First pregnancy abortion or miscarriage: a cohort study of mental health services utilization

Abstract

Introduction 

While both induced abortion and natural pregnancy loss have been associated with subsequent mental health problems, population-based studies directly comparing these two pregnancy outcomes are rare. We sought to compare the mental health morbidity of women subsequent to an induced abortion or natural loss (miscarriage).

Methods

Participants were continuously eligible Medicaid beneficiaries age 16 in 1999 and assigned to two cohorts based upon the first pregnancy outcome: abortion (n = 1,331) or miscarriage (n = 605). Outcomes were mental health outpatient visits, inpatient hospital admissions and hospital days of stay per patient per year. Average exposure periods before and after the first pregnancy outcome were determined for each cohort and used to adjust the mental health service utilization rates.

Results

For the abortion cohort, the per patient per year increase from the pre- to post-pregnancy periods was significant for all three utilization rates: 2.04 times for outpatient visits (mean difference 1.66, t = 5.16, p < 0.0001); 3.02 times for inpatient admissions (mean difference 0.0154, t = 3.16, p = 0.0003); and 3.01 times for hospital days of stay (mean difference 0.1452, t = 2.54, p = 0.0112). None of the pre-to-post rate increases were significant for the natural loss cohort.

Conclusion

Higher pre-pregnancy use rates for women who experience a miscarriage indicate that increased mental health services use following abortion cannot be solely attributed to pre-existing mental illness.