On 2014 Jul 06, David Reardon commented:

The Munk-Olsen team’s study of antidepressant use and psychological treatments before, during, and after childbirth¹ unfortunately omits any control for the effects of prior pregnancies and any comparison to other pregnancy outcomes.

A history of pregnancy loss (including induced abortion or miscarriage) can be a stressor that may arouse unresolved feelings during and following subsequent pregnancies.^2,3,4 This is also evidenced by findings that women with a history of abortion are significantly more likely to self-medicate with drugs or alcohol during a subsequent pregnancy than women without a history of this pregnancy loss.⁵

The Munk-Olsen study would have been much more informative if it had included (a) controls for prior pregnancy outcomes, and (b) parallel analyses showing the treatment rates a year before and after other pregnancy outcomes, including abortion, miscarriage, and other natural losses. The failure to provide this additional analysis is most striking given the fact that Munk-Olsen has used the same data to publish a much more nuanced comparison of psychiatric treatment rates among women who have abortions and women who carry to terms.

Both the American Psychological Task Force on Abortion and Mental Health and the Royal College of Psychiatry have called for more research regarding abortion and mental health.

In a broad sense, efforts to study the interactions between reproductive health and mental health will never be reliable as long as researchers ignore or suppress analyses which fail to encompass the full reproductive history of women, including both voluntary and involuntary pregnancy losses. Journal editors and peer reviewers should be alert to this problem and should heed the call for better research by demanding that every study regarding reproductive outcomes and mental health should include segregated results allowing for direct comparison of outcome variables relative to the entire range of pregnancy outcomes: live birth, abortion, miscarriage, and other natural losses. By pressing researchers to address and report on these related pregnancy issues, reviewers and editors will helping to advance more rigorous investigation of all of these issues. Without such requests for more detailed analyses, study designs can easily be fashioned to avoid or minimize the investigation of controversial issues.

It is my hope that Munk-Olsen will address the research imperatives raised herein by expanding the study design presented in the present paper.¹

Reanalysis should include segregated results allowing comparisons between: (a) delivering women with no history of pregnancy loss, (b) delivering women with a history of one abortion, (c) delivering women with a history of two or more abortions, (d) delivering women with a history of one miscarriages, (e) delivering women with a history of two or more miscarriages, and treatment rates for (f) women with no prior pregnancy whose first pregnancy is aborted, and (g) women with no prior live birth who have two or more abortions or other losses.

References

(1) Munk-Olsen T, Gasse C, Laursen TM. Prevalence of antidepressant use and contacts with psychiatrists and psychologists in pregnant and postpartum women. Acta Psychiatr Scand. 2011 Nov 25. doi: 10.1111/j.1600-0447.2011.01784.x. [Epub ahead of print]

(2) Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Psychiatric admissions of low income women following abortion and childbirth. Can Med Assoc J. 2003; 168(10):1253-7.

(3) Burke T, Reardon DC. Forbidden Grief. The Unspoken Pain of Abortion. Springfield, IL: Acorn Books; 2002.

(4) Stotland NL. Abortion: social context, psychodynamic implications. Am J Psychiatry. 1998 Jul;155(7):964-7.

(5) Coleman PK, Reardon DC, Cougle JR. Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. Br J Health Psychol. 2005 May;10(Pt 2):255-68.

On 2014 Jul 06, David Reardon commented:

The Munk-Olsen team’s study of antidepressant use and psychological treatments before, during, and after childbirth¹ unfortunately omits any control for the effects of prior pregnancies and any comparison to other pregnancy outcomes.

A history of pregnancy loss (including induced abortion or miscarriage) can be a stressor that may arouse unresolved feelings during and following subsequent pregnancies.^2,3,4 This is also evidenced by findings that women with a history of abortion are significantly more likely to self-medicate with drugs or alcohol during a subsequent pregnancy than women without a history of this pregnancy loss.⁵

The Munk-Olsen study would have been much more informative if it had included (a) controls for prior pregnancy outcomes, and (b) parallel analyses showing the treatment rates a year before and after other pregnancy outcomes, including abortion, miscarriage, and other natural losses. The failure to provide this additional analysis is most striking given the fact that Munk-Olsen has used the same data to publish a much more nuanced comparison of psychiatric treatment rates among women who have abortions and women who carry to terms.

Both the American Psychological Task Force on Abortion and Mental Health and the Royal College of Psychiatry have called for more research regarding abortion and mental health.

In a broad sense, efforts to study the interactions between reproductive health and mental health will never be reliable as long as researchers ignore or suppress analyses which fail to encompass the full reproductive history of women, including both voluntary and involuntary pregnancy losses. Journal editors and peer reviewers should be alert to this problem and should heed the call for better research by demanding that every study regarding reproductive outcomes and mental health should include segregated results allowing for direct comparison of outcome variables relative to the entire range of pregnancy outcomes: live birth, abortion, miscarriage, and other natural losses. By pressing researchers to address and report on these related pregnancy issues, reviewers and editors will helping to advance more rigorous investigation of all of these issues. Without such requests for more detailed analyses, study designs can easily be fashioned to avoid or minimize the investigation of controversial issues.

It is my hope that Munk-Olsen will address the research imperatives raised herein by expanding the study design presented in the present paper.¹

Reanalysis should include segregated results allowing comparisons between: (a) delivering women with no history of pregnancy loss, (b) delivering women with a history of one abortion, (c) delivering women with a history of two or more abortions, (d) delivering women with a history of one miscarriages, (e) delivering women with a history of two or more miscarriages, and treatment rates for (f) women with no prior pregnancy whose first pregnancy is aborted, and (g) women with no prior live birth who have two or more abortions or other losses.

References

(1) Munk-Olsen T, Gasse C, Laursen TM. Prevalence of antidepressant use and contacts with psychiatrists and psychologists in pregnant and postpartum women. Acta Psychiatr Scand. 2011 Nov 25. doi: 10.1111/j.1600-0447.2011.01784.x. [Epub ahead of print]

(2) Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Psychiatric admissions of low income women following abortion and childbirth. Can Med Assoc J. 2003; 168(10):1253-7.

(3) Burke T, Reardon DC. Forbidden Grief. The Unspoken Pain of Abortion. Springfield, IL: Acorn Books; 2002.

(4) Stotland NL. Abortion: social context, psychodynamic implications. Am J Psychiatry. 1998 Jul;155(7):964-7.

(5) Coleman PK, Reardon DC, Cougle JR. Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. Br J Health Psychol. 2005 May;10(Pt 2):255-68.