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Women who have had abortions were more likely to attempt suicide than women who did not have abortions, although their increased risk was the same in the year before and after the abortion, according to a Danish registry study.

Among more than 500,000 adult women, those who had an abortion were at an increased risk of attempting suicide for the first time over the following year compared with women who did not have an abortion (adjusted incidence rate ratio [aIRR] 2.54, 95% CI 2.29-2.81), reported Julia Steinberg, MD, of the University of Maryland in College Park, and colleagues.

However, the increased risk was similar in the year before the abortion (aIRR 2.46, 95% CI 2.22-2.71), the team wrote in the .

Moreover, their risk decreased as more time passed after the abortion, such that women had a lower risk from 1 to 5 years later (aIRR 1.90, 95% CI 1.75-2.06) and 5 or more years later (aIRR 1.73, 95% CI 1.53-1.96), they added.

"Because the risk was the same before and after the abortion, relative to women who did not have an abortion, the abortion cannot be the reason for the increased risk of suicide attempts," Steinberg told 木瓜直播 in an email. "That is, abortion did not cause or increase women's risk of suicide attempts."

Currently, 12 states require that women be told that abortion may have , and in South Dakota, physicians are required to tell patients that abortion is associated with an increased risk of suicide ideation and suicide.

Attributing the increased risk of mental health problems to the abortion is incorrect in light of these findings, Steinberg said.

Instead, it may be that one or more unmeasured variables contributed to the increased risk for suicidality, such as undiagnosed or untreated mental health problems, wrote Jenneke van Ditzhuijzen, PhD, of the University of Amsterdam in the Netherlands, in an .

It could also be due to risk factors that occur around the time of unwanted pregnancy, like intimate partner violence, unstable relationships, or other factors not controlled for in this study, van Ditzhuijzen noted.

That's not to say that having an abortion means women are going through a difficult time or that mental disorders are attributable to abortions, but that "some women are at an elevated risk of multiple adversities at a certain period in their life, which could include an unwanted pregnancy and abortion," van Ditzhuijzen wrote.

"To successfully prevent unwanted pregnancies and abortions, we should focus on the circumstances and characteristics that predispose women to having these unwanted pregnancies, rather than focus on the potential mental health consequences of abortion," she concluded.

Study Details

For the study, the authors used the and the to track the first non-fatal suicide attempts or self-harm incidents in women ages 18 to 36. Women with prior non-fatal suicide attempts were excluded.

Of the 523,280 women included, 48,990 (9.4%) had an abortion and 10,216 (2%) had a recorded suicide attempt. Those in the group who had an abortion versus those who did not were more likely to have histories of childbirth, poorer physical health, and prior mental health problems, indicated by the use of inpatient or outpatient psychiatric visits or the use of medication for anxiety, psychosis, or depression.

Those in the abortion group were also more likely to have parents with mental health problems and parents with less education than women who did not have an abortion, the authors reported.

Overall, the strongest risk factors for suicide attempts were psychiatric contact (aIRR 5.88, 95% CI 5.59-6.18), and prior use of antidepressants (aIRR 2.77, 95% CI 2.63-2.92), anti-anxiety medication (aIRR 1.48, 95% CI 1.41-1.56), or antipsychotic medication (aIRR 1.69, 95% CI 1.60-1.79).

Study limitations, the team said, included that coding measures used to track self-harm and suicide attempts may have misclassified such attempts, and that women may have had more mental health problems that went unrecorded as well. In addition, the findings may not be generalizable to other countries, like the U.S., where there are legal restrictions on abortion, and that the researchers did not measure recurrent suicide attempts.

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