Interesting article in the American Psychologist

Just got my December issue of the American Psychologist (64:9). In it is an article but Brenda Major (and others) entitled, “Abortion and Mental Health.” These authors wrote a report in 2008 for the APA task force on Mental Health and Abortion (available at here). What I find interesting in the article is the discussion of the research on the association of mental health problems with abortion. Set aside, just for a moment, your strong feelings about the topic and consider this question: how would you go about studying the effects of abortion on women using robust measures?

You cannot do a randomized, double-blind study (you subjects get an abortion while you other subjects have your baby). Thus, you cannot fully control pre-existing or co-occurring risk factors. So, what do most researchers do? Try to indicate risk markers–correlations–that may point to possible but not proven causes. The writers of this article point out that the downside of correlation or associations is that folk tend to mistake them as causes. They give one specific example: If age is the “most important known risk factor for Alzheimer’s disease (AD)” one might assume that age causes AD. But it does not. Similarly, one can do a study that shows 100% of convicted sex offenders have their own sexual victimization and wrongly assume that sexual abuse leads to sex offending. Not so.

These authors emphasize the benefits of asking two other questions (on p. 865):

1. What is the relative risk of mental health problems associated with abortion compared to the same risks associated with having an unwanted baby (whether keeping or adopting out)?

2. What predicts individual variation in women’s psychological experiences following abortion?

The authors go on to say that the hypothesis of the researcher really impacts the kinds of research questions asked (and thus conclusions). Some research focuses on traumatic experiences, others on stress and coping, still others on the sociocultural context.

By the way, it is a long article but concludes this way (p. 886):

Mental health among women who experience an unwanted pregnancy reflects a number of factors. It reflects preexisting and co-occurring conditions in a woman’s life that place her at greater or lesser risk for poor mental health in general regardless of how she resolves her pregnancy. It reflects her appraisals of the meaning of a pregnancy and abortion and her appraisals of her ability to cope with either option.

There’s more to their final thoughts but you get the point. How you look at pregnancy, abortion, adoption is likely to have a big impact on your immediate mental health. Sadly, I suspect the research also reflects the biases of the researcher (how could it not?).

I found this article interesting because it does a great job illustrating the benefits AND drawbacks of research. Researching mental health of women with unwanted pregnancies is a good idea but will fail to address the moral and ethical questions that, in my mind, take precedence in the public debate.