Keskustelu, jossa puhutaan, että "94 % abortin tehneistä katuu sitä", menee jo tuolla kolmannella sivulla, joten laitan vielä uudeksi aloitukseksikin oikeita ja sellaisenaan julkaistuja tutkimustuloksia, kun ne kerran löysin.
Alla yhden aiheen Review-artikkelin otsikko, tekijätiedot ja tiivistelmä sekä luku, joka kertoo naisten tunteista abortin jälkeen.
Minä en löytänyt mistään 94 %, etsikää joku paremmin :D
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The effects of induced abortion on emotional experiences and relationships: A critical review of the literature
Zoë Bradshaw1 and Pauline SladeCorresponding Author Contact Information
Department of Psychology, Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2UR, UK
Received 6 March 2002; revised 28 February 2003; accepted 4 September 2003. ; Available online 13 November 2003.
Abstract
This paper reviews post-1990 literature concerning psychological experiences and sexual relationships prior to and following induced abortion. It assesses whether conclusions drawn from earlier reviews are still supported and evaluates the extent to which previous methodological problems have been addressed.
Following discovery of pregnancy and prior to abortion, 40–45% of women experience significant levels of anxiety and around 20% experience significant levels of depressive symptoms. Distress reduces following abortion, but up to around 30% of women are still experiencing emotional problems after a month. Women due to have an abortion are more anxious and distressed than other pregnant women or women whose pregnancy is threatened by miscarriage, but in the long term they do no worse psychologically than women who give birth. Self-esteem appears unaffected by the process. Less research has considered impact on the quality of relationships and sexual functioning, but negative effects were reported by up to 20% of women.
Conclusions were generally concordant with previous reviews. However, anxiety symptoms are now clearly identified as the most common adverse response. There has been increasing understanding of abortion as a potential trauma, and studies less commonly explore guilt. The quality of studies has improved, although there are still some methodological weaknesses.
Author Keywords: Termination; Pregnancy; Abortion; Psychological; Distress; Relationships
-----------
7. How do women feel after their abortion?
Most studies addressing this question have involved longitudinal designs, usually with assessments prior to and following abortion. However, changes in psychological variables when a preabortion baseline is used should be interpreted with caution, as previous reviews have found this to be the time of greatest distress [Adler et al., 1992]. Unfortunately, many studies report only comparative information, rather than information that allows the interpretation of absolute levels of distress or adjustment.
7.1. How do women feel immediately after their abortion?
Situational anxiety was assessed immediately before and after abortion by [Wells, 1992]. Mean levels of anxiety decreased significantly. This provides support for Wells' suggestion that anxiety around the time of abortion is due to anticipation of the mild–moderate pain associated with this procedure, as well as the general experience of abortion, as anxiety reduces once the procedure is complete and there is no longer fear of pain. However, whilst levels of anxiety prior to abortion were elevated and comparable to levels found in preoperative samples, it was unclear whether levels had decreased to within a normal range immediately after the abortion. Additionally, this study has several problems in terms of its sample that severely limit its reliability and generalisability.
Depressive symptoms were assessed immediately after abortion, and for the month prior to abortion, by [Major et al., 2000], using the depression scale of the Brief Symptom Inventory. Levels of depressive symptoms were significantly lower after the abortion, but no general population norms were provided to aid further interpretation. Major at al. also found that women felt significantly more positive than negative emotions immediately following abortion, and significantly more relief than either positive or negative emotions.
In contrast to the decrease in depressive symptoms found by [Cozzarelli, 1993 and Major et al., 2000] found no changes in levels of depression, when it was assessed immediately before abortion using the CES-D and after abortion using the Depression subscale of the SCL-90. Low to moderate levels of depression were found at both time points, with mean scores being closer to levels found in the general population (albeit slightly raised) than reported for psychiatric populations. This study was not designed to look specifically at pre–post abortion depression, but rather was focussed on factors that predicted coping. Different measures of depression were used for each time point (to minimise recall of earlier responses) and so comparisons across time were hindered.
The final study focussing on depression [Major et al., 1990] used the short form of the Beck Depression Inventory (BDI) immediately after abortion. The mean score for the sample as a whole was in the range of no to minimal depression. In terms of classification into groups, 64% of women could be classed as having no or only minimal depression, 21% were mildly depressed, 11% were moderately depressed, and 4% were severely depressed. [Major et al., 1990] also used an 8-item original mood measure (including items on guilt, relief, sadness, control and loss), which suggested that women showed good adjustment after abortion. Whilst this measure assessed some interesting variables, it was difficult to interpret.
[Cozzarelli et al., 1998] found quite high levels of self-esteem immediately after abortion, using the Rosenberg Self-Esteem Scale (RSES). In previous work, [Cozzarelli, 1993] also found high levels of self-esteem prior to abortion. Taken together, these studies suggest quite strongly that self-esteem is quite high and stable immediately prior to and following abortion.
Evidence for immediate consequences of abortion is limited, and the relevance of looking at changes over such a short period of time could be questioned. There were no good-quality studies focussing on anxiety, but the better quality studies looking at depression suggested that although depression decreased immediately following abortion, levels of depression were still slightly raised.
7.2. Are emotional responses sustained during the following month?
Whilst distress seems to decrease following abortion, there is considerable variation in rates of “caseness” reported for the first few weeks after abortion, even where the same measures are used and preabortion rates are similar. For example, [Henshaw et al., 1994] and [Slade et al., 1998] both reported rates of caseness before abortion of 40–45% for anxiety and 20% for depression, but Henshaw et al. reported fewer cases of anxiety and depression 2 weeks after abortion (19% for anxiety and 3% for depression) than Slade et al. at 4 weeks (27% for anxiety and 9% for depression). It is of note that both studies found a higher frequency of significant anxiety than depression. The fact that anxiety remained high suggests that whilst preoperative anxiety may be relevant to preabortion anxiety, it is unlikely to be the sole contributor to anxiety.
