Previous research suggested that women who had abortions had higher rates of suicide attempts and antidepressant use, but those higher rates were seen both in the year before the abortion and in the year after.In the same Danish cohort, there were small increased risks for any first psychotropic medication prescription in the first year after both medication and procedural abortion compared with the year before an abortion.Outside experts argued that a marginal increase in psychotropic medications following abortion is not “surprising” and “could be explained by factors associated with the abortion rather than the abortion itself.”

The risk for first psychotropic medication prescription increased slightly in the year following an abortion, but this risk no longer met statistical significance after adjustment for multiple statistical tests, according to a Danish population-based cohort study.

Using conventional levels of statistical significance, there were small increased risks for any first psychotropic medication prescription claim in the first year after both medication abortion (incidence rate ratio [IRR] 1.10, 95% CI 1.02-1.19, P=0.01) and procedural abortion (IRR 1.09, 95% CI 1.01-1.16, P=0.02) compared with the year before an abortion, reported Julia R. Steinberg, PhD, of the University of Maryland in College Park, and co-authors.

There were decreased risks for any first psychotropic medication prescription claim more than 5 years after medication abortion (IRR 0.85, 95% CI 0.78-0.91, P<0.001) and procedural abortion (IRR 0.83, 95% CI 0.78-0.88, P<0.001), they noted in JAMA Psychiatry.

However, following Bonferroni adjustment for multiple tests (P<0.002), which was done to prevent type 1 errors, the risks in the first year after abortion compared with the year before abortion no longer met criteria for statistical significance, while the lower risks more than 5 years after abortion still met this criteria.

A 2024 study using the same Danish cohort found that neither medication abortion nor procedural abortion raised the risk of any first psychiatric diagnosis in the short or long term. However, psychiatric diagnoses usually indicate more severe symptoms than the use of psychotropic medication alone, Steinberg told MedPage Today.

The authors’ 2019 study suggested that women who had abortions had higher rates of suicide attempts and antidepressant use, but those higher rates were seen both in the year before the abortion and in the year after, she added.

In an accompanying editorial, Katherine L. Wisner, MD, of the Developing Brain Institute at Children’s National Hospital in Washington, D.C., and colleagues took issue with the authors’ use of Bonferroni adjustment, arguing that the effort to reduce type 1 errors (false positives) may have increased type II errors (false negatives).

“A marginally elevated risk of first prescription of a psychotropic medication during the first year following abortion should not be surprising,” Wisner and colleagues wrote. “Deciding to continue or terminate a pregnancy can create a stressful milieu. Distress due to maternal or paternal health problems, financial insecurity, intimate partner violence, and interference with educational or career goals may become magnified in the context of an undesired pregnancy.”

“In short, the slightly elevated risk could be explained by factors associated with the abortion rather than the abortion itself,” they added. “We therefore concur with the main conclusions reached by Steinberg et al but differ in the interpretation of the statistical findings.”

For this study, Steinberg and team tracked elective medication and procedural abortions up to 11 weeks, 6 days of gestation. They examined any first psychotropic medication prescription redemption before and after abortions over four periods: within 1 year; 1 to 2 years; 2 to 5 years; and more than 5 years.

They included 67,390 women, of whom 33,793 had a first-trimester medication abortion and 33,597 had a first-trimester procedural abortion. Mean age was 21.8, and 6.8% had a prior psychiatric diagnosis. More than three-quarters were neither married nor cohabiting.

Altogether, 29.6% received a first psychotropic medication prescription during the study period of January 1999 through December 2018, with 58.2% receiving antidepressants, 26.9% receiving anti-anxiety medications, and 2.4% receiving both. The other 12.6% of women received antipsychotic medications, mood stabilizers, or attention deficit-hyperactivity disorder medications.

There were no statistically significant associations in the 1 to 2 years and 2 to 5 years after abortion relative to the year before an abortion for each abortion method.

The study was limited to Danish people who were largely white, and results may not be generalizable to other countries. In addition, Denmark has universal healthcare, and far less stigma around abortion compared with the U.S., Steinberg said.

More research is needed to better understand these results, the authors noted.