Abortion, Substance Abuse and Mental Health in Early Adulthood: Thirteen-Year Longitudinal Evidence from the United States

Abstract

Objective: To examine the links between pregnancy outcomes (birth, abortion, or involuntary pregnancy loss) and mental health outcomes for U. S. women during the transition into adulthood to determine the extent of increased risk, if any, associated with exposure to induced abortion.

Method: Panel data on pregnancy history and mental health history for a nationally-representative cohort of 8,005 women at (average) ages 15, 22, and 28 years from the National Longitudinal Study of Adolescent to Adult Health were examined for risk of depression, anxiety, suicidal ideation, alcohol abuse, drug abuse, cannabis abuse, and nicotine dependence by pregnancy outcome (birth, abortion, involuntary pregnancy loss). Risk ratios (RR) were estimated for time-dynamic outcomes from population-averaged longitudinal logistic and poisson regression models.

Results: After extensive adjustment for confounding, other pregnancy outcomes, and sociodemographic differences, abortion was consistently associated with increased risk of mental health disorder. Overall risk was elevated 45% (RR 1.45, 95% CI 1.30-1.62, p. < .0001). Risk of mental health disorder with pregnancy loss was mixed, but also elevated 24% (RR 1.24, 95% CI 1.13-1.37, p. < .0001) overall. Birth was weakly associated with reduced mental disorders. One-eleventh (8.7%, 95% CI 6.0-11.3) of the prevalence of mental disorders examined over the period were attributable to abortion.

Conclusion: Evidence from the United States confirms previous findings from Norway and New Zealand that, unlike other pregnancy outcomes, abortion is consistently associated with a moderate increase in risk of mental health disorders during late adolescence and early adulthood.

SSRN version includes supplemental tables.

Keywords: Abortion, Substance Abuse, Mental Health, Pregnancy Outcomes, Longitudinal Data, National Longitudinal Study of Adolescent to Adult Health