[Urquhart & Templeton, 1991a] and [Zolese, 1991] also found similar rates of caseness (using measures that combined anxiety and depression) before abortion and both found that rates of distress decreased following abortion, but again their findings for the weeks immediately following the abortion differed. Compared to rates of around 65% prior to abortion, Urquhart and Templeton reported relatively low incidence rates of 18% at 1 week (a significant decrease) and 8% at 4 weeks, whereas Zolese reported rates of 28–32% at 3 weeks. The variation in scores postabortion was attributed to differences in measurement by [Zolese, 1991] and to differences in definitions of incidence by [Urquhart & Templeton, 1991b], although this raises the question of why the results of the studies were similar prior to abortion.
Decreases in distress were again found by [Lauzon et al., 2000]. The prevalence of women reporting “high” distress on the IPSI dropped from 57% (prior to the abortion) to 42% (1 to 3 weeks after the abortion), and significantly more women were highly distressed at follow-up than in the general population comparison group (22%). The prevalence in men dropped from 41% to 31% over the same period, although at follow-up the differences between the study (31%) and general population comparison group (22%) were no longer significant.
Other studies have considered distress as a continuous variable rather than in terms of caseness. Depression and mood were assessed 3 weeks following abortion by [Cozzarelli, 1993]. Mean levels of depression had dropped significantly compared to immediately following abortion and the “moderately good” mood (assessed on a newly developed mood measure) found immediately following abortion had also improved significantly by the 3-week follow-up. Clinical significance was not addressed and though statistically significant, changes in scores were small and levels of depression were still higher than typically found in the general population. However, these results may overestimate levels of distress at the follow-up stage, as there had been a high rate of attrition (62%) by the 3 week follow-up, with analysis suggesting that women who were coping well immediately after abortion were less likely to complete the follow-up measure.
Information on emotional responses 1 month after abortion was presented by three papers, based on the same sample of women [Cozzarelli et al., 1998, Major et al., 1998 and Major et al., 1997]. The article by [Major et al., 1997] reported the most complete data, with information on 615 women. An abbreviated version of the Positive Well-being Scale and four subscales of the SCL-90 (anxiety, depression, hostility, and somatization) were used to create composite scores of “well-being” and “distress,” respectively. The well-being of women 1 month following abortion was described as “relatively high.” The distress levels were not interpreted, but appeared to be quite low. Whilst the authors did check the reliability of their composite measure, norms for the general population were not available to assist in the interpretation of the results.
[Major et al., 1998] also gathered information on levels of “distress” experienced by women in the month before and in the month after abortion. Although statistical comparisons were not reported, levels of distress were lower in the month after abortion and the anxiety, depression, and hostility subscales were all below the clinical cutoff for the scale, but higher than nonpatient female norms.
[Miller et al., 1998] found that state anxiety (on the State-Trait Anxiety Scale) was highest prior to abortion, but had decreased significantly 2 weeks after the abortion. It remained stable 6–8 months later.
In summary, whilst the majority of studies found decreases in distress following abortion, this was not invariably the case. In contrast, [Rizzardo et al., 1992] found stability in scores on the SCL-90 prior to abortion and 3 months afterwards. [Major et al., 2000] also reported that levels of depression on the Brief Symptom Inventory increased significantly 1 month after abortion, as compared to immediately post abortion. However, levels of depression at both these times were significantly lower than immediately prior to abortion.
Consideration of posttraumatic stress (PTS) symptoms in relation to abortion is an interesting addition to research in this area. [Miller et al., 1998] also assessed avoidance and intrusions before and after abortion, and found that mean levels were highest prior to abortion. Levels had dropped significantly 2 weeks after the abortion and significantly decreased even further 6–8 months following abortion. Clinically, the largest change occurred in the preabortion to 2-week postabortion phase. Unfortunately, a modified version of the Impact of Event Scale (IES) was used and interpretation of absolute levels of PTS symptoms was not possible because parameters of measurement were not provided. The use of the IES prior to abortion could be questioned, as it was designed for use after traumatic events. Prior to abortion, the IES may assess anticipatory anxiety, rather than PTS symptoms. However, the fact that avoidance and intrusions were higher prior to the abortion could suggest that not only the actual experience of having the abortion might be traumatic, but also that factors such as anticipating abortion or even having an unplanned pregnancy could act in this way.
[Slade et al., 1998] also assessed women on the IES a month following abortion. The authors were interested in whether medical abortions were associated with more PTS symptoms than surgical abortions. Such procedures involve factors previously associated with PTS symptoms (for instance, the woman is conscious and has a more active role in a procedure that involves blood, pain, and the death of the foetus). No symptomatic differences were found between the two groups, although women having medical abortions who saw the foetus experienced more intrusive events than those who did not. No comments on the absolute levels of avoidance or intrusions found were made, and no comparisons of these results with other populations were provided. Compared with a population diagnosed as suffering from stress response syndromes after serious life events [Horowitz et al., 1979], levels of avoidance were similar, whereas levels of intrusions were somewhat lower for the women who had an abortion. It must be noted that instruments potentially diagnostic of posttraumatic stress disorder (PTSD) were not utilized and aspects important to diagnosis (such as hypervigilance and symptom duration of 4 weeks) were not included. However, there is an emerging literature indicating that pain and/or medical procedures may lead to high levels of PTS symptoms, with some people meeting criteria for PTSD [Czarnocka & Slade, 2000 and Schreiber & Galai-Gat, 1993].
Considering other dimensions, [Miller et al., 1998] found that 62% of women reported that they had felt “a great deal” of relief in the first 2 weeks following abortion, 32.5% said they had felt “a moderate amount” or “a little” relief and 5.5% had felt “none.” A quarter of women reported feeling guilty “a little” in the first 2 weeks following their abortion, whereas almost three-quarters had not felt guilty. Finally, a third of women reported that they had felt depressed “a little” in the first 2 weeks, and two thirds had not felt depressed at all. However, this study is relatively weak, as the variables were assessed with a single question with restricted response options. This study also assessed self-esteem prior to, 2 weeks after, and 6–8 months after abortion, using the RSES. Mean levels of self-esteem remained constant over these times. However, it was unclear whether self-esteem was high or low, as only comparative information on a composite measure was provided. Levels of self-esteem were also found to be similar prior to and 1 month after abortion by [Major et al., 2000] using a shortened version of the RSES.
