title: Does abortion increase women's risk for post-traumatic stress? Findings from a prospective longitudinal cohort study.
abstract: OBJECTIVE
  To prospectively assess women's risk for post-traumatic stress disorder (PTSD) and of experiencing post-traumatic stress symptoms (PTSS) over 4 ears after seeking an abortion, and to assess whether symptoms are attributed to the pregnancy, abortion or birth, or other events in women's lives.
  
  
  METHODS
  Prospective longitudinal cohort study which followed women from approximately 1 week after receiving or being denied an abortion (baseline), then every 6 months for 4 years (9 interview waves).
  
  
  METHODS
  30 abortion facilities located throughout the USA.
  
  
  METHODS
  Among 956 women presenting for abortion care, some of whom received an abortion and some of whom were denied due to advanced gestational age; 863 women are included in the longitudinal analyses.
  
  
  METHODS
  PTSS and PTSD risk were measured using the Primary Care PTSD Screen (PC-PTSD). Index pregnancy-related PTSS was measured by coding the event(s) described by women as the cause of their symptoms.
  
  
  METHODS
  We used unadjusted and adjusted logistic mixed-effects regression analyses to assess whether PTSS, PTSD risk and pregnancy-related PTSS trajectories of women obtaining abortions differed from those who were denied one.
  
  
  RESULTS
  At baseline, 39% of participants reported any PTSS and 16% reported three or more symptoms. Among women with symptoms 1-week post-abortion seeking (n=338), 30% said their symptoms were due to experiences of sexual, physical or emotional abuse or violence; 20% attributed their symptoms to non-violent relationship issues; and 19% said they were due to the index pregnancy. Baseline levels of PTSS, PTSD risk and pregnancy-related PTSS outcomes did not differ significantly between women who received and women who were denied an abortion. PTSS, PTSD risk and pregnancy-related PTSS declined over time for all study groups.
  
  
  CONCLUSIONS
  Women who received an abortion were at no higher risk of PTSD than women denied an abortion.
authors.affiliation: Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA.
authors.forename: M Antonia
authors.initials: MA
authors.lastname: Biggs
authors.affiliation: Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA.
authors.forename: Brenly
authors.initials: B
authors.lastname: Rowland
authors.affiliation: Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Advancing New Standards in Reproductive Health, A Program of the University of California, San Francisco, Oakland, California, USA.
authors.forename: Diana G
authors.initials: DG
authors.lastname: Foster
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: ABORTION; MENTAL HEALTH; PREGNANCY
references.citation: BMC Womens Health. 2013;13:52
references.pmid: 24364878
references.citation: Perspect Sex Reprod Health. 2013 Sep;45(3):122-31
references.pmid: 24020773
references.citation: Soc Sci Med. 2014 Feb;102:18-25
references.pmid: 24565137
references.citation: Perspect Sex Reprod Health. 2014 Mar;46(1):3-14
references.pmid: 24494995
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2014 Mar;49(3):447-57
references.pmid: 24022753
references.citation: Am J Public Health. 2014 Sep;104(9):1687-94
references.pmid: 23948000
references.citation: BMC Med. 2014;12:144
references.pmid: 25262880
references.citation: J Pregnancy. 2015;2015:646345
references.pmid: 25734016
references.citation: Sex Reprod Healthc. 2015 Jun;6(2):50-3
references.pmid: 25998870
references.citation: Psychol Med. 2015 Jul;45(10):2073-82
references.pmid: 25628123
references.citation: Psychosom Med. 2004 Mar-Apr;66(2):265-71
references.pmid: 15039513
references.citation: Med Sci Monit. 2004 Oct;10(10):SR5-16
references.pmid: 15448616
references.citation: Int J Soc Psychiatry. 1993 Winter;39(4):255-65
references.pmid: 8150571
references.citation: Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
references.pmid: 7492257
references.citation: Gen Hosp Psychiatry. 2005 Jan-Feb;27(1):36-43
references.pmid: 15694217
references.citation: BMC Med. 2005;3:18
references.pmid: 16343341
references.citation: Perspect Sex Reprod Health. 2008 Mar;40(1):6-16
references.pmid: 18318867
references.citation: Contraception. 2008 Dec;78(6):436-50
references.pmid: 19014789
references.citation: J Psychiatr Res. 2009 May;43(8):770-6
references.pmid: 19046750
references.citation: Harv Rev Psychiatry. 2009;17(4):268-90
references.pmid: 19637075
references.citation: Am Psychol. 2009 Dec;64(9):863-90
references.pmid: 19968372
references.citation: Depress Anxiety. 2010 Aug;27(8):699-707
references.pmid: 20577979
references.citation: MMWR Surveill Summ. 2011 Feb 25;60(1):1-42
references.pmid: 21346710
references.citation: J Pregnancy. 2010;2010:130519
references.pmid: 21490737
references.citation: Curr Opin Obstet Gynecol. 2011 Oct;23(5):340-3
references.pmid: 21836505
references.citation: J Psychiatr Res. 2012 Mar;46(3):407-8; discussion 408-11
references.pmid: 22348853
references.citation: Womens Health Issues. 2012 Jul-Aug;22(4):e359-64
references.pmid: 22609254
references.citation: J Trauma Acute Care Surg. 2012 Aug;73(2):462-7; discussion 467-8
references.pmid: 22846957
references.citation: Int J Gynaecol Obstet. 2012 Sep;118 Suppl 2:S152-9
references.pmid: 22920620
references.citation: J Behav Health Serv Res. 2013 Jul;40(3):279-93
references.pmid: 23576135
references.citation: Perspect Sex Reprod Health. 2013 Jun;45(2):79-88
references.pmid: 23750622
references.citation: Psychiatry Clin Neurosci. 2013 Jul;67(5):301-10
references.pmid: 23859662
references.citation: BMC Womens Health. 2013;13:29
references.pmid: 23829590
references.citation: Womens Health Issues. 2014 Jan-Feb;24(1):e115-23
references.pmid: 24439937