[Psychiatric complications of abortion].
BACKGROUND
The psychiatric consequences of induced abortion continue to be the object of controversy. The reactions of women when they became aware of conception are very variable. Pregnancy, whether initially intended or unintended, may provoke stress; and miscarriage may bring about feelings of loss and grief reaction. Therefore, induced abortion, with its emotional implications (of relief, shame and guilt) not surprisingly is a stressful adverse life event. METHODOLOGICAL CONSIDERATIONS: There is agreement among researchers on the need to compare the mental health outcomes (or the psychiatric complications) with appropriate groups, including women with unintended pregnancies ending in live births and women with miscarriages. There is also agreement on the need to control for the potential confounding effects of multiple variables: demographic, contextual, personal development, previous or current traumatic experiences, and mental health prior to the obstetric event. Any psychiatric outcome is multi-factorial in origin and the impact of life events depend on how they are perceived, the psychological defence mechanisms (unconscious to a great extent) and the coping style. The fact of voluntarily aborting has an undeniable ethical dimension in which facts and values are interwoven.


RESULTS
No research study has found that induced abortion is associated with a better mental health outcome, although the results of some studies are interpreted as <<neutral>> or <<mixed.>> Some general population studies point out significant associations with alcohol or illegal drug dependence, mood disorders (including depression) and some anxiety disorders. Some of these associations have been confirmed, and nuanced, by longitudinal prospective studies which support causal relationships.


CONCLUSIONS
With the available data, it is advisable to devote efforts to the mental health care of women who have had an induced abortion. Reasons of the woman's mental health by no means can be invoked, on empirical bases, for inducing an abortion.
Departamento de Psiquiatría y Psicología Médica, Facultad de Medicina, Universidad de Granada, Granada, Spain. gurpegui@ugr.es
Manuel
M
Gurpegui
Dolores
D
Jurado
D000028:Abortion, Induced / Q000523:psychology*; D000022:Abortion, Spontaneous / Q000523:psychology; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology; D015986:Confounding Factors, Epidemiologic; D004644:Emotions; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D012107:Research Design; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology; D019966:Substance-Related Disorders / Q000150:complications; D013405:Suicide; D055815:Young Adult