On 2015 Dec 18, David Reardon commented:

Oversight of Bipolar Disorder Link to Abortion Demonstrated by Subsequent 2015 Study

Munk-Olsen's failure to account for prior abortion history in this study is underscored by a new study in the Journal of Affective Disorders, in which researchers found that 42.4 percent of the women with bipolar disorders had a history of abortion compared to only 13.5 percent of the control group.¹

These findings are consistent with a 2003 record linkage study of 56,741 low income women in California that I conducted with my colleagues. In that study we found that the rate of first-time psychiatric admissions for bipolar disorders was three times higher after abortion compared to childbirth during the four years following the pregnancy.²

References

1. Marengo E, Martino DJ, Igoa A, Scápola M, Fassi G, Baamonde MU, Strejilevich SA.Unplanned pregnancies and reproductive health among women with bipolar disorder. J Affect Disord. 2015 Jun 1;178:201-5.

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.

On 2014 Mar 05, David Reardon commented:

BiPolar Disorder Study Neglects Prior Research and Adequate Controls

The Munk-Olsen team’s study of elevated risk of bipolar affective disorder following psychiatric illness in the first month after a delivery is potentially important.¹ Unfortunately, the study neglected to control for the effects of prior pregnancy outcomes on bipolarity.

This omission is striking given the fact that Munk-Olsen has used the same data to publish two studies on abortion and subsequent psychiatric treatment.^2,3 She is also familiar with the three similar record linkage studies we have published in regard to a population of 56,751 low income women in California. ^4,5,6

One of these latter studies revealed that women with a history of abortion were three times more likely (OR 3.0, 95% CI 1.5-6.0) to be hospitalized for bipolar disorder than women who carried to term during the four years following pregnancy outcome.⁴ Our study also found that women who had abortions were 2.6 times more likely to be hospitalized for psychiatric treatment than were women delivered. ⁴ Similarly, Munk-Olsen has also found higher rates of psychiatric contact for each of the first 12 months following an abortion compared to delivery.² All of these facts have a direct bearing on the present study¹ and should have been addressed in the study design.

It is therefore tremendously baffling . . . if not suspicious . . . that the present study¹ did not include additional analyses relative to other pregnancy outcomes: abortion, miscarriage, and other pregnancy losses. Clearly, a history of pregnancy loss may impact the rates of postpartum depression following a live birth.^7,8 The failure to consider and control for pregnancy loss history is a major methodological weakness in this new study.

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. Yet studies such as this one continue to be published without information about the effects of pregnancy loss on the outcome, even when the researchers have access to complete reproductive histories. Whether investigation of these effects is being neglected due to lack of insight, or whether results are being redacted for ideological reasons, is unclear.

Journal editors and peer reviewers should heed the call for more research on associations between abortion and mental health by requesting that every study regarding reproductive outcomes and mental health should include segregated results allowing for comparisons relative to pregnancy outcome: live birth, miscarriage, abortion, and other losses.

While I communicated my hope that Munk-Olsen would correct this oversight in a reanalysis of the data shortly after this study was first published, no such results have yet been reported. To the contrary, the author has indicated there is no interest in addressing any of the issues I have raised. Despite this rebuff, it is important that reanalyses should be conducted to include segregated results allowing comparisons between delivering women with no history of pregnancy loss, women with a history of one abortion, women with a history of two or more abortions, and women with a history of one or more miscarriages.

References

(1) Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. 2011 Dec 5. [Epub ahead of print]

(2) Munk-Olsen T, Laursen TM, Pedersen CB, Lidegaard O, Mortensen PB. First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder. Arch Gen Psychiatry. 2012 Feb;69(2):159-65.

(3) Munk-Olsen T, Laursen TM, Pedersen CB, Lidegaard Ø, Mortensen PB. Induced first-trimester abortion and risk of mental disorder. N Engl J Med. 2011 Jan 27;364(4):332-9.

(4) 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.

(5) Coleman PK, Reardon DC, Rue VM, Cougle JR.State-funded abortions vs. deliveries: A comparison of outpatient mental health claims over five years. American Journal of Orthopsychiatry, 2002; 72(1):141–52.

(6) Reardon DC, Coleman PK. Relative treatment rates for sleep disorders and sleep disturbances following abortion and childbirth: a prospective record-based study. Sleep. 2006 Jan;29(1):105-6.

