No Link Between Abortion and Suicide Attempts

Abortion does not increase a woman's risk of attempting suicide, new research shows.

In the first study to compare attempted suicide risk before and after an abortion, investigators found there was no difference in the rate of suicide attempts between women who did and did not attempt suicide.

The new findings, investigators note, call into question state policies that require providers to tell patients about potential mental health risks, including suicide.

"The view that having an abortion leads to suicidal thoughts, plans, or even 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," lead author Julia R. Steinberg, MD, University of Maryland, College Park, said in a release.

The study did show that women who have abortions were more likely to attempt suicide than those who did not have abortions. However, the risk of suicide attempt was the same the year before, and the year after, the abortion and decreased as time went on. Therefore, the increased risk can't be attributed to the abortion itself, the researchers conclude.

Instead, the study showed that pre-existing mental health problems, which were more common in women having abortions, were associated with the increased risk of attempted suicide.

"The findings suggest mental health screening in the abortion care setting may help a group vulnerable to pre-existing mental health problems that otherwise may not have had screenings, diagnoses, or treatment for mental health problems," lead researcher Julie Steinberg, PhD, from the University of Maryland, College Park, told Medscape Medical News.

The study was published online November 19 in Lancet Psychiatry. It was funded by the Society of Family Planning, American Foundation for Suicide Prevention, and Lundbeck Foundation Initiative for Integrative Psychiatric Research.

Policies Not Evidence-Based

Using data on Danish women aged 18 to 36 years, the researchers assessed the association between abortion and first-time nonfatal suicide attempts in the year before abortion, the year after, and with increasing time since abortion.

Of the 523,380 women included in the study, 48,990 (9.4%) had at least one first-trimester abortion and 10,216 (2.0%) had a suicide attempt during the 17-year study period. Among those who had an abortion, 1409 (2.9%) had a first suicide attempt after the first abortion.

There were no differences in the unadjusted rates of suicide attempts in the year before and after an abortion — 8.9 attempts in every 1000 women in the year before an abortion and 8.6 attempts in every 1000 women in the year after.

Over time, the unadjusted rate of suicide attempts decreased to 4.6 attempts in every 1000 women per year between 1 to 5 years after an abortion, and to 2.2 in every 1000 women per year after 5 years or more. This rate is similar to the rate of 2 per 1000 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 was the same rate as in women who had not had an abortion. This counters the notion of "post-abortion syndrome", which suggests the effects are not experienced until a long time afterward, Steinberg said in a statement.

Similarly, in the fully adjusted model, compared with their counterparts who did not have an abortion, the risk of first-time nonfatal suicide attempt was similar in the year before an abortion (incidence rate ratio [IRR], 2.46; 95% CI, 2.22 - 2.72) and the year after an abortion (IRR, 2.54; 95% CI, 2.29 - 2.81; P = .509). This rate decreased over time since the abortion (1-5 years: IRR, 1.90; 95% CI, 1.75 - 2.06; ≥ 5 years: IRR, 1.73; 95% CI, 1.53 - 1.96).

Researchers note the strongest risk factors for suicide attempts were having previous contact with a psychiatric service, previous use of antidepressant medication, previous use of antianxiety medication, and previous use of antipsychotic medication.

"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," Steinberg said. "These policies are not evidence-based according to our findings, and other published findings with these data and other data."

"A Welcome Addition"

Writing in a linked comment, Jenneke van Ditzhuijzen, PhD, from the University of Amsterdam, the Netherlands, said the study findings are based on "an impressively large, bias-free, real-world registry dataset, and is a welcome addition to the academic literature."

The available evidence, writes van Ditzhuijzen, suggests that an abortion is not the cause of mental health problems, "but can be considered a byproduct of conditions that preceded or co-occurred with the unintended pregnancy and abortion, which is in line with conclusions from larger review studies."

"To successfully prevent unwanted pregnancies and abortions, we should focus on the circumstances and characteristics that predispose women to having these unwanted pregnancies, rather than focus on the potential mental health consequences of abortion," van Ditzhuijzen suggests.

Lancet Psych. Published online November 19, 2019. Article, Comment

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