Trauma Symptoms After Abortion Are Common

Post-traumatic reactions to induced abortion may be far more common than previously thought, according to a study published in the Medical Science Monitor.

Sixty-five percent of American women studied experienced multiple symptoms of Post-Traumatic Stress Disorder (PTSD), which they attributed to their abortions. Slightly over 14 percent reported all the symptoms necessary for a clinical diagnosis of abortion induced PTSD.

Researchers gathered data from women seeking general health care treatment at clinics and hospitals in both the United States and Russia. Women with a history of pregnancy loss, including miscarriage or abortion, were asked to complete an extensive questionnaire about their experiences.

The subsample used in this study included 331 Russian women and 217 American women. American women were significantly more likely to report traumatic reactions they attributed to their abortions, while Russian women were more likely to report disruption of cognitive schema, which is described as the equivalent of one's "psychological road map" for understanding the world and one's place in it.

Both Russian and American women were more likely to experience negative reactions to abortion if they had prior negative opinions of abortion, felt pressured into unwanted abortions, were more religious, or received little or no counseling prior to the abortion. American women were more likely to report being exposed to one or more of these risk factors. For example, 64 percent of American women felt pressured by others to choose abortion compared to 37 percent of Russian women. In addition, only 25 percent of American women reported receiving adequate counseling prior to their abortions compared to 64 percent of the Russian women.

American and Russian women reported fewer postive reactions to abortion than negative ones. The most commonly reported positive reaction was relief, but only 7 percent of Russian women and 14 percent of American women attributed this feeling to their abortions. American women were more likely to attribute to their abortion subsequent thoughts of suicide (36 percent), increased use of drugs or alcohol (27 percent), sexual problems (24 percent), relationship problems (27 percent), guilt (78 percent), and an inability to forgive themselves (62 percent). Approximately two percent of the American women studied attributed a subsequent psychiatric hospitalization to their abortion.

"This is the first published study to compare reactions to abortion among women in two different countries," said Dr. Vincent Rue, the lead author of the study and a traumatologist who heads the Institute for Pregnancy Loss. "It is also the first to provide a detailed breakdown of traumatic symptoms which the subjects themselves attribute to their abortions. These results will help mental health workers to be better prepared to recognize and treat the psychological complications of abortion."

While this new study focuses on traumatic reactions to abortion, it follows on the heals of nearly a dozen other peer-reviewed studies published in the last three years linking abortion to increased risk of depression, anxiety, substance abuse, suicidal behavior. Recent studies have also linked abortion to higher rates of death from heart disease, which investigators believe may be a long term effect of elevated rates of anxiety and depression.

Because of the increasing concern about the mental health effects of abortion on women, legislation has been introduced in Congress to expand funding for treatment programs and research in this area.

Citing: Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit, 2004 10(10): SR5-16.
Springfield, IL (November 16, 2004)

The article can be downloaded free of charge at

http://www.medscimonit.com/medscimonit/modules.php?name=GetPDF&pg=2&idm=4923
Excerpts below:

Induced abortion and traumatic stress: A preliminary comparison of American and Russian women
Vincent M. Rue1ABCDEFG, Priscilla K. Coleman2CDEF, James J. Rue3AEF,
David C. Reardon4CDEF
1 Institute for Pregnancy Loss, Jacksonville, FL, U.S.A.
2 Human Development and Family Studies, Bowling Green State University, Bowling Green, OH, U.S.A.
3 Sir Thomas More Clinic, Downey, CA, U.S.A.
4 Elliot Institute, Springfi eld, IL, U.S.A.
Source of support: Partial funding for this study was made possible by grants from the Trust Funds Foundation and the Alberto Vollmer Foundation.

Summary
Background: Individual and situational risk factors associated with negative postabortion psychological sequelae have been identified, but the degree of posttraumatic stress reactions and the effects of culture are largely unknown.

Material/Methods: Retrospective data were collected using the Institute for Pregnancy Loss Questionnaire (IPLQ) and the Traumatic Stress Institute’s (TSI) Belief Scale administered at health care facilities to 548 women (331 Russian and 217 American) who had experienced one or more abortions, but no other pregnancy losses.

Results: Overall, the fi ndings here indicated that American women were more negatively infl uenced by their abortion experiences than Russian women. While 65% of American women and 13.1% of Russian women experienced multiple symptoms of increased arousal, re-experiencing and avoidance associated with posttraumatic stress disorder (PTSD), 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for PTSD. Russian women had signifi cantly higher scores on the TSI Belief Scale than American women, indicating more disruption of cognitive schemas. In this sample, American women were considerably more likely to have experienced childhood and adult traumatic experiences than Russian women. Predictors of positive and negative outcomes associated with abortion differed across the two cultures.

Conclusions: Posttraumatic stress reactions were found to be associated with abortion. Consistent with previous research, the data here suggest abortion can increase stress and decrease coping abilities, particularly for those women who have a history of adverse childhood events and prior traumata. Study limitations preclude drawing defi nitive conclusions, but the fi ndings do suggest additional crosscultural research is warranted.

Full-text PDF: http://www.MedSciMonit.com/pub/vol_10/no_10/4923.pdf
Word count: 4645
Tables: 7
Figures: 1
References: 50

BACKGROUND
Beyond politics, increasing public health concern is focusing on the adverse emotional outcomes women can experience following abortion [1–15]. Researchers on both side of
the abortion debate agree that some women’s mental health is negatively impacted by abortion and that more investigation is warranted to better assist those women and to prevent
future harm to others. Extensive research has documented how traumatic stress can significantly alter individuals’ lives [16]. Traumatic stressors are strong predictors of PTSD. While the lifetime prevalence of PTSD has been estimated to be up to 12% of U.S. women [17], limited research has examined the role of induced abortion as a traumatic stressor.

Anxiety and depression have long been associated with induced abortion [18]. In a major review of the literature, anxiety symptoms were identifi ed as the most common adverse
postabortion response [19]. As an anxiety disorder, posttraumatic stress disorder (PTSD) can be identified with an overwhelming and life-threatening event and with an inability to process the trauma. Earlier research reported a connection between experiencing a traumatic abortion and the onset of posttraumatic stress related symptoms [20–24].

These studies were limited due to their reliance upon either case studies or small samples, with the exception of one larger
study that reported a 1% incidence of PTSD following abortion [25]. The present study focused on the degree to which induced abortion was associated with posttraumatic stress and whether or not posttraumatic responses following abortion were evident in another culture.

Women’s psychological responses to abortion are likely influenced by complex socio-cultural factors. In some nations the social environment surrounding abortion is defined by strong moral sanctions against it; whereas in other parts of the world abortion is a passively accepted medical practice.

The present study represents an exploratory comparison of abortion reactions of American and Russian women. The comparison of these two groups is especially interesting because abortion continues to be a highly charged political issue in the United States since its legalization in 1973, while there has been very little political controversy about abortion in Russia following its legalization in 1955. For many years, Russian women have used abortion as one of their principle means of birth control due to the relative scarcity of other birth control options; although more restrictive policies are emerging [26–28].

Some research has suggested that PTSD is not just limited to Euro-Americans [29]. However, assessment of PTSD symptoms may vary widely due to ethnocultural infl uences [30–32]. While there is some evidence of PTSD following abortion in the U.S. [20–24], no equivalent research has been conducted with Russian women.

Hence, the primary purpose of this research was to examine whether or not abortion was perceived as traumatic, and if so, whether or not its manifestations were equivalent to PTSD symptoms in both American and Russian women.

The secondary purposes of this research included identifying demographic and pregnancy circumstances most predictive of possible negative outcomes, as well as evaluating the extent to which negative responses could be due to cultural factors, rather than individual
characteristics in American and Russian women.

MATERIAL AND METHODS
Women who had experienced a pregnancy loss (spontaneous abortion, induced abortion, stillbirth, or adoption) were asked to participate in a study of women’s reactions to a pregnancy loss. Data were collected in 1994 at U.S. and Russian healthcare facilities (public and private hospitals, and health care clinics).

All women between the ages of 18 and 40 were surveyed on a continuous basis until 992 women with at least one pregnancy loss had been identifi ed. The sample used in the current study includes only those women who had one or more induced abortion and no miscarriages, stillbirths, or adoptions (n=548 or 55.2% of the larger sample). If multiple abortions were reported, the respondent was asked to identify and only report on the “most stressful” one. As to nationality, the sample used in the current study included 331 Russian and 217 American women.

At the time of their reported abortion experience, the mean age of the Russian women was 22.11 (SD=5.80) and for the American women, the mean age was 23.07 (SD=5.71).
The mean age at the time the women completed the questionnaire was 28.24 (SD=9.67) for the Russians and 33.86 (SD=8.85) for the American. Among Russian women, the mean number of weeks pregnant at the time of the abortion was 6.75 (SD=3.19); whereas among the American women, the mean number of weeks pregnant was 10.07 (SD=4.55).

RESULTS
Various demographic and psychosocial background variables were assessed. In this sample, as to ethnicity, most of the women from the former Soviet Union identified themselves as Russian (78.2%); in the American sample, 59.4% were white, 24.9% Hispanic, and 10.1% black.

Most Russian women worked full-time (63.4%) compared to 34.3% of the women in the American sample. In both cultures, the majority of women worked in the professional/ business sector (62% Russian v. 57.9% American). More Russian women were married (59.1%) compared to American women (49.1%), and Russian women had slightly more years of education than American women (48.9% had 16 years of education v. 42.9%). As to number of children, 52% of Russian women had none compared to 30.4% of American women.

Regarding the psychosocial variables, these data generally suggest that women in the Russian sample perceived their childhoods (8.5% Russian v. 51.6% American) and adolescence (74.2% Russian v. 36.6% American) to be happier than American women. American women were considerably more likely to report being physically or sexually abused before age 18 (42.3% American v. 11.4% Russian).

When asked about religious convictions, 63.1% of the Russian sample and 89.4% of the American sample indicated having religious beliefs. The mean rating of the importance of these beliefs was 2.49 (SD=0.73) for the Russian sample and 1.49 (SD=0.71) for the American sample on a scale of 1 to 4, with scores closer to 1 suggesting more importance.
Table 1 contains the descriptive statistics for all the outcome measures for both the Russian and American samples.

On a 1 to 4 scale, women in both countries generally reported their abortion experiences as stressful. Overall, when compared to Russian women, American women who chose to abort were more than twice as likely to experience negative psychological effects and report PTSD symptoms of arousal, re-experience, and avoidance, particularly the latter. Russian women only scored higher than American women on the TSI scale.

DISCUSSION
Women from Russia and the U.S. were compared with respect to negative and positive outcomes after an induced abortion. Compared to Russian women, American women exhibited more negative effects, more symptoms of PTSD, and reported higher levels of stress associated with experiencing an abortion. However, the Russian women reported significantly higher rates of disruption in cognitive schemata.

No nationality differences were observed relative to positive effects. In the present study, American women were exposed to considerably more preabortion traumatic events than their Russian counterparts. The percentage of American women reporting preabortion trauma is high but roughly equivalent to an earlier study that found 40% of females reported unwanted sexual experiences prior to age 18 [40] and another which found 38% reported childhood emotional abuse [41].

Approximately half of women who experience early childhood trauma also experience PTSD at some point [42]. Other research has confirmed that childhood traumata are more likely to result in subsequent high risk-taking behaviors, including a significantly higher number of abortions [43–45].

The findings here suggest that abortion may well exacerbate prior posttraumatic stress symptoms, even if in remission. Hence, an individual’s trauma history should be fully explored in counseling prior to obtaining an abortion.

In this study, for Russian women, the least endorsed PTSD subscale was that of avoidance. This finding corroborates prior research that the PTSD subscale of avoidance is more difficult to assess in non Euro-American cultures, and that failure to diagnose PTSD is often due to lack of cultural comprehension of avoidance symptoms [29].

The TSI Belief Scale was used in this study to examine disruption
of cognitive schemata relative to basic needs impacted by trauma: self/other-safety, self/other-trust, self/other esteem,
self/other-intimacy, and self/other-control.

The higher the total score, the greater the degree of disrupted
cognitive schemata. Numerous factors may explain why Russian women scored higher on this scale than American women, e.g., repeated exposure to a