Abortion and later psychotropic prescriptions: small early rise did not survive correction

Design

Population-based national registry cohort

Population

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

Primary outcome

First redeemed psychotropic prescription versus the year before abortion

Effect

Year 1: IRR 1.10 (1.02–1.19) medication, 1.09 (1.01–1.16) procedural; not significant after Bonferroni

A Danish national registry cohort, published in JAMA Psychiatry on 1 October, followed 67,390 females aged 12–38 with a first elective first-trimester abortion between 2000 and 2018: 33,793 medication and 33,597 procedural. The outcome was a first redeemed prescription for any psychotropic, compared with the year before the abortion.

In the first year after abortion, first psychotropic redemptions were slightly higher after medication (IRR 1.10, 95% CI 1.02–1.19) and procedural abortion (IRR 1.09, 1.01–1.16). After Bonferroni correction for multiple tests, neither remained significant. There was no difference at 1–5 years, and rates were lower more than five years later (IRR about 0.85 and 0.83), which did survive correction.

For counselling, the two methods looked similar, and the data do not support telling patients that abortion causes lasting mental health problems. Prescription redemption is a crude marker of mild symptoms, and the comparison is within people over time, so it cannot account for everything else that happens around an unplanned pregnancy.

• Tell patients the two abortion methods showed similar patterns of later psychotropic use.
• Do not describe abortion as a cause of long-term mental illness; these data do not support it.
• Screen for depression and anxiety around the time of abortion as at any life event.
• Offer follow-up to those with a prior psychiatric diagnosis, who made up about 7% of this cohort.

Why it matters

It speaks directly to a common counselling question with registry data rather than opinion.

Don't overread it

Prescription redemption is a crude marker of mental health and cannot capture distress that was never treated.

The statistics, in plain English

An incidence rate ratio of 1.10 is a 10% relative rise. Because the authors ran many comparisons, they used a stricter threshold (P below .002), and the first-year rises did not meet it, which means they could plausibly be chance.

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