New York.
[53] Horowitz, M., Wilner, N. and Alvarez, W. (1979) Impact of Event Scale: A Measure of Subjective Stress. Psychosomatic Medicine, 41, 209-218. http://dx.doi.org/10.1097/00006842-197905000-00004
[54] Angelo, E.J. (1992) Psychiatric Sequelae of Abortion: The Many Faces of Post Abortion Grief. Linacre Quarterly, 59, 69-80.
[55] Institute of Medicine Report (2000) To Err Is Human: Building a Safer Health System. National Academy Press, Washington DC.

  
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