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Induced Abortions and Posttraumatic Stress - Is there any relation?: A Swedish multi-centre study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Sophiahemmet University.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers, and there is lack of knowledge about the relationship between posttraumatic disorder (PTSD) and induced abortion. Aims: To study and compare PTSD, posttraumatic stress symptoms (PTSS) and anxiety- and depressive symptoms among women seeking abortion, allowing for demographic variables. Further aims were to assess risk factors and to assess PTSD and PTSS following induced abortion in relation to experienced care at the clinic. Methods: This was a multi-centre cohort study targeting women who requested an induced abortion at the outpatient clinics of the gynaecology and obstetrics departments of six public hospitals in Sweden. All women who requested an induced abortion before the end of gestational week 12 were approached for participation. PTSD, PTSS, anxiety- and depressive symptoms, personality traits and women’s perceptions of abortion care were measured by means of questionnaires. Measurements were made at the first visit before the abortion as well as three- and six-months thereafter. Data collection was performed from September 2009 to January 2011. Results: 1,514 women filled out the questionnaire before the abortion. Abortion-seeking women did not suffer from PTSD to a greater extent than the general Swedish female population. Few women (51/720) developed PTSD or PTSS after the abortion, 11 did so due to trauma experience related to the abortion. Women at risk of posttraumatic stress were more likely to be young, having anxiety- or depressive symptoms and personality traits related to neuroticism. Furthermore, women with PTSD or PTSS were more likely to perceive certain aspects of the abortion care as deficient. Conclusions: The vast majority of women coped well with the induced abortion. Few developed posttraumatic stress post abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Young women and women with mental distress are vulnerable groups that need to be paid attention to in abortion care. These women are at risk for negative experiences of the abortion care, and may be at risk of PTSD or PTSS post abortion

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1022
Keyword [en]
Abortion Induced, Stress Disorders Posttraumatic, Anxiety, Depression, Mental Health, Personality Traits, Ambulatory Care Facilities
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-230489ISBN: 978-91-554-9014-0 (print)OAI: oai:DiVA.org:uu-230489DiVA: diva2:740899
Public defence
2014-10-10, Eva Netzelius-salen, Blåsenhus, von Kraemers allé 1A, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Note

Contact: Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden

Available from: 2014-09-19 Created: 2014-08-26 Last updated: 2015-01-22
List of papers
1. The prevalence of posttraumatic stress among women requesting induced abortion
Open this publication in new window or tab >>The prevalence of posttraumatic stress among women requesting induced abortion
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2013 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 6, 480-488 p.Article in journal (Refereed) Published
Abstract [en]

Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-206289 (URN)10.3109/13625187.2013.828030 (DOI)000327484700008 ()23978220 (PubMedID)
Available from: 2013-12-14 Created: 2013-08-30 Last updated: 2017-12-06Bibliographically approved
2. Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study
Open this publication in new window or tab >>Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study
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2013 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 13, 52- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

METHODS:

This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups.

RESULTS:

The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

CONCLUSION:

Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-213495 (URN)10.1186/1472-6874-13-52 (DOI)000329240600001 ()24364878 (PubMedID)
Available from: 2013-12-25 Created: 2013-12-25 Last updated: 2017-12-06Bibliographically approved
3. Neuroticism-related personality traits are associated with post-abortion posttraumatic stress
Open this publication in new window or tab >>Neuroticism-related personality traits are associated with post-abortion posttraumatic stress
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2014 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102Article in journal (Other academic) Submitted
Keyword
abortion induce, anxiety disorders, personality, stress disorder posttraumatic
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-230475 (URN)
Available from: 2014-08-26 Created: 2014-08-26 Last updated: 2017-12-05Bibliographically approved
4. How do women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress
Open this publication in new window or tab >>How do women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress
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2015 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, 211-222 p.Article in journal (Refereed) Published
Abstract [en]

Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.

Keyword
Abortion; Ambulatory care facilities; Stress disorders; Posttraumatic stress disorders; Anxiety; Depression
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-230480 (URN)10.3109/13625187.2014.1002032 (DOI)000355981900007 ()25666812 (PubMedID)
Available from: 2014-08-26 Created: 2014-08-26 Last updated: 2017-12-05Bibliographically approved

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