Depression itself is a well-recognized medical condition. But can depression be caused by abortion?
There is only limited research into the psychological effects of abortion. A lot of the research has been complicated by technical problems such as not being able to control for other factors that could be behind a case of depression, rather than the abortion itself.
The experience of abortion is different for each woman and varies widely. Feelings after an abortion can be mixed. Women may have both positive and negative feelings.
In general, abortion may be followed by feelings of sadness, grief, loss or regret. If these feelings do occur and are severe enough, or last for long enough, they may amount to depression.
First feelings about abortion
Abortion can be a stressful life event for some women who choose to terminate their pregnancy.
The pregnancy in the first place may be a source of stress itself. It may have been an unwanted pregnancy or linked with other problems.
Following an abortion, women can have unexpected reactions and emotions. The topic can be difficult to talk about for cultural and religious reasons. Some women may feel greater guilt and emotional distress because of religious influences that create stigma around abortion.
Abortion may be followed by feelings of sadness, grief, loss, or regret.
Many of the psychological and emotional responses to abortion are normal. Most should not be persistent or severe enough to badly affect a woman's daily life, and should go away.
The range of typical feelings experienced with abortion might include:
- Grief, a sense of loss
- Remorse or regret
- Stress, reduced ability to cope
- Loss of self-esteem
- Relief, reduced anxiety
Not all women have negative emotional responses to abortion. Most who do will not have any lasting mental health problems.
Many women have positive responses to abortion, including feelings of relief. Some women feel no regret, instead having a sense of confidence about having made "the right choice."
What is depression?
Depression is a psychological or mental health condition. It is a mood disorder.
People with depression may have these signs and symptoms:
- Feeling low or sad
- Reduced thinking abilities
- Poor concentration, and difficulty making decisions
- Feeling irritable
- Lack of energy, tiredness
- Loss of interest in sex
- Loss of interest in activities that were previously enjoyed
- Disturbed sleep patterns
Depression comes with different levels of severity. People with mild depression are able to carry on with their usual daily activities.
Severe depression affects life so badly that it may prove difficult to work. Severe depression can also lead to more serious mental health symptoms such as psychosis.
Suicidal feelings or self-harm are serious symptoms that need urgent help.
Depression does not cause physical changes, although people who are depressed may talk more slowly.
The effects of depression on levels of interest can also have a secondary effect. Depression that causes loss of interest in food may lead to weight loss.
Depression, or grief about abortion?
Grief after the death of a partner, for example, is a natural reaction that should not lead to long-term depression.
Grief has the symptoms of depression but is clearly related to the loss.
Feelings of loss are also natural after the unplanned termination of a pregnancy, such as caused by illness or injury. These symptoms in response to spontaneous abortion should also not be lasting.
Even when a woman has chosen to terminate her pregnancy with an abortion, there can still be natural feelings of loss, sadness, grief, guilt, and regret afterward.
Some women may have been greatly influenced by people around them when making their decision. Feelings that are similar to symptoms of depression should normally improve.
An aborted pregnancy can be spontaneous. This means an abortion that has not been chosen by the woman but has been caused by illness or injury. Problems with the placenta, for example, can cause loss of pregnancy.
Other terms used for spontaneous abortion are stillbirth and miscarriage. Stillbirth generally refers to loss of later pregnancies, while miscarriage means termination happening in the first 24 weeks.
Depression risk factors
Women who have a mental disorder before having an unwanted pregnancy and then an abortion may experience the event differently than mentally healthy women. They may be more at risk, but the scientific evidence is not strong that there are particular depression risk factors related to abortion itself.
There is a higher risk of depression if the woman has a history of alcohol or drug abuse.
Women who already have a psychiatric disorder may be more likely than others to experience feelings of doubt before having an abortion. They are more likely to rate the experience of an abortion as having been an emotional burden, too.
The American Psychological Association Task Force on Mental Health and Abortion found in 2008 that some women are at a higher risk of depression. This higher risk was the same for women who opted for abortion as for the range of other pregnancy outcomes. The risk factors included:
- History of violence or emotional problems
- History of drug or alcohol use
- Previous unwanted childbirth
More general risk factors behind depression beyond any specific effects that might result from pregnancy and abortion are not well understood. The exact causes of depression are not known.
A higher risk of depression is linked to genetics. People with a first-degree relative who have depression are more likely to have it themselves, too.
Life events can trigger episodes of depression, but these are usually temporary. It is not clear why some people are triggered into lasting, more severe depression. Major life stresses include separation and loss.
Other risk factors are a poorer ability to cope with life's pressures, being female, and having more exposure to things that cause stress daily.
What is post-abortion stress syndrome?
Post-abortion stress syndrome (PASS or PAS) is a controversial name. Neither psychologists nor psychiatrists agree that the term should be used.
The features allotted to PASS have been compared to those of PTSD (posttraumatic stress disorder).
Talking therapy is a great way to treat depression.
It may be more appropriate to consider that some women might develop a form of PTSD following the trauma of an abortion, but such a level of distress is very rare.
The consensus, including from the American Psychological Association, is that the risk of mental ill health following abortion is no worse than following a decision to continue a pregnancy. Many agree that there is no reliable research to show that PASS exists.
One study following 500 women from birth until the age of 30 years found that mental health after abortion was slightly worse than for other courses of pregnancy. The effect was small, however, and would not amount to a trauma-related syndrome.
Treatment of depression
Depression is a treatable mental health condition. Three broad options are used to treat depression:
- Talking therapy
A mild case of depression may benefit from the support of a doctor in the form of monitoring. The symptoms may clear up on their own, and later follow-ups with the doctor can confirm this.
Talking therapies are available for all severities of depression. These include talking to a trained psychologist for psychotherapy or cognitive behavioral therapy (CBT). CBT helps the person to understand their thoughts and how they respond to them.
Counseling may also be available with non-specialist counselors or through group activities.
Talking to someone about abortion may be helpful. Healthcare providers often offer someone to talk to after an abortion as well as leading up to the decision.
Drug options for depression are numerous. There are dozens of antidepressant drugs that may be tried with the help of a doctor. These are usually used for moderate or severe cases of depression.
Having depression can be a long-term problem. Living with the disorder and recovering from it may be helped by improving diet and taking exercise.
More physical activity can lift mood and has wider health benefits. It may also prove to be a good way to get away from depressing, worrying, or stressful thoughts, and to make new social contacts.
Other options for coping with depression include activities such as yoga and mindful meditation.