[Henshaw et al., 1994] found that compared to before abortion, self-esteem had fallen in 38% of women 2 weeks after abortion, improved in 55% of women, and remained the same in 7% of women. However, the measure of self-esteem was unstandardised and no definition of “change” was provided. The seemingly different results found compared to [Major et al., 2000 and Miller et al., 1998] probably reflects differences in reporting (i.e., the use of changes in individual scores rather than changes in group means), with group means masking individual changes.
One of the few comparative studies in this section [Cohan et al., 1993] recruited women at their pregnancy test. As mentioned previously, women who later had an abortion reported significantly more negative and less positive affect around the time of their pregnancy test, than women who decided to continue their pregnancies. Following abortion these differences almost disappeared, with moderate/high levels of positive affect and only low levels of negative affect being reported by the women who had an abortion. This suggests that the periods associated with highest distress are when women are anticipating and discovering an unwanted pregnancy and that the distress is not long lasting. However, conclusions from this study should be viewed with caution due to the small sample.
7.3. What are the long-term emotional implications of abortion?
Studies considering longer term implications tended to be of a high quality and generally found low levels of distress. With longer follow-up periods and broader measures, it becomes increasingly difficult to attribute any identified emotional problems to the abortion, as the possibility for other distressing life events to have occurred in the intervening period increases with time. [Howie et al., 1997] reported a 2-year follow-up of the sample reported by [Henshaw et al., 1994]. Scores on the Short Form 36, which includes a Mental Health subscale, were within the range found in the general population, and consultation rates for psychiatric problems were 15–19% (although no general population comparison figures were provided). Unfortunately, comparison with previous scores on the HAD was not possible as this measure was not repeated at follow-up, and it was not possible to interpret changes in self-esteem over time. The low follow-up rate of 39% reflects problems of attrition often found in studies with longer follow-up periods. [Major & Gramzow, 1999] also found low levels of distress (on a composite measure using the depression, anxiety, and hostility subscales of the Brief Symptom Inventory) in their 2 year follow-up of the sample recruited by [Major et al., 1997], where 50% of women responded. The mean level of distress was significantly lower than prior to abortion, although in real terms the amount of change was small. The follow-up study focused on how attempts at thought suppression due to stigma involved in discussing the abortion with others could lead to intrusive thoughts. This presents an alternative to the PTS explanation of intrusions. Unfortunately, though, this study focused on the relationship between the variables mentioned previously, and provided only limited details of the actual levels of intrusions experienced. The majority of women reported some intrusive thoughts, but only 3% reported experiencing intrusive thoughts “quite a bit” or “a great deal,” and 35% of women experienced no intrusive thoughts. The measure of intrusions consisted of only four items, taken from two established questionnaires, and was unstandardised.
[Major et al., 2000] also assessed PTS symptoms associated with abortion (using an adapted PTS measure), and found that only 1% of their sample of 442 women could be classed as showing evidence of PTSD 2 years after abortion. This must be placed in context of community prevalence estimates for women of equivalent age range, which are suggested to be around 2% [Perkonigg et al., 2000 and Stein et al., 1997]. Rates of depression were also assessed by [Major et al., 2000], who found that 20% of women had experienced depression in the 2 years since their abortion, as compared to 26% of the sample who had experienced depression at any time prior to the pregnancy (according to their questionnaire version of the Diagnostic Interview Schedule Depression interview). They also found that a history of depression prior to pregnancy was a risk factor for depression and lower self-esteem 2 years after the abortion. Levels of depression on the Brief Symptom Inventory were still lower 2 years postabortion than prior to abortion, although levels were higher at 2 years than immediately after abortion. This study reported a relatively wide range of measurements. Women still reported feeling more relief than negative or positive emotions after 2 years, the same as immediately after abortion. Small, but significant increases in self-esteem were also found at 2 years, compared to immediately before and a month after the abortion.
Two large-scale prospective longitudinal studies followed women for around 10 years. Both used comparison groups and were relatively sound in design. The psychiatric morbidity of over 13,000 UK women with an unplanned pregnancy was assessed over a period of 8 to 11 years in a study by [Gilchrist et al., 1995]. Total rates of psychiatric disorder were no higher following abortion than they were following childbirth, when previous psychiatric history was controlled for. However, problems may have been underrecognised as the assessments were solely via GP reports.
[Russo & Zierk, 1992] followed the reproductive status of over 5000 American women over 8 years, interviewing them annually. Having had one abortion over this period of time was associated with higher self-esteem. In terms of group comparison, those who had one abortion reported higher self-esteem than those who had had wanted or unwanted children or repeat abortions. However, these differences disappeared once preexisting self-esteem and other contextual factors were controlled. In addition the initial significant correlation was too small to be of any clinical significance (accounting for less than 1% of the variance). The authors interpreted this as meaning that the relationship between abortion and well-being was due to the role of abortion in controlling fertility and due to there being a relationship between abortion and coping resources. This was the only study to collect comprehensive baseline data before pregnancy and illustrates the importance of controlling for preexisting psychological and contextual factors. Taken together, these two studies suggest that women who have abortions have at least similar outcomes to women who continue their wanted or unwanted pregnancies.
Alla yhden aiheen Review-artikkelin otsikko, tekijätiedot ja tiivistelmä sekä luku, joka kertoo naisten tunteista abortin jälkeen.
Minä en löytänyt mistään 94 %, etsikää joku paremmin :D
-----
The effects of induced abortion on emotional experiences and relationships: A critical review of the literature
Zoë Bradshaw1 and Pauline SladeCorresponding Author Contact Information
Department of Psychology, Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2UR, UK
Received 6 March 2002; revised 28 February 2003; accepted 4 September 2003. ; Available online 13 November 2003.
Abstract
This paper reviews post-1990 literature concerning psychological experiences and sexual relationships prior to and following induced abortion. It assesses whether conclusions drawn from earlier reviews are still supported and evaluates the extent to which previous methodological problems have been addressed.
