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<h5 class="section-title" id="d3639633e356">Question</h5>
<p id="d3639633e358">Is first-trimester first abortion associated with an increase
in women’s risk of first-time
antidepressant use?
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<h5 class="section-title" id="d3639633e361">Findings</h5>
<p id="d3639633e363">In this cohort study of 396 397 women born in Denmark between
January 1, 1980, and
December 31, 1994, women who had a first abortion had a higher risk of first-time
antidepressant use compared with women who did not have an abortion. However, for
women who had a first abortion, the risk was the same in the year before and the year
after the abortion and decreased as time from the abortion increased.
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<h5 class="section-title" id="d3639633e366">Meaning</h5>
<p id="d3639633e368">Having a first abortion is not associated with an increase in
a woman’s risk of first-time
antidepressant use.
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<h5 class="section-title" id="d3639633e372">Importance</h5>
<p id="d3639633e374">The repercussions of abortion for mental health have been used
to justify state policies
that limit access to abortion in the United States. Much earlier research has relied
on self-report of abortion or mental health conditions or on convenience samples.
This study uses data that rely on neither.
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<h5 class="section-title" id="d3639633e377">Objective</h5>
<p id="d3639633e379">To examine whether first-trimester first abortion or first childbirth
is associated
with an increase in women’s initiation of a first-time prescription for an antidepressant.
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<h5 class="section-title" id="d3639633e382">Design, Setting, and Participants</h5>
<p id="d3639633e384">This study linked data and identified a cohort of women from
Danish population registries
who were born in Denmark between January 1, 1980, and December 30, 1994. Overall,
396 397 women were included in this study; of these women, 30 834 had a first-trimester
first abortion and 85 592 had a first childbirth.
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<h5 class="section-title" id="d3639633e387">Main Outcomes and Measure</h5>
<p id="d3639633e389">First-time antidepressant prescription redemptions were determined
and used as indication
of an episode of depression or anxiety, and incident rate ratios (IRRs) were calculated
comparing women who had an abortion vs women who did not have an abortion and women
who had a childbirth vs women who did not have a childbirth.
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<h5 class="section-title" id="d3639633e392">Results</h5>
<p id="d3639633e394">Of 396 397 women whose data were analyzed, 17 294 (4.4%) had
a record of at least
1 first-trimester abortion and no children, 72 052 (18.2%) had at least 1 childbirth
and no abortions, 13 540 (3.4%) had at least 1 abortion and 1 childbirth, and 293 511
(74.1%) had neither an abortion nor a childbirth. A total of 59 465 (15.0%) had a
record of first antidepressant use. In the basic and fully adjusted models, relative
to women who had not had an abortion, women who had a first abortion had a higher
risk of first-time antidepressant use. However, the fully adjusted IRRs that compared
women who had an abortion with women who did not have an abortion were not statistically
different in the year before the abortion (IRR, 1.46; 95% CI, 1.38-1.54) and the year
after the abortion (IRR, 1.54; 95% CI, 1.45-1.62) (
<i>P</i> = .10) and decreased as time from the abortion increased (1-5 years: IRR,
1.24; 95%
CI, 1.19-1.29; >5 years: IRR, 1.12; 95% CI, 1.05-1.18). The fully adjusted IRRs
that
compared women who gave birth with women who did not give birth were lower in the
year before childbirth (IRR, 0.47; 95% CI, 0.43-0.50) compared with the year after
childbirth (IRR, 0.93; 95% CI, 0.88-0.98) (
<i>P</i> < .001) and increased as time from the childbirth increased (1-5 years:
IRR, 1.52;
95% CI, 1.47-1.56; >5 years: IRR, 1.99; 95% CI, 1.91-2.09). Across all women in
the
sample, the strongest risk factors associated with antidepressant use in the fully
adjusted model were having a previous psychiatric contact (IRR, 3.70; 95% CI, 3.62-3.78),
having previously obtained an antianxiety medication (IRR, 3.03; 95% CI, 2.99-3.10),
and having previously obtained antipsychotic medication (IRR, 1.88; 95% CI, 1.81-1.96).
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<h5 class="section-title" id="d3639633e403">Conclusions and Relevance</h5>
<p id="d3639633e405">Women who have abortions are more likely to use antidepressants
compared with women
who do not have abortions. However, additional aforementioned findings from this study
support the conclusion that increased use of antidepressants is not attributable to
having had an abortion but to differences in risk factors for depression. Thus, policies
based on the notion that abortion harms women's mental health may be misinformed.
</p>
</div><p class="first" id="d3639633e408">This study of a large cohort of Danish women
examines the association between first-trimester
first abortion or first childbirth with risk of a first-time prescription for an antidepressant.
</p>