By Karla Gale

NEW YORK (Reuters Health) – Two investigators evaluating data from the National Longitudinal Study of Youth agree that induced abortion is associated with depression, but take issue with the reasons for the association.

In the British Medical Journal for January 19, Drs. David C. Reardon and Jesse R. Cougle, of the Elliot Institute in Springfield, Illinois, write that women who were married in 1992 and had previously undergone an abortion were significantly more likely to be at high risk of clinical depression than those who delivered unintended pregnancies.

The Illinois investigators analyzed data for 421 women who had their first abortion or first unintended delivery between 1980 and 1992. They controlled for family income, education, age at first pregnancy, and 1979 Rotter scores for internal-external locus of control.

Depression was assessed in 1992 using the Center for Epidemiological Studies depression scale (CES-D). Among married women who did not abort between 1980 and 1992, 17.3% scored >15 on the CES-D, compared with 26.2% of those who did undergo abortion.

For unmarried women, the corresponding proportions were 30.2% and 28.7%, an insignificant difference. The authors speculate that the lack of difference in unmarried women may be explained by the higher rate of nonreporting of abortions among these individuals.

However, Dr. Reardon states in a press release that Dr. Nancy Russo, of Arizona State University, used the same data set to examine women's self-esteem. Her research revealed no significant difference between aborting women and women who carried to term.

"She concluded that abortion has no effect on women, which I found to be highly dubious in the first place," Dr. Reardon told Reuters Health.

In an interview with Reuters Health, Dr. Russo said, "All of my work has emphasized that if you take women who had abortions, they will have higher depression levels than women who haven't had or don't report any abortions. However, we found that this relationship [between abortion and depression] is explained by the levels of violence in the lives of those women. Abortion doesn't contribute independently to that depression level."

She added that Drs. Reardon and Cougle did not control for violence, the number of children, or the number of abortions the women had, all of which are known to contribute to depression. She also looked askance at their use of the Rotter scale, which she says is a correlate of self-esteem, but is not intended to be used as an indicator of psychiatric state.

"It's important to recognize that this is a complicated picture," Dr. Russo added. "The bottom line is that it is very important not to prejudge a woman's source of mental health problems. There is usually more than one thing. It does no one any service to attribute it all to abortion. Such women need to get help from a qualified mental health specialist and work through their issues."

Dr. Russo charged that part of Dr. Reardon's agenda is "to create this idea that there is a post-abortion syndrome in order to give malpractice lawyers a vehicle to sue abortion doctors." In fact, the Elliott Institute funded the research by the Illinois investigators. As noted on the Institute's Web site, http://www.afterabortion.org, Dr. Reardon has published several books on strategies to end the right to abortion.

Dr. Reardon's final recommendation does not seem to differ from that of Dr. Russo. He told Reuters Health, "Clinicians should routinely inquire about any reproductive loss, since research also indicates that miscarriage is related to depression."

He added, "Being aware of reproductive loss in a patient's background may help the physician to be more alert to depression, potential suicide, or other unresolved mental health issues."