Following discovery of pregnancy and prior to abortion, 40–45% of women experience significant levels of anxiety and around 20% experience significant levels of depressive symptoms. Distress reduces following abortion, but up to around 30% of women are still experiencing emotional problems after a month. Women due to have an abortion are more anxious and distressed than other pregnant women or women whose pregnancy is threatened by miscarriage, but in the long term they do no worse psychologically than women who give birth. Self-esteem appears unaffected by the process. Less research has considered impact on the quality of relationships and sexual functioning, but negative effects were reported by up to 20% of women.
Conclusions were generally concordant with previous reviews. However, anxiety symptoms are now clearly identified as the most common adverse response. There has been increasing understanding of abortion as a potential trauma, and studies less commonly explore guilt. The quality of studies has improved, although there are still some methodological weaknesses.
Author Keywords: Termination; Pregnancy; Abortion; Psychological; Distress; Relationships
-----------
7. How do women feel after their abortion?
Most studies addressing this question have involved longitudinal designs, usually with assessments prior to and following abortion. However, changes in psychological variables when a preabortion baseline is used should be interpreted with caution, as previous reviews have found this to be the time of greatest distress [Adler et al., 1992]. Unfortunately, many studies report only comparative information, rather than information that allows the interpretation of absolute levels of distress or adjustment.
7.1. How do women feel immediately after their abortion?
Situational anxiety was assessed immediately before and after abortion by [Wells, 1992]. Mean levels of anxiety decreased significantly. This provides support for Wells' suggestion that anxiety around the time of abortion is due to anticipation of the mild–moderate pain associated with this procedure, as well as the general experience of abortion, as anxiety reduces once the procedure is complete and there is no longer fear of pain. However, whilst levels of anxiety prior to abortion were elevated and comparable to levels found in preoperative samples, it was unclear whether levels had decreased to within a normal range immediately after the abortion. Additionally, this study has several problems in terms of its sample that severely limit its reliability and generalisability.
Depressive symptoms were assessed immediately after abortion, and for the month prior to abortion, by [Major et al., 2000], using the depression scale of the Brief Symptom Inventory. Levels of depressive symptoms were significantly lower after the abortion, but no general population norms were provided to aid further interpretation. Major at al. also found that women felt significantly more positive than negative emotions immediately following abortion, and significantly more relief than either positive or negative emotions.
In contrast to the decrease in depressive symptoms found by [Cozzarelli, 1993 and Major et al., 2000] found no changes in levels of depression, when it was assessed immediately before abortion using the CES-D and after abortion using the Depression subscale of the SCL-90. Low to moderate levels of depression were found at both time points, with mean scores being closer to levels found in the general population (albeit slightly raised) than reported for psychiatric populations. This study was not designed to look specifically at pre–post abortion depression, but rather was focussed on factors that predicted coping. Different measures of depression were used for each time point (to minimise recall of earlier responses) and so comparisons across time were hindered.
The final study focussing on depression [Major et al., 1990] used the short form of the Beck Depression Inventory (BDI) immediately after abortion. The mean score for the sample as a whole was in the range of no to minimal depression. In terms of classification into groups, 64% of women could be classed as having no or only minimal depression, 21% were mildly depressed, 11% were moderately depressed, and 4% were severely depressed. [Major et al., 1990] also used an 8-item original mood measure (including items on guilt, relief, sadness, control and loss), which suggested that women showed good adjustment after abortion. Whilst this measure assessed some interesting variables, it was difficult to interpret.
[Cozzarelli et al., 1998] found quite high levels of self-esteem immediately after abortion, using the Rosenberg Self-Esteem Scale (RSES). In previous work, [Cozzarelli, 1993] also found high levels of self-esteem prior to abortion. Taken together, these studies suggest quite strongly that self-esteem is quite high and stable immediately prior to and following abortion.
Evidence for immediate consequences of abortion is limited, and the relevance of looking at changes over such a short period of time could be questioned. There were no good-quality studies focussing on anxiety, but the better quality studies looking at depression suggested that although depression decreased immediately following abortion, levels of depression were still slightly raised.
7.2. Are emotional responses sustained during the following month?
Whilst distress seems to decrease following abortion, there is considerable variation in rates of “caseness” reported for the first few weeks after abortion, even where the same measures are used and preabortion rates are similar. For example, [Henshaw et al., 1994] and [Slade et al., 1998] both reported rates of caseness before abortion of 40–45% for anxiety and 20% for depression, but Henshaw et al. reported fewer cases of anxiety and depression 2 weeks after abortion (19% for anxiety and 3% for depression) than Slade et al. at 4 weeks (27% for anxiety and 9% for depression). It is of note that both studies found a higher frequency of significant anxiety than depression. The fact that anxiety remained high suggests that whilst preoperative anxiety may be relevant to preabortion anxiety, it is unlikely to be the sole contributor to anxiety.
[Urquhart & Templeton, 1991a] and [Zolese, 1991] also found similar rates of caseness (using measures that combined anxiety and depression) before abortion and both found that rates of distress decreased following abortion, but again their findings for the weeks immediately following the abortion differed. Compared to rates of around 65% prior to abortion, Urquhart and Templeton reported relatively low incidence rates of 18% at 1 week (a significant decrease) and 8% at 4 weeks, whereas Zolese reported rates of 28–32% at 3 weeks. The variation in scores postabortion was attributed to differences in measurement by [Zolese, 1991] and to differences in definitions of incidence by [Urquhart & Templeton, 1991b], although this raises the question of why the results of the studies were similar prior to abortion.
Decreases in distress were again found by [Lauzon et al., 2000]. The prevalence of women reporting “high” distress on the IPSI dropped from 57% (prior to the abortion) to 42% (1 to 3 weeks after the abortion), and significantly more women were highly distressed at follow-up than in the general population comparison group (22%). The prevalence in men dropped from 41% to 31% over the same period, although at follow-up the differences between the study (31%) and general population comparison group (22%) were no longer significant.
