Dimensions of decision difficulty in women's decision-making about abortion: A mixed methods longitudinal study

Relatively little is known about the ease or difficulty with which women decide to have an abortion, and most research uses single-item measurements. We used a mixed methods approach to combine data from the Dutch Abortion and Mental Health Study (DAMHS, n = 325) with data from a qualitative study about the decision process with a small subsample (n = 69) of the DAMHS study. We used the findings from the qualitative study to develop the Dimensions of Abortion Decision Difficulty [DADD] scale, and tested this scale among a larger sample of women who took part in the second wave of the cohort study (n = 264). Qualitative analyses revealed six dimensions of decision difficulty. The DADD scale was based on these six dimensions. Results from the DADD scale at follow-up reduced these to four dimensions: (1) unrealistic fears about the abortion and fantasies about the pregnancy; (2) decision conflict; (3) negative abortion attitudes; and (4) general indecisiveness. Decision conflict was the only dimension related to previous mental disorders. The findings suggest that the concept of decision difficulty seems multidimensional, rather than unidimensional. On a clinical level, it could be important to separate the more general fears, attitudes, and indecisiveness from strong decision conflict, because the latter might involve pressure of others, lack of decision ownership, and might be related to previous mental health.

Long-term incidence and recurrence of common mental disorders after abortion. A Dutch prospective cohort study

In a previous study (Van Ditzhuijzen et al., 2017) we investigated the incidence and recurrence of mental disorders 2.5 to 3 years post-abortion. The aim of the current study was to extend these findings with longer term follow up data, up until 5-6 years post-abortion. We compared data of women who had had an abortion of the Dutch Abortion and Mental Health Study (DAMHS) to women who did not have an abortion from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) (N_total = 2227). We used 1-to-1 matching on background confounding variables and measured post-abortion incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, and substance use disorders) using the Composite International Diagnostic Interview (CIDI) version 3.0. After matching on confounding variables, abortion did not increase the likelihood that women had incident or recurrent mental disorders in the 5-6 years post-abortion (any incident mental disorder: OR = 3.66, p = .16; any recurrent mental disorder: OR = 0.22, p = .47). We found no evidence that experiencing an abortion increases the risk on new or recurrent mental disorders on the longer term.

Correlates of Common Mental Disorders Among Dutch Women Who Have Had an Abortion: A Longitudinal Cohort Study

CONTEXT

Credible research has not found any evidence that abortion causes mental disorders. It is not known, however, whether abortion-specific risk indicators and other variables are associated with the incidence or recurrence of mental disorders after abortion.

METHODS

As part of a prospective cohort study conducted in the Netherlands, 325 women were interviewed between April 2010 and January 2011, between 20 and 40 days after having an abortion; 264 were followed up an average of 2.7 years later. Associations between selected baseline variables and postabortion incident or recurrent mental disorders among the 199 women at risk were investigated using bivariate and multivariate logistic regression analyses.

RESULTS

Thirty-two percent of women at risk of an incident or recurrent mental disorder experienced one after the abortion. In multivariate analyses, no abortion-related variables (e.g., history of multiple abortions, second-trimester abortion, preabortion decision difficulty or uncertainty, and postabortion negative emotions) were associated with experience of any postabortion incident or recurrent mental disorders. The outcome was positively associated with having conceived within an unstable relationship (odds ratio, 3.0), number of negative life events in the past year (1.4) and having a history of mental disorders (2.4).

CONCLUSIONS

Correlates of postabortion mental disorders were variables that have been identified as general risk factors for mental disorders, which supports the idea that abortion does not pose specific risks to future mental health. Future research should investigate in what way unstable relationships, adverse life events and psychiatric history affect postabortion mental health.

Incidence and recurrence of common mental disorders after abortion: Results from a prospective cohort study

Research in the field of mental health consequences of abortion is characterized by methodological limitations. We used exact matching on carefully selected confounders in a prospective cohort study of 325 women who had an abortion of an unwanted pregnancy and compared them 1-to-1 to controls who did not have this experience. Outcome measures were incidence and recurrence of common DSM-IV mental disorders (mood, anxiety, substance use disorders, and the aggregate measure 'any mental disorder') as measured with the Composite International Diagnostic Interview (CIDI) version 3.0, in the 2.5-3 years after the abortion. Although non-matched data suggested otherwise, women in the abortion group did not show significantly higher odds for incidence of 'any mental disorder', or mood, anxiety and substance use disorders, compared to matched controls who were similar in background variables but did not have an this experience. Having an abortion did not increase the odds for recurrence of the three disorder categories, but for any mental disorder the higher odds in the abortion group remained significant after matching. It is unlikely that termination of an unwanted pregnancy increases the risk on incidence of common mental disorders in women without a psychiatric history. However, it might increase the risk of recurrence among women with a history of mental disorders.

Young People Smokers' Reactions on Peer Influence Not to Smoke

BACKGROUND

Peers exert influence not to smoke but little is yet known on how this affects young people's behavior and cognitions.

OBJECTIVES

This experimental study investigates the impact of two types of peer influence not to smoke on the verbalized attitudes and responses of daily-smoking young people.

METHODS

Two conditions were conducted: 1) a peer confederate stating three times that s/he had quit smoking and was glad to have done so (covert peer influence); 2) a peer confederate making similar statements, but urging to quit smoking (overt peer influence). The participant performed a music task with the peer in order to disguise the true nature of the experiment. Thirty-one daily-smoking young people (16-24 years) participated; 44 responses in the overt and 34 responses in the covert condition were analyzed in a discourse analysis.

RESULTS

The participants in the covert condition were more elaborative about smoking, i.e., taking an active role in a dialogue about the experiences of the peer or the participant in quitting smoking while in the overt condition participants showed more passive resistance, i.e., not showing an intention to follow the advice but avoid causing the peer embarrassment or discomfort. Open resistance, i.e., demonstration of being well-informed and indicating the redundancy of the advice, does not significantly differ in these two conditions but occurs, for both, primarily at the third discouragement.

CONCLUSIONS

Overt and frequent discouragement seems to be less effective in stimulating young people to take an active role in the dialogue with their peers about smoking.

Psychiatric history of women who have had an abortion

Prior research has focused primarily on the mental health consequences of abortion; little is known about mental health before abortion. In this study, the psychiatric history of women who have had an abortion is investigated. 325 Women who recently had an abortion were compared with 1902 women from the population-based Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Lifetime prevalence estimates of various mental disorders were measured using the Composite International Diagnostic Interview 3.0. Compared to the reference sample, women in the abortion sample were three times more likely to report a history of any mental disorder (OR = 3.06, 95% CI = 2.36-3.98). The highest odds were found for conduct disorder (OR = 6.97, 95% CI = 4.41-11.01) and drug dependence (OR = 4.96, 95% CI = 2.55-9.66). Similar results were found for lifetime-minus-last-year prevalence estimates and for women who had first-time abortions only. The results support the notion that psychiatric history may explain associations that have been found between abortion and mental health. Psychiatric history should therefore be taken into account when investigating the mental health consequences of abortion.