Study Reveals Nuanced Findings on Psychotropic Medication Use Following Abortion

A Danish population-based cohort study has uncovered mixed results regarding the association between abortion and subsequent use of psychotropic medications, with findings highlighting both short-term risks and long-term benefits.

The study, led by Julia R. Steinberg, PhD, of the University of Maryland, found that women who underwent abortion exhibited a small increased risk of their first psychotropic medication prescription in the first year following the procedure. However, this association lost statistical significance after adjusting for multiple comparisons using the Bonferroni correction. Long-term data (beyond five years) showed a reduced risk of such prescriptions, which remained statistically significant even after adjustment.

Prior research indicated that women with abortions had higher rates of antidepressant use and suicide attempts, but these elevated rates were observed both before and after the procedure. The current study, however, suggests a more nuanced picture. Conventional statistical thresholds initially revealed a marginally elevated risk for first-time psychotropic medication claims in the year post-abortion—10% for medication abortions (incidence rate ratio [IRR] 1.10, 95% CI 1.02–1.19, *P*=0.01) and 9% for procedural abortions (IRR 1.09, 95% CI 1.01–1.16, *P*=0.02)—compared with the pre-abortion period. These risks, however, became non-significant after applying the Bonferroni-adjusted threshold (P<0.002).

In contrast, long-term follow-up (over five years) demonstrated statistically significant reductions in first-time medication use: 15% lower for medication abortions (IRR 0.85, 95% CI 0.78–0.91, *P*<0.001) and 17% lower for procedural abortions (IRR 0.83, 95% CI 0.78–0.88, *P*<0.001).

Contextualizing the Findings

While the initial short-term risk was statistically significant by traditional standards, co-authors and external experts emphasized that this marginal increase does not imply causation. Katherine L. Wisner, MD, and colleagues, in an accompanying editorial, argued that stressors associated with the decision to terminate a pregnancy—such as financial strain, health concerns, or relationship instability—likely explain the temporal association. “The slightly elevated risk could be explained by factors associated with the abortion rather than the abortion itself,” they wrote.

The 2024 follow-up study using the same Danish cohort found no increased risk of psychiatric diagnoses (a more severe indicator than medication use alone) following abortion, either short- or long-term. This aligns with the broader interpretation that contextual factors—not the procedure itself—drive the observed medication use patterns.

Study Details and Limitations

Steinberg and colleagues analyzed 67,390 women (mean age 21.8 years), with 33,793 undergoing medication abortions and 33,597 procedural abortions. Over 29.6% received a first psychotropic prescription during the 20-year study period (1999–2018), most commonly antidepressants (58.2%) and anti-anxiety medications (26.9%). No significant associations emerged in the 1- to 5-year post-abortion periods after adjusting for baseline comparisons.

Limitations include the study’s focus on a largely white, Danish population with universal healthcare, which may not reflect other contexts. Additionally, the stigma around abortion and healthcare access differ markedly from regions like the U.S., potentially influencing results. The authors caution that further research is needed to clarify these findings.

The study was published in JAMA Psychiatry, adding to ongoing debates about abortion-related mental health outcomes.

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