The Association Between Repeated Abortions During Childbearing Age and the Psychological Well-being of Postmenopausal Women in Southwest China: an Observational Study

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2024 Nov 30

PMID 39616318

Authors

Xu Li

Anjiao Peng

Lin Li

Lei Chen

Affiliations

Soon will be listed here.

Abstract

Background: The issue of whether abortion increases the risk of future mental health problems for women remains a debated topic, and there is a lack of evidence from large-scale studies conducted in China. This study aimed to investigate the potential associations between abortions, particularly repeated abortions, and the mental health status of postmenopausal women in Southwest China.

Methods: The data were obtained from the baseline survey of a multi-center natural population cohort study in cooperated with medical consortia in Southwest China. A standard structured questionnaire was used to assess abortion status among women of childbearing age. The 7-item Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate psychological well-being. Subsequently, multiple logistic regression analysis was employed to examine the associations between the quantity and reasons for abortions and the mental health status of postmenopausal women.

Results: A total of 9991 postmenopausal women were enrolled (mean age: 60.51 years), of whom 11.09% (1108 individuals) reported mental health problems (5.54% for depression and 8.27% for anxiety). Multiple logistic regression analysis revealed that, compared with women without any history of abortion, postmenopausal women who reported three or more abortions during their childbearing years were likely to have worse mental health conditions (OR [95% CI]: 1.37 [1.13, 1.67]). Additionally, women who reported a history of abortions for socio-economic reasons were also correlated with an increased risk of mental health issues after menopause (OR [95% CI]: 1.34 [1.08, 1.66]).

Conclusions: Women who reported a history of three or more abortions were at an increased risk of experiencing mