By Randall K. O’Bannon, Ph.D., NRL-ETF Director of Education & Research
Just this past September, I was remarking how a major meta-analysis appearing in the August 2011 issue of the British Journal of Psychiatry showed a significant association between abortion and mental health problems, despite long standing denials from abortion defenders at the American Psychological Association. (See National Right to Life News Today, 9/2/11).
That meta-analysis, by Bowling Green State University professor Priscilla Coleman, looked at 22 studies tracking 877,181 women, including 163,831 who had had abortions, and found an 81% increase in mental health problems among the aborting women. Risk of alcohol abuse among this group was 110% higher and suicidal behavior was up 155%.
This was apparently more than the abortion establishment could bear, so, shortly on the heels of the publication of Coleman’s meta-analysis, Britain’s Royal College of Psychiatrists (RCP) issued a report of its own, denying any real link between abortion and mental illness. That report, eerily similar to denials issued by the APA, examined literature on the study and claimed that the best studies show no link.
Coleman, in a detailed critique of the RCP review (available at http://www.nationalrighttolifenews.org/news/2011/12/a-critique-of-the-systematic-review-of-induced-abortion-and-mental-health-released-by-the-royal-college-of-psychiatrists/), found numerous factual and methodological errors and says the resulting product “was not undertaken in a scientifically responsible manner.”
Cherry Picked Studies
To obtain the conclusion it did, the RCP picked and chose among the available studies, excluding many of those offering strong evidence of the connection between abortion and mental health issues. Coleman identified 19 literature reviews and 20 empirical studies involving risk factors for post-abortion health problems that were ignored by the RCP team.
The exclusion might have been legitimate if the data was faulty or the studies poorly designed. But Coleman says that many of these were dismissed for “vague and/or inappropriate reasons.”
For example, the RCP report dismissed 35 studies which followed women’s mental health for only 90 days. While significant numbers of women do experience problems after that initial three month period, this does not warrant dismissing those studies covering the period in which many of these women’s difficulties first surfaced.
Coleman also notes that many of the studies the RCP ignored also happened to be ones that controlled for prior psychological history and other factors, which would have led to more robust results. (A “control” neutralizes the impact of a given factor likely to influence one group more than another—in this case prior psychological history—so that it does not distort the results.) As it was 27 of the 34 studies that the RCP looked at had no controls for previous mental health, although nearly two thirds (14 of 22) of the studies in Coleman’s own meta-analysis did.
Loose with the Facts
The RCP report claimed (referring to Coleman’s, the APA’s, and the work of another researcher, Charles) that “previous mental health problems were not controlled for within the review.” In fact most of the studies Coleman examined did have controls for prior psychological history, while few of the studies in the RCP review did.
The RCP was careless with even the smallest of details, identifying Coleman as a member of Bowling Green State University’s Department of Psychiatry. Bowling Green State University has no medical school. Coleman is a long- time member of the Human Development and Family Studies Department.
The RCP pitches its assessment as superior because of the way that it rates the various studies. However Coleman finds several problems with its quality scale. Among the problems she finds with their quality assessments are:
1) Ignoring critical issues like participation and retention rates, i.e., the percentages of a given group choosing to participate in a study and the number who stayed with the study to the end;
2) The lack of any scientific basis or consensus regarding the selection or ranking of assessment criteria;
3) The failure to spell out clear criteria for the assignment of “+” or “-“ within the various assessment categories;
4) No real explanation offered for how the various plusses or minuses within the category are added to yield the overall rating ranging from “Very Poor” to “Very Good.”
Coleman relates the story of one study the RCP found “Good.” It had few controls for income, quality of relationship (including exposure to domestic violence), and other factors. It also had poor retention rates, no standardized measures for mental health diagnoses, and voluntary assessments by general practitioners rather than mental health professionals.
At the same time, other studies that looked at specific evidence of anxiety, depression, suicide ideation, drug and alcohol abuse, psychiatric treatment, etc., were rated “Very Low” for not controlling for pregnancy intention.
Coleman says that “There are loose, poorly conceived rationales and inconsistencies like this throughout the report and the problem lies in the application of an inadequate quality assessment protocol for individual studies and for the body of evidence.”
The RCP’s conclusions are “based on a very small number of studies that are not properly rated for quality,” Coleman says, and “should, therefore, not be trusted as a basis for professional training protocols or health care policy initiatives.”
On her own, Coleman says that she identified 119 studies published between 1972 and 2011 and come up with a list of the most common risk factors associated with post-abortion psychological health. They include aborting at a younger age, ambivalence, pressure, belief in the humanity of the fetus, conflicted or unsupportive relationships with the father or others, poor abortion care, etc. Coleman says that the RCP conclusions looking at risk factors make little or no mention of most of these factors, raising serious questions about the thoroughness of their study.
In the end, when the RCP concludes, on the basis of only four studies, that there is no special mental health risk associated with abortion relative to the delivery of an unintended pregnancy, it is on rather shaky ground.
Coleman asks, “how many of these purposefully driven ‘systematic reviews’ have to be published with results splashed all over the world, before women’s psychological health will finally take precedence over political, economic, and ideological agendas?”
“Until there is acknowledgement that scores of women suffer from their decision to undergo abortion,” Coleman says, “we will remain in the dark ages relative to the development of treatment protocols, training of professionals, and our ability to compassionately assist women to achieve the understanding and closure they need to resume healthy lives.”
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