Other studies have considered distress as a continuous variable rather than in terms of caseness. Depression and mood were assessed 3 weeks following abortion by [Cozzarelli, 1993]. Mean levels of depression had dropped significantly compared to immediately following abortion and the “moderately good” mood (assessed on a newly developed mood measure) found immediately following abortion had also improved significantly by the 3-week follow-up. Clinical significance was not addressed and though statistically significant, changes in scores were small and levels of depression were still higher than typically found in the general population. However, these results may overestimate levels of distress at the follow-up stage, as there had been a high rate of attrition (62%) by the 3 week follow-up, with analysis suggesting that women who were coping well immediately after abortion were less likely to complete the follow-up measure.
Information on emotional responses 1 month after abortion was presented by three papers, based on the same sample of women [Cozzarelli et al., 1998, Major et al., 1998 and Major et al., 1997]. The article by [Major et al., 1997] reported the most complete data, with information on 615 women. An abbreviated version of the Positive Well-being Scale and four subscales of the SCL-90 (anxiety, depression, hostility, and somatization) were used to create composite scores of “well-being” and “distress,” respectively. The well-being of women 1 month following abortion was described as “relatively high.” The distress levels were not interpreted, but appeared to be quite low. Whilst the authors did check the reliability of their composite measure, norms for the general population were not available to assist in the interpretation of the results.
[Major et al., 1998] also gathered information on levels of “distress” experienced by women in the month before and in the month after abortion. Although statistical comparisons were not reported, levels of distress were lower in the month after abortion and the anxiety, depression, and hostility subscales were all below the clinical cutoff for the scale, but higher than nonpatient female norms.
[Miller et al., 1998] found that state anxiety (on the State-Trait Anxiety Scale) was highest prior to abortion, but had decreased significantly 2 weeks after the abortion. It remained stable 6–8 months later.
In summary, whilst the majority of studies found decreases in distress following abortion, this was not invariably the case. In contrast, [Rizzardo et al., 1992] found stability in scores on the SCL-90 prior to abortion and 3 months afterwards. [Major et al., 2000] also reported that levels of depression on the Brief Symptom Inventory increased significantly 1 month after abortion, as compared to immediately post abortion. However, levels of depression at both these times were significantly lower than immediately prior to abortion.
Consideration of posttraumatic stress (PTS) symptoms in relation to abortion is an interesting addition to research in this area. [Miller et al., 1998] also assessed avoidance and intrusions before and after abortion, and found that mean levels were highest prior to abortion. Levels had dropped significantly 2 weeks after the abortion and significantly decreased even further 6–8 months following abortion. Clinically, the largest change occurred in the preabortion to 2-week postabortion phase. Unfortunately, a modified version of the Impact of Event Scale (IES) was used and interpretation of absolute levels of PTS symptoms was not possible because parameters of measurement were not provided. The use of the IES prior to abortion could be questioned, as it was designed for use after traumatic events. Prior to abortion, the IES may assess anticipatory anxiety, rather than PTS symptoms. However, the fact that avoidance and intrusions were higher prior to the abortion could suggest that not only the actual experience of having the abortion might be traumatic, but also that factors such as anticipating abortion or even having an unplanned pregnancy could act in this way.
[Slade et al., 1998] also assessed women on the IES a month following abortion. The authors were interested in whether medical abortions were associated with more PTS symptoms than surgical abortions. Such procedures involve factors previously associated with PTS symptoms (for instance, the woman is conscious and has a more active role in a procedure that involves blood, pain, and the death of the foetus). No symptomatic differences were found between the two groups, although women having medical abortions who saw the foetus experienced more intrusive events than those who did not. No comments on the absolute levels of avoidance or intrusions found were made, and no comparisons of these results with other populations were provided. Compared with a population diagnosed as suffering from stress response syndromes after serious life events [Horowitz et al., 1979], levels of avoidance were similar, whereas levels of intrusions were somewhat lower for the women who had an abortion. It must be noted that instruments potentially diagnostic of posttraumatic stress disorder (PTSD) were not utilized and aspects important to diagnosis (such as hypervigilance and symptom duration of 4 weeks) were not included. However, there is an emerging literature indicating that pain and/or medical procedures may lead to high levels of PTS symptoms, with some people meeting criteria for PTSD [Czarnocka & Slade, 2000 and Schreiber & Galai-Gat, 1993].
Considering other dimensions, [Miller et al., 1998] found that 62% of women reported that they had felt “a great deal” of relief in the first 2 weeks following abortion, 32.5% said they had felt “a moderate amount” or “a little” relief and 5.5% had felt “none.” A quarter of women reported feeling guilty “a little” in the first 2 weeks following their abortion, whereas almost three-quarters had not felt guilty. Finally, a third of women reported that they had felt depressed “a little” in the first 2 weeks, and two thirds had not felt depressed at all. However, this study is relatively weak, as the variables were assessed with a single question with restricted response options. This study also assessed self-esteem prior to, 2 weeks after, and 6–8 months after abortion, using the RSES. Mean levels of self-esteem remained constant over these times. However, it was unclear whether self-esteem was high or low, as only comparative information on a composite measure was provided. Levels of self-esteem were also found to be similar prior to and 1 month after abortion by [Major et al., 2000] using a shortened version of the RSES.
[Henshaw et al., 1994] found that compared to before abortion, self-esteem had fallen in 38% of women 2 weeks after abortion, improved in 55% of women, and remained the same in 7% of women. However, the measure of self-esteem was unstandardised and no definition of “change” was provided. The seemingly different results found compared to [Major et al., 2000 and Miller et al., 1998] probably reflects differences in reporting (i.e., the use of changes in individual scores rather than changes in group means), with group means masking individual changes.
One of the few comparative studies in this section [Cohan et al., 1993] recruited women at their pregnancy test. As mentioned previously, women who later had an abortion reported significantly more negative and less positive affect around the time of their pregnancy test, than women who decided to continue their pregnancies. Following abortion these differences almost disappeared, with moderate/high levels of positive affect and only low levels of negative affect being reported by the women who had an abortion. This suggests that the periods associated with highest distress are when women are anticipating and discovering an unwanted pregnancy and that the distress is not long lasting. However, conclusions from this study should be viewed with caution due to the small sample.
