Psychotropic prescriptions after abortion: small early rise that did not hold up to correction

Design

Population-based Danish registry cohort, before-and-after comparison within women

Population

67,390 females aged 12 to 38 with a first-trimester elective abortion, 2000 to 2018

Primary outcome

First psychotropic medication prescription redemption

Effect

First year after medication abortion IRR 1.10 (95% CI 1.02 to 1.19); after procedural abortion 1.09 (1.01 to 1.16); not significant after Bonferroni correction

Using Danish registers, researchers followed 67,390 women aged 12 to 38 who had a first-trimester elective abortion, either medication (33,793) or procedural (33,597), from one year before the abortion. The outcome was the first redemption of any psychotropic prescription.

Compared with the year before, rates were slightly higher in the first year after medication abortion (incidence rate ratio 1.10, 95% CI 1.02 to 1.19) and procedural abortion (1.09, 1.01 to 1.16). After a Bonferroni correction for multiple testing these increases no longer reached significance. More than five years later, rates were lower than before (0.85, 0.78 to 0.91 and 0.83, 0.78 to 0.88).

The comparison is with the same women's earlier year, so it cannot separate the effect of abortion from the circumstances that led to it or from help-seeking around the time. The authors say replication is needed.

• About 30% of the cohort redeemed a psychotropic prescription during follow-up.
• First-year increases were about 10% in relative terms and not significant after correction.
• Rates were lower more than five years after either method.
• Method of abortion made little difference.
• Ask about mood and anxiety in the weeks after any pregnancy loss or termination, without assuming a cause.

Why it matters

It undercuts a simple story that abortion leads to mental illness, while noting a small, uncertain early signal.

Don't overread it

A registry measure of prescription redemptions is a proxy for mild symptoms and cannot show cause in either direction.

The statistics, in plain English

An incidence rate ratio of 1.10 means prescriptions were started about 10% more often than in the comparison period. When many comparisons are tested, some will cross the 5% threshold by chance; the Bonferroni correction tightens the threshold, and the early increase failed it, so it may be noise. The later reductions passed it.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.