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Induced abortion and implications for long-term mental health: a cohort study of 1.2 million pregnancies
Nathalie Auger1, Jessica Healy-Profitós2, Aimina Ayoub2
1University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Background:
The relationship between induced abortion and long-term mental health is not clear. We assessed whether having an induced abortion was associated with an increase in the long-term risk of mental health hospitalization.
Methods:
We carried out a retrospective cohort study of 28,721 induced abortions and 1,228,807 births in hospitals of Quebec, Canada, between 2006 and 2022. The exposure was induced abortion compared with other pregnancies, and the outcome was hospitalization for a psychiatric disorder, substance use disorder, or suicide attempt over time. We followed patients up to 17 years after the end of pregnancy to identify mental health-related hospitalizations. We calculated hazard ratios (HR) and 95 % confidence intervals (CI) for the association between induced abortion and mental health hospitalization, adjusted for pregnancy characteristics.
Results:
Rates of mental health-related hospitalization were higher following induced abortions than other pregnancies (104.0 vs. 42.0 per 10,000 person-years). Abortion was associated with hospitalization for psychiatric disorders (HR 1.81, 95 % CI 1.72-1.90), substance use disorders (HR 2.57, 95 % CI 2.41-2.75), and suicide attempts (HR 2.16, 95 % CI 1.91-2.43) compared with other pregnancies. The associations were greater for patients who had preexisting mental illness or were aged less than 25 years at the time of the abortion. Abortion was strongly associated with mental health hospitalization within five years but risks waned over time.
Conclusion:
Induced abortion is associated with an increased risk of mental health-related hospitalization in the long term but the association weakens with time.
