Psychiatric aspects of therapeutic abortion

A search of the literature on the psychiatric aspects of abortion revealed poor study design, a lack of clear criteria for decisions for or against abortion, poor definition of psychologic symptoms experienced by patients, absence of control groups in clinical studies, and indecisiveness and uncritical attitudes in writers from various disciplines. A review of the sequelae of therapeutic abortion revealed that although the data are vague, symptoms of depression were reported most frequently, whereas those of psychosis were rare. Positive emotional responses and a favourable attitude toward therapeutic abortion were often reported, although again the statistical bases for these reports were inadequate. There was a lack of evidence that the reported effects were due to having an abortion rather than to other variables.Other areas dealt with inadequately in most of the articles reviewed included analyses of symptoms and of the evidence on the duration of sequelae, descriptions of the criteria for approving abortions, investigation of the psychiatric histories of the patients, presentation of data on the effects of refusing abortion requests, systematic study of a number of epidemiologic factors, and analyses of the circumstances leading to pregnancy in patients having abortions. The evidence was found to be sparse on the effects of supportive relationships, different abortion techniques and the length of gestation on the psychologic status of patients. Little attention was paid to the consequences of psychiatric labelling of patients, or to the effect of having an abortion on factors that may influence future pregnancies.The potential roles of health care professionals appear to deserve more study, and little research seems to have been done to compare the psychologic factors associated with abortion and those associated with live birth. As well, there is little evidence that differences in abortion legislation account for significant differences in the psychologic reactions of patients to abortion.