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

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

On 2014 Mar 05, David Reardon commented:

BiPolar Disorder Study Neglects Prior Research and Adequate Controls

The Munk-Olsen team’s study of elevated risk of bipolar affective disorder following psychiatric illness in the first month after a delivery is potentially important.¹ Unfortunately, the study neglected to control for the effects of prior pregnancy outcomes on bipolarity.

This omission is striking given the fact that Munk-Olsen has used the same data to publish two studies on abortion and subsequent psychiatric treatment.^2,3 She is also familiar with the three similar record linkage studies we have published in regard to a population of 56,751 low income women in California. ^4,5,6

One of these latter studies revealed that women with a history of abortion were three times more likely (OR 3.0, 95% CI 1.5-6.0) to be hospitalized for bipolar disorder than women who carried to term during the four years following pregnancy outcome.⁴ Our study also found that women who had abortions were 2.6 times more likely to be hospitalized for psychiatric treatment than were women delivered. ⁴ Similarly, Munk-Olsen has also found higher rates of psychiatric contact for each of the first 12 months following an abortion compared to delivery.² All of these facts have a direct bearing on the present study¹ and should have been addressed in the study design.

It is therefore tremendously baffling . . . if not suspicious . . . that the present study¹ did not include additional analyses relative to other pregnancy outcomes: abortion, miscarriage, and other pregnancy losses. Clearly, a history of pregnancy loss may impact the rates of postpartum depression following a live birth.^7,8 The failure to consider and control for pregnancy loss history is a major methodological weakness in this new study.

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. Yet studies such as this one continue to be published without information about the effects of pregnancy loss on the outcome, even when the researchers have access to complete reproductive histories. Whether investigation of these effects is being neglected due to lack of insight, or whether results are being redacted for ideological reasons, is unclear.

Journal editors and peer reviewers should heed the call for more research on associations between abortion and mental health by requesting that every study regarding reproductive outcomes and mental health should include segregated results allowing for comparisons relative to pregnancy outcome: live birth, miscarriage, abortion, and other losses.

While I communicated my hope that Munk-Olsen would correct this oversight in a reanalysis of the data shortly after this study was first published, no such results have yet been reported. To the contrary, the author has indicated there is no interest in addressing any of the issues I have raised. Despite this rebuff, it is important that reanalyses should be conducted to include segregated results allowing comparisons between delivering women with no history of pregnancy loss, women with a history of one abortion, women with a history of two or more abortions, and women with a history of one or more miscarriages.

References

(1) Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. 2011 Dec 5. [Epub ahead of print]

(2) Munk-Olsen T, Laursen TM, Pedersen CB, Lidegaard O, Mortensen PB. First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder. Arch Gen Psychiatry. 2012 Feb;69(2):159-65.

(3) Munk-Olsen T, Laursen TM, Pedersen CB, Lidegaard Ø, Mortensen PB. Induced first-trimester abortion and risk of mental disorder. N Engl J Med. 2011 Jan 27;364(4):332-9.

(4) 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.

(5) Coleman PK, Reardon DC, Rue VM, Cougle JR.State-funded abortions vs. deliveries: A comparison of outpatient mental health claims over five years. American Journal of Orthopsychiatry, 2002; 72(1):141–52.

(6) Reardon DC, Coleman PK. Relative treatment rates for sleep disorders and sleep disturbances following abortion and childbirth: a prospective record-based study. Sleep. 2006 Jan;29(1):105-6.

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

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

On 2015 Dec 18, David Reardon commented:

Oversight of Bipolar Disorder Link to Abortion Demonstrated by Subsequent 2015 Study

Munk-Olsen's failure to account for prior abortion history in this study is underscored by a new study in the Journal of Affective Disorders, in which researchers found that 42.4 percent of the women with bipolar disorders had a history of abortion compared to only 13.5 percent of the control group.¹

These findings are consistent with a 2003 record linkage study of 56,741 low income women in California that I conducted with my colleagues. In that study we found that the rate of first-time psychiatric admissions for bipolar disorders was three times higher after abortion compared to childbirth during the four years following the pregnancy.²

References

1. Marengo E, Martino DJ, Igoa A, Scápola M, Fassi G, Baamonde MU, Strejilevich SA.Unplanned pregnancies and reproductive health among women with bipolar disorder. J Affect Disord. 2015 Jun 1;178:201-5.

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.