Using the US National Comorbidity Survey (NCS), Coleman, Coyle, Shuping, and Rue (2009) published an analysis indicating that compared to women who had never had an abortion, women who had reported an abortion were at an increased risk of several anxiety, mood, and substance use disorders. Here, we show that those results are not replicable. That is, using the same data, sample, and codes as indicated by those authors, it is not possible to replicate the simple bivariate statistics testing the relationship of ever having had an abortion to each mental health disorder when no factors were controlled for in analyses (Table 2 in Coleman et al., 2009). Furthermore, among women with prior pregnan cies in the NCS, we investigated whether having zero, one, or multiple abortions (abortion history) was associated with having a mood, anxiety, or substance use disorder at the time of the interview. In doing this, we tested two competing frameworks: the abortion-as-trauma versus the common-risk-factors approach. Our results support the latter framework. In the bivariate context when no other factors were included in models, abortion history was not related to having a mood disorder, but it was related to having an anxiety or substance use disorder. When prior mental health and violence experience were controlled in our models, no significant relation was found between abortion history and anxiety disorders. When these same risk factors and other background factors were controlled, women who had multiple abortions remained at an increased risk of having a substance use disorder compared to women who had no abortions, likely because we were unable to control for other risk factors associated with having an abortion and substance use.

A clear trend emerges from this systematic review: the highest quality studies had findings that were mostly neutral, suggesting few, if any, differences between women who had abortions and their respective comparison groups in terms of mental health sequelae.

The best scientific evidence published indicates that among adult women who have an unplanned pregnan cy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnan cy. The evidence regarding the relative mental health risks associated with multiple abortions is more equivocal. Positive associations observed between multiple abortions and poorer mental health may be linked to co-occurring risks that predispose a woman to both multiple unwanted pregnan cies and mental health problems.

The few published studies that examined women's responses following an induced abortion due to fetal abnormality suggest that terminating a wanted pregnan cy late in pregnan cy due to fetal abnormality appears to be associated with negative psychological reactions equivalent to those experienced by women who miscarry a wanted pregnan cy or who experience a stillbirth or death of a newborn, but less than those who deliver a child with life-threatening abnormalities.

The differing patterns of psychological experiences observed among women who terminate an unplanned pregnan cy versus those who terminate a planned and wanted pregnan cy highlight the importance of taking pregnan cy intendedness and wantedness into account when seeking to understand psychological reactions to abortion.

This review identified several factors that are predictive of more negative psychological responses following first-trimester abortion among women in the United States. Those factors included:
-Perceptions of stigma, need for secrecy, and low or anticipated social support for the abortion decision;
-A prior history of mental health problems;
-Personality factors such as low self-esteem and use of avoidance and denial coping strategies; and
-Characteristics of the particular pregnan cy, including the extent to which the woman wanted and felt committed to it.
Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.