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  • Title: Psychological responses following medical abortion (using mifepristone and gemeprost) and surgical vacuum aspiration. A patient-centered, partially randomised prospective study.
    Author: Henshaw R, Naji S, Russell I, Templeton A.
    Journal: Acta Obstet Gynecol Scand; 1994 Nov; 73(10):812-8. PubMed ID: 7817735.
    Abstract:
    BACKGROUND: A substantial body of objective data now exists to support the consensus view that induced abortion results in a low incidence of psychiatric morbidity. However, these data do not include more recent advances in abortion technology. Medical abortion entails a participatory role on the part of the woman, who may perceive more pain or see products of conception. The physical and psychological events experienced by women undergoing this procedure may lead to differences in psychopathology. METHODS: 363 women undergoing legal induced abortion up to 63 days gestation were allocated by a prospective partially randomised design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration performed under general anesthesia. This study design allowed women with a preference for a particular method to undergo that method; women without preferences were allocated at random. Women completed sensitive and reliable psychometric instruments (the Hospital Anxiety and Depression Scale and a semantic differential rating scale designed to measure self-esteem) prior to abortion and 16 days later. RESULTS: There were no significant differences between women allocated at random to medical abortion or vacuum aspiration in post-abortal anxiety, depression or low self-esteem. Women with high levels of mood disturbance prior to abortion, who were smokers or who had medical complications following abortion were at highest risk of post-abortal mood disorder. CONCLUSIONS: Medical abortion is a psychologically safe as surgical vacuum aspiration. The quantitative findings of the study support the consensus view that abortion is associated with high incidence of psychological benefit, whichever method is used. A prospective study of 363 abortion patients failed to provide evidence that women who receive a mifepristone/gemeprost medical abortion are at any greater risk of subsequent psychiatric morbidity than those who undergo the traditional vacuum aspiration procedure. Since women who undergo medical abortions are exposed to more pain, may see the products of conception, and generally play a more participatory role in the process, they were hypothesized to experience more psychological trauma than other abortion patients. The 168 women in the medical abortion subgroup received 600 mg of mifepristone followed 48 hours later by a vaginal pessary containing 1 mg of gemeprost. All subjects completed the Hospital Anxiety and Depression Scale and a self-esteem measure before and an average of 16 days after abortion. Overall, 165 women (45.5%) were significantly anxious and 67 (18,5%) were clinically depressed at baseline; after abortion, these rates had dropped to 37 (10.2%) and 9 (2.5%), respectively. Only 4 women who were non-anxious at baseline were anxious at follow up, while post-abortion depression developed in just 2 women. 190 women (55%) reported an improvement in self-esteem at follow up compared to baseline, 25 (7%) experienced no change, and 130 (38%) reported a decrease in self-esteem--a finding that is considered temporary and an integral part of the post-abortion grieving process. There was a significant correlation between anxiety and depression subscale scores before and after abortion and a significant negative correlation with self-esteem scores. There were no significant differences in any of these scores, however, between women who received medical versus vacuum aspiration procedures. Depression subscale scores at follow up were significantly related to postabortal medical complications, while anxiety scores after abortion were correlated with the number of physician consultations and the time required to resume normal activities. Baseline characteristics significantly associated with high anxiety and depression scores included cigarette smoking and a pre-existing mood disorder.
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