7.3. What are the long-term emotional implications of abortion?
Studies considering longer term implications tended to be of a high quality and generally found low levels of distress. With longer follow-up periods and broader measures, it becomes increasingly difficult to attribute any identified emotional problems to the abortion, as the possibility for other distressing life events to have occurred in the intervening period increases with time. [Howie et al., 1997] reported a 2-year follow-up of the sample reported by [Henshaw et al., 1994]. Scores on the Short Form 36, which includes a Mental Health subscale, were within the range found in the general population, and consultation rates for psychiatric problems were 15–19% (although no general population comparison figures were provided). Unfortunately, comparison with previous scores on the HAD was not possible as this measure was not repeated at follow-up, and it was not possible to interpret changes in self-esteem over time. The low follow-up rate of 39% reflects problems of attrition often found in studies with longer follow-up periods. [Major & Gramzow, 1999] also found low levels of distress (on a composite measure using the depression, anxiety, and hostility subscales of the Brief Symptom Inventory) in their 2 year follow-up of the sample recruited by [Major et al., 1997], where 50% of women responded. The mean level of distress was significantly lower than prior to abortion, although in real terms the amount of change was small. The follow-up study focused on how attempts at thought suppression due to stigma involved in discussing the abortion with others could lead to intrusive thoughts. This presents an alternative to the PTS explanation of intrusions. Unfortunately, though, this study focused on the relationship between the variables mentioned previously, and provided only limited details of the actual levels of intrusions experienced. The majority of women reported some intrusive thoughts, but only 3% reported experiencing intrusive thoughts “quite a bit” or “a great deal,” and 35% of women experienced no intrusive thoughts. The measure of intrusions consisted of only four items, taken from two established questionnaires, and was unstandardised.
[Major et al., 2000] also assessed PTS symptoms associated with abortion (using an adapted PTS measure), and found that only 1% of their sample of 442 women could be classed as showing evidence of PTSD 2 years after abortion. This must be placed in context of community prevalence estimates for women of equivalent age range, which are suggested to be around 2% [Perkonigg et al., 2000 and Stein et al., 1997]. Rates of depression were also assessed by [Major et al., 2000], who found that 20% of women had experienced depression in the 2 years since their abortion, as compared to 26% of the sample who had experienced depression at any time prior to the pregnancy (according to their questionnaire version of the Diagnostic Interview Schedule Depression interview). They also found that a history of depression prior to pregnancy was a risk factor for depression and lower self-esteem 2 years after the abortion. Levels of depression on the Brief Symptom Inventory were still lower 2 years postabortion than prior to abortion, although levels were higher at 2 years than immediately after abortion. This study reported a relatively wide range of measurements. Women still reported feeling more relief than negative or positive emotions after 2 years, the same as immediately after abortion. Small, but significant increases in self-esteem were also found at 2 years, compared to immediately before and a month after the abortion.
Two large-scale prospective longitudinal studies followed women for around 10 years. Both used comparison groups and were relatively sound in design. The psychiatric morbidity of over 13,000 UK women with an unplanned pregnancy was assessed over a period of 8 to 11 years in a study by [Gilchrist et al., 1995]. Total rates of psychiatric disorder were no higher following abortion than they were following childbirth, when previous psychiatric history was controlled for. However, problems may have been underrecognised as the assessments were solely via GP reports.
[Russo & Zierk, 1992] followed the reproductive status of over 5000 American women over 8 years, interviewing them annually. Having had one abortion over this period of time was associated with higher self-esteem. In terms of group comparison, those who had one abortion reported higher self-esteem than those who had had wanted or unwanted children or repeat abortions. However, these differences disappeared once preexisting self-esteem and other contextual factors were controlled. In addition the initial significant correlation was too small to be of any clinical significance (accounting for less than 1% of the variance). The authors interpreted this as meaning that the relationship between abortion and well-being was due to the role of abortion in controlling fertility and due to there being a relationship between abortion and coping resources. This was the only study to collect comprehensive baseline data before pregnancy and illustrates the importance of controlling for preexisting psychological and contextual factors. Taken together, these two studies suggest that women who have abortions have at least similar outcomes to women who continue their wanted or unwanted pregnancies.
Vastaukset 14
Vanhimmat
pakkosynnytysasiamies sen löytää:D.
Minä en ainakaan löytänyt...
Palstan sääntöjen mukaan viesit pitäisi olla suomen kielisiä. Minä en ainakaan jaksanut lukea tuota pitkää selostusta. Voisiko joku suomentaa tai noudattaa palstan sääntöjä.
PS: En tosiaan kannata pakkosynnytystä.
Noin pitkää englanninkielistä ei todellakaan jaksa lukee. Olisit suomentanu ja poiminu sieltä itse ne mielestäs oleellisimmat kohdat.
Ja missä tossa on se linkki tai sivu mistä se on löydetty eli mistä tuon nyt voi tietää kuinka luotettava koko lähde edes on (ehkä taas yks näistä epämääräsistä kun englanninkielinenki...)
Siis kyse on julkaisusta, jossa käsitellään kirjallisuuskatsauksen omaisesti eri abortin psyykkisistä vaikutuksista tehtyjä tutkimuksia. Oleellisimmat tiedot löytyvät tuosta tiivistelmästä. Jos nyt nopeasti yritän suomentaa : raskautta eppäillessään ja aborttia odottaessaan 40-45 % naisista kokee merkittävän tason "huolestumista" ja 20 %:lla on selviä depressiivisiä ajatuksia. Abortin jälkeen "huoli" vähenee, mutta vielä kuukauden jälkeen noin 30 % kokee vielä emotionaalisia ongelmia. Kuitenkin pitkällä aikavälillä abortin kokeneet naiset eivät reagoineet yhtään enempää psyykkisesti kuin "syntymän antaneet" naiset.
Valitettavasti kyse on siis lehdestä, jonka nettilukeminen voi olla maksullista. En siis pysty laittamaan linkkiä suoraan, koska se ei teillä välttämättä avautuisi. Alla on kuitenkin yksityiskohtaiset tiedot sen julkaisemisesta ja julkaisutahosta.
Lehden nimi jäi edellisestä vahingossa pois. Julkaisutiedot ovat siis:
Clinical Psychology Review
Volume 23, Issue 7 , December 2003, Pages 929-958
Julkaisun otsikko:
The effects of induced abortion on emotional experiences and relationships: A critical review of the literature
Sen kirjoittajat:
Zoë Bradshaw1 and Pauline Slade
Missä kirjoittajat ovat tutkijoina ja missä siis review on tehty:
Department of Psychology, Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2UR, UK
Received 6 March 2002; revised 28 February 2003; accepted 4 September 2003. ; Available online 13 November 2003.
Abstract= Tiivistelmä artikkelista
This paper reviews post-1990 literature concerning psychological experiences and sexual relationships prior to and following induced abortion. It assesses whether conclusions drawn from earlier reviews are still supported and evaluates the extent to which previous methodological problems have been addressed.
Following discovery of pregnancy and prior to abortion, 40–45% of women experience significant levels of anxiety and around 20% experience significant levels of depressive symptoms. Distress reduces following abortion, but up to around 30% of women are still experiencing emotional problems after a month. Women due to have an abortion are more anxious and distressed than other pregnant women or women whose pregnancy is threatened by miscarriage, but in the long term they do no worse psychologically than women who give birth. Self-esteem appears unaffected by the process. Less research has considered impact on the quality of relationships and sexual functioning, but negative effects were reported by up to 20% of women.
Conclusions were generally concordant with previous reviews. However, anxiety symptoms are now clearly identified as the most common adverse response. There has been increasing understanding of abortion as a potential trauma, and studies less commonly explore guilt. The quality of studies has improved, although there are still some methodological weaknesses.
Author Keywords: Termination; Pregnancy; Abortion; Psychological; Distress; Relationships
Mitä siitä nyt nopsaa kattoen ymmärsi(?) että 40-45% tuskaisuutta tms? (anxiety), 20% masennusta (depression)...suhteiden laatu ja seksin toimivuus häiriöö 20%..
Ja tutkimusaikoina oli ilmeisesti ennen, heti jälkeen abortin, 2 vkon, kuukauden, 6-8 kk ja 2 vuoden päästä.
2 vkon päästä helpotusta mut 2 vuoden päästä ne jokku oireet/tasot taas korkeempia ku mitä välillä?
Olis tietysti ihan kohtuullista kysyä niiltäki joilla 10 vuotta tai vielä kauemmin abortista.
Ja siis onko tää noiden kahden tyypin tekemä joku väitöshomma vai mikä?
Olikos se myös niin ettei jonku muun maan tutkimukset päde Suomen oloissa..?
Ja oliko siellä jossain mainittu katumuksesta (regret) jotain..? Empä huomannu.
"Mitä siitä nyt nopsaa kattoen ymmärsi(?) että 40-45% tuskaisuutta tms? (anxiety), 20% masennusta (depression)...suhteiden laatu ja seksin toimivuus häiriöö 20%"
Niin tosiaan, minun ymmärykseni mukaan nuo oli tunnetilat ENNEN aborttia (siis kun on toivomattaan raskaana, tai epäilee sitä, ja aborttia harkitsemassa).
"Olis tietysti ihan kohtuullista kysyä niiltäki joilla 10 vuotta tai vielä kauemmin abortista."
Sellaisia tietoja voi olla vaikea jo saadakin ja tutkimuksissa aina joudutaan rajamaan asioita pois. Sitä paitsi niissä vaikuttaa aina yhä enemmän kaikki muut "depressiota" aiheuttavat tekijät, mitä kauemmin abortista kuluu ja mitä enemmän ihmiset ovat kokeneet abortin jälkeen. Siis asioita, jotka eivät liity välttämättä siihen aborttiin enää mitenkään.
"Ja siis onko tää noiden kahden tyypin tekemä joku väitöshomma vai mikä?"
Tieteellinen "kriittisen ja vertailevan näkökulman kokoelmajulkaisu". Tarkemmat tiedot löytyvät tuolta toisesta vastauksestani.
"Olikos se myös niin ettei jonku muun maan tutkimukset päde Suomen oloissa..?"
Osittain on toki. Siitä huolimatta oikea tieteellinen julkaisu, etenkin review-julkaisu (tutkimustuokset eri maista; USA, UK, Ruotsi, Kanada, Italia...), on varmasti pätevämpi lähtökohta arvailuille (ei tarvitse edes arvailla niin paljoa) kuin lause "94 % katuu" nettisivulla, jonka linkki ei johda minnekään ja josta ei edes tiedä, kuka sen tutkimuksen on tehnyt.
"Ja oliko siellä jossain mainittu katumuksesta (regret) jotain..? Empä huomannu."
En tiedä käytettiinkö sanaa "regret". Mutta kuten on tullut huomatuksi, "katua"-sanalla tarkoitetaan hyvin eri asioita, joten on parempikin olla käyttämättä sitä. Sitä vastoin siellä puhuttiin psyykkisistä ongelmista, tunteista jne. Eiköhän ne kuvaa asiaa paremmin kuin tuo "regret".
Kaiken kaikkiaan mielenkiintoinen pätkä luettavaksi, kiitos satualle. Liian pitkä suomennettavaksi tältä situmalta tosin, kyllä... erittäin valottava sen suhteen miten ennen aborttia mitatut tunnetilat muuttuvat abortin jälkeen ja suhteessa "normaaliväestöön".
Ongelma on siinä että jos ja kun kielitaito joillakin on puutteellinen, sitä on hyvin helppoa lukea väärin. Sanakirja kouraan kaverit, ja rohkeasti kysymään jos jokin kohta on epäselvä! :D
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Tuon mukaan 20 pros tuntee masennusta, 11 prosenttia syvempää masennusta ja ja oliko jotain 4 prosenttia jotka vaipuvat ihan pahaan psykoosiin asian suhteen...
Eli jotain 35 prosenttia yhteensä. 65 prosenttia selviävät tekonsa kanssa ilman ongelmia...
Tutkimus oli englannista... Vai ymmärsinkö, kun lähteet oli United Kingdomista? Millainenkohan on Englannin abortti laki: saakohan niillä helpommin tai jotain, kun on tuollainen ero siihen miten suomalaiset sairastuu? (noh, vain kymmenenprosentin heitto...)
Mietin vain kun itsestäni abortti lähetteen hakeminen ei olut paha meilläkään; niin voiko olla vielä helpompaa tuolla, kun ilmeisesti tekevät vielä enemmän hätiköityjä valintoja?
Nuo masennustilat olivat mitattuja välittömästi toimenpiteen jälkeen. Ymmärrettävästi siinä vaiheessa monikin on melko sekavissa tunnelmissa... kaikkein järkevintä on aktsoa tuota muutaman kuukauden ja kahden vuoden kuluttua tehtyä seurantaa.
Hätiköidyksi valinnaksi en menisi luokittelemaan aborttia jonka jälkeen lääkärin vastaanotolta asteltuaan nainen on epävakaassa tilassa ja tuntee negatiivisia tunteita ja masennusta :D eiköhän se ole melko normaali reaktio.
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Niinpä olikin sori..
Tuntuu vielä karmivammalta, että 4 prosenttia on aivan sijoiltaan heti toimenpiteen jälkeen... Miten tälläinen nainen, joka ilmiselvästi aborttia ei ole halunnut, sellaisen saa?
Täälläkinhän on joskus joku kertonut itkeneensä jo ensimmäisellä käynnillä neuvolassa. Silti on abortin saanut ja itkee luonnollisesti vielä pahemmin jälkeenpäinkin. Voisi jo ihmetellä lääkärin vastuuta kun tälläisille ilmiselville katujille abortti myönnetään. Vaikka miten hyvin perustelisi, jos ihminen tykkää lapsista, niin eiköhän se mene silloin kaikkien sosiaalisten syiden ohi... Luulisi lääkäreiden tunnistavan vähän paremmin noita oireita.
Mietin kyllä samaa. Lääkärinä, mitä miettisin jos olisin tekemässä aborttia naiselle joka itkee kuin suihkulähde mutta kivenkovaan väittää tahtovansa aborttia? Tehdäkö niinkuin potilas toivoo vai mitä itse näkee? Itse kyllä pistäisin potilaan jatkoneuvontaan ja harkinta-ajalle vielä, mutta voi olla että jos niitä aborttejakin tekee satoja vuodessa niin kaikkeen turtuu. Että sitä (mikä on suomenkielinen vastine sanalle "distress"?) ei vain huomaa.
Ymmärrän että lääkärille itselleen on lakiteknisesti aina turvallisempaa tehdä se mitä on sovittu ja papereissa lukee.
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Siinä lomakkeessa on jokin kohta johon lääkärin pitää kuvata tunnetila tai tälläistä... jos haastatteleva lääkäri joutuu kirjottamaan "epävarma, sekava ja itkee" uskoisi, että ei mene läpi. Tai että lääkäri saisi jonkin huomautuksen jos laskee läpi, kun nämä hakemuksethan menee suhteellisen tiukkaan syyniin.
Epävarmuuden luulisi näkyvän tosi selvästi... Jos on shokissa tapahtuneen jälkeen heti, ei voi olla ollut kovin varma etukäteenkään.
Noh, ehkä se on sitä vastuuta omasta elämästään ja omista päätöksistään mitä tällä haetaan. Ei kai lääkärit oikeasti voi päättää toisten puolesta, mutta jokin lisä keskustelu voisi olla tarpeen määrätä (resurssi pula varmaan estää. Lääkäreillä on nykyisin hirveä vastuu laitosten taloudellisuudesta...).
Lomakkeesta en tosiaan tiennytkään! Oikein hyvä että sellainen syynäyskäytäntö on.
Olet kyllä oikeassa siitä että shokkitila jos iskee samantien, voi olla aika varma että ei ollut mennyt aivan perille jakeluun saakka mitä oltiin tekemässä. Jos se kolahtaa vasta toimenpiteen jälkeen (ja etenkin jos välittömästi jälkeen)... en voi kuin kuvitella miten kauheaa se olisi.
Ihminenhän voi luulla olevansa täysin varma olematta sitä. Lasten tekemiseen liittyvissä asioissa kyse kun on aina elämän suuruisista päätöksistä jotka aina jossain vaiheessa mietityttävät, väittäisin että melkein jokainen raskaana ollut on jossain vaiheessa raskautta toivnut hetkellisesti että koko tila menisi vain pois :D etten minä olekaan vielä valmis, en minä halua... ja sitten se menee ohi vaikka kuinka lopulliselta tuntuisi. Hetkelliset tunteet sillä hetkellä tuntuvat ikuisilta :D ei kai avioliittoja muuten solmittaisi ollenkaan.
"Ei kai lääkärit oikeasti voi päättää toisten puolesta, mutta jokin lisä keskustelu voisi olla tarpeen määrätä "
Exactly. Taloudelliset pointit tässä tulevat vastaan mutta... jokin alueellinen projekti voisi olla kantava juttu, ottaa selvää paikallisesti miten lisäneuvonnan määrääminen vaikuttaa aborttimääriin ja kuluihin sillä saralla, jos tuloksia tulee Yhtään, on helppoa (helppo ja helppo :D) saada lisärahoitusta terveydenhuollolle tuolla varjolla. Opiskeleeko joku täällä alaa sinnepäin? Ehdotuksia? Neuvontaprojekti paikallisesti? Miten tuon voisi toteuttaa, mitä kautta, kenen toimesta?
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Oikeestaan kun tuota tutkimusta tarkemmin tavaa, niin siinähän on, että 26 prosenttia aborttiin hakeutuneista naisista on masentunut mennessään toimenpiteeseen. Ja abortin jälkeen 20 prosenttia (siis parin vuoden päästä), eli on se joillekin silti oikea vaihtoehto, vaikka etukäteen olisikin ihan rikki... kuudella prosentilla masennus "paranee" abortin myötä.