First-Time Abortion Not Associated with Increase in First-Time Antidepressant Use

Risk of antidepressant use decreased as the time after abortion increased.

Julia Steinberg, PhD

A recently published cohort study concluded that having a first abortion is not associated with an increase in a woman's risk of first-time antidepressant use.

Researchers from the University of Maryland School of Public Health analyzed data on 396,397 Danish women born between 1980—1994. The data studied included abortions, childbirths and antidepressant prescriptions recorded by the Danish National Registries and was used to analyze whether first-trimester first abortion is associated with an increase in women’s risk of first-time antidepressant use.

Study findings determined that compared with women who did not have an abortion, those who had a first abortion had a higher risk of first-time antidepressant; risk for first-time antidepressant use did not change the year before or after an abortion; and risk decreased as more time elapsed.

This is the first study to explore the risk of antidepressant use around abortion as a proxy for depression.

“Policies based on the notion that abortion harms women’s mental health are misinformed,” Julia Steinberg, PhD, University of Maryland said in a statement. “Abortion is not causing depression. Our findings show that women were not more likely to suffer from depression after an abortion compared to beforehand.”

First prescription redemption for antidepressant was determined and used as an indication of an episode of depression or anxiety. Researchers used incident rate ratios (IRR) to compare women who had an abortion with those who didn’t and women who gave birth with those who didn’t.

In the study population, 17,294 (4.4%) had a record of at least 1 first-trimester abortion and no children, 72,052 (18.2%) had at least 1 childbirth and no abortions, 13,540 (3.4%) had at least 1 abortion and 1 childbirth, 293,511 (74.1%) had neither an abortion nor a childbirth, and 59,465 (15%) of women redeemed at least 1 antidepressant prescription.

Among 30,834 women who had an abortion, 5705 (18.5%) initiated antidepressant use after a first abortion, while among 85,592 women who endured a first-childbirth, 10,825 (12.7%) initiated antidepressant use.

Researchers concluded that childbirth was associated with an increased likelihood of women using antidepressants more than 1 year later, but the increased use wasn’t due to the abortion but to differences in risk factors for depression.

This finding indicates that preexisting mental health conditions and other covariates are representative of the association between abortion and antidepressant use.

The strongest risk factors associated with first-time antidepressant use included indicators of previous mental health problems like prior psychiatric contact and previously obtained antipsychotic and antianxiety medication.

Compared with not having a childbirth, having a childbirth was associated with a decreased risk of antidepressant use in the year before childbirth and the year after. Rates of antidepressant use increased in the year after childbirth compared with the year before childbirth, and the risk of first-time antidepressant use in the year after was greater than the risk in the year before childbirth relative to not giving birth.

Furthermore, the risk of antidepressant use increased with increasing time after childbirth, while the risk of antidepressant use decreased as the time after abortion increased.

Compared with women who did not have an abortion, those who have an abortion may be at an increased risk of depression after undergoing the procedure because of a higher risk prior, so consequently, policies based on the notion that abortions harm women’s mental health may be misinformed.

The study, "Examining the Association of Antidepressant Prescriptions With First Abortion and First Childbirth" was published in JAMA Psychiatry.