Women With Anxiety Disorders

Using data from the 1995 National Survey of Family Growth (NSFG), Cougle et al. (2005) examined survey records of women for risk of generalized anxiety to see if having an abortion or giving birth to a child during their first pregnancies made any difference to their mental states. Approximately two-thirds of them (N = 1,813) carried their first pregnancies to term while approximately one-third (N = 1,033) had an abortion. They excluded both women who reported a period of anxiety prior to their first pregnancy as well as women with subsequent abortions. Although the entire group who chose to have an abortion demonstrated significantly greater prevalence of anxiety than the entire group of those who had the child, the subsection of women over 20 years old in both groups showed less divergent levels of anxiety, and the entire sample had rates 5% higher than the general population (Cougle et al., 2005).

These results indicated that it may be that first pregnancies, and not abortion, are more likely to be related to anxiety. Additionally, although the authors cautioned that no causal relationship was sought in the data, nor were any post-delivery or post-abortion measures collected, it is easy for those not familiar with the difference between correlational and causal statistical analyses to misattribute abortion as the cause of anxiety disorders such as general anxiety disorder (GAD) from this study. In fact, this same misattribution has been seen in legal arguments proposed by those interested in restricting access to abortion (Rubin & Russo, 2004; Russo, in press). At best, the findings suggest abortion may be more stressful for younger women and that generalized worry may be a form of cognitive avoidance. However, while both of these possibilities could be considered as risk factors for post-abortion distress, this study, like others, did not assess for any causal factors (Adler et al., 1992; Coleman et al., 2005).

Several other serious methodological errors in collecting the data for this study make it difficult to truly assess levels of anxiety in pregnant women. First, there were no standardized tests used to measure postabortion anxiety. Second, the measures of anxiety that were used were substantially higher that those found in other surveys, because the measure of anxiety used by the National Survey of Family Growth (NSFG) did not correspond to the criteria used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R or DSM-IV). In addition, despite the availability of rape history information, exposure to violence was not assessed (Steinberg & Russo, 2007). This last flaw is critical given the high risk that exposure to rape and other forms of violence can cause posttraumatic stress disorder (PTSD), which is an anxiety disorder. It is entirely possible that Cougle and his colleagues were actually measuring PTSD from physical and sexual abuse and not anxiety from the abortion. In fact, had this been a better designed study, the findings might well have been that women with PTSD who had an abortion may have fewer anxiety symptoms and greater relief than those who carry the pregnancy to term.

Steinberg and Russo reanalyzed the NSFG data because of the limitations in appropriate sampling weights. In reanalyzing the data, the authors controlled for rape history, age at first pregnancy outcome, race, marital status, income, education, subsequent abortions, and subsequent deliveries. In doing so, there was no relationship found between relationship between abortion of the first pregnancy and subsequent anxiety symptoms.

Steinberg and Russo then analyzed National Comorbidity Survey (NCS) data to examine the relationship between abortion of the first pregnancy to GAD, social phobia, and PTSD. Although the mental health outcomes are well defined in the NCS, unwantedness of pregnancy is not identified. Even with this delivery group advantage, ever-pregnant women who reported having an abortion did not differ in rates of GAD or social phobia from such women who never had an abortion. Women who experienced abortion had substantially higher rates of PTSD, however. Logistic regression analyses found these rates accounted for by the higher rates of violence in the lives of women in the abortion group. Steinberg and Russo (2007) concluded that the elevated rates of anxiety found in Cougle et al. likely reflect elevated PTSD symptoms that were unidentified due to inadequacies of the NSFG data set.

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