Psychiatric outcomes following medical and surgical abortion

Dorothy Sit, Anthony J. Rothschild, Mitchell D Creinin, Barbara H. Hanusa, Katherine L. Wisner

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

BACKGROUND: Hypercortisolaemia is associated with certain depressive disorders. Mifepristone has possible antidepressant properties related to its anti-glucocorticoid activity. To explore the possible mood effects of mifepristone, we examined the mood outcomes after surgical and medical (mifepristone-misoprostol) abortion. The objectives were to determine post-abortion depression risk, evaluate risk factors for post-abortion depression and to explore the relationship between cortisol and depression. METHODS: We enrolled 47 surgical and 31 medical abortion patients. Women were assessed pre-abortion and 1 month post-abortion with the Edinburgh Postnatal Depression Scale (EPDS) and salivary cortisol levels. RESULTS: Pre-abortion, 36% (17/47) of surgical and 35% (11/31) of medical patients had high depression risk (EPDS ≥ 10; (χ2 = 0.31, df = 1, P = 0.58). At follow-up, 17% (7/42) of surgical and 21% (5/24) of medical patients had an EPDS ≥ 10 (χ2 = 0.18, df = 1, P = 0.67). The decline post-abortion in the women with EPDS ≥ 10 was significant (P = 0.01). Women with past psychiatric history (Fisher's exact P = 0.05) or anxiety disorders (Fisher's exact P = 0.005) had elevated risk for post-abortion depression. Change in cortisol levels was not correlated with change in EPDS (r = 0.10, P = 0.28). CONCLUSIONS: Most patients experienced post-abortion mood improvement. Mifepristone did not offer additional antidepressant effects. The lack of correlation between cortisol and depression could represent hypersuppression of the hypothalamic-pituitary- adrenal (HPA) axis or insufficient mifepristone dose to alter HPA axis activity.

Original languageEnglish (US)
Pages (from-to)878-884
Number of pages7
JournalHuman Reproduction
Volume22
Issue number3
DOIs
StatePublished - Mar 2007
Externally publishedYes

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Keywords

  • Biomarker
  • Depression
  • Mifepristone
  • Salivary cortisol

ASJC Scopus subject areas

  • Rehabilitation
  • Obstetrics and Gynecology
  • Reproductive Medicine
  • Physiology
  • Developmental Biology

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