Depression and Unwanted First Pregnancy: Longitudinal Cohort Study

Objective: To examine the outcomes of an unwanted first pregnancy (abortion v live delivery) and risk of depression and to explain discrepancies with previous research that used the same dataset.

Design: Longitudinal cohort study.

Setting: Nationally representative sample of US men and women aged 14-24 in 1979.

Participants: 1247 women in the US national longitudinal survey of youth who aborted or delivered an unwanted first pregnancy.

Main Outcome Measures: Clinical cut-off and continuous scores on a 1992 measure of the Center for Epidemiological Studies depression scale.

Results: Terminating compared with delivering an unwanted first pregnancy was not directly related to risk of clinically significant depression (odds ratio 1.19, 95% confidence interval 0.85 to 1.66). No evidence was found of a relation between pregnancy outcome and depression in analyses of subgroups known to vary in under-reporting of abortion. In analyses of the characteristics of non-respondents, refusal to provide information on abortion did not explain the lack of detecting a relation between abortion and mental health. The abortion group had a significantly higher mean education and income and lower total family size, all of which were associated with a lower risk of depression.

Conclusions: Evidence that choosing to terminate rather than deliver an unwanted first pregnancy puts women at higher risk of depression is inconclusive. Discrepancies between current findings and those of previous research using the same dataset primarily reflect differences in coding of a first pregnancy.