Jane McCredie: Abortion fact and fiction

WHEN research published in a medical journal this month reported that 10% of mental illness in women was caused by abortion, it was no surprise to see the news picked up by anti-abortion websites around the world.

And it wasn’t a surprise to see the sensational findings receive uncritical coverage in the global media.

“Publication in the peer-reviewed journal is a signal that the psychiatric establishment now takes seriously the possibility that abortion is a cause of anxiety, depression, alcoholism, drug abuse and suicide”, Sydney’s Daily Telegraph reported.

If abortion does cause all those things we’d certainly want to know about it, but did the review in the British Journal of Psychiatry actually make the case for a causal relationship?

The review’s author, Professor Priscilla Coleman, from Bowling Green State University in Ohio, certainly believes her findings are robust enough to warrant clinicians warning women of the increased mental health risks associated with the procedure.

This is not a new cause for Professor Coleman, who has devoted much of her career to exposing what she sees as a cover-up of the link between abortion and subsequent mental health problems.

In this latest paper, she calls on the research community to “set aside personal ideological commitments” and “objectively examine all high-quality published data”. Worthwhile aims indeed, although not everybody is convinced Professor Coleman herself delivers on them.

She is, for example, listed as an author on half of the 22 papers included in her review — testament to her commitment to the topic, though not perhaps to her objectivity when scrutinising the research.

The assumption of causality is also problematic: several critics have pointed to a failure to adequately allow for confounders such as pre-existing mental illness when assessing the association between abortion and mental health problems.

Britain’s Royal College of Obstetricians and Gynaecologists was swift to issue a statement pointing out that Professor Coleman’s conclusions did not match those of three earlier systematic reviews.

“What this research does not fully examine is if these women had pre-existing mental health complications such as dependency issues and mood disorders before the abortion”, the college said.

A group of researchers from King’s College, London, were even blunter in a letter published in the same issue of the journal, raising a series of serious concerns about the methodology of the review and many of the primary studies it relied upon.

The conclusion that 10% of mental illness in women was caused by abortion was simply wrong, they wrote.

It’s not the first time Professor Coleman’s research has been subjected to this sort of criticism. For example, one paper coauthored by her and included in the current review, used data from the US National Comorbidity Survey to claim abortion contributed to increased risk of a range of mental health problems.

However, University of California researchers were unable to replicate the findings when they re-analysed the data, controlling for prior mental health issues and experience of violence.

Some will see these criticisms as further evidence of a conspiracy to hide the “real facts” about abortion, but if there’s one thing I’d agree with Professor Coleman on it’s that we do need high-quality, objective research in this area.

And it is essential that medical journals maintain those standards.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 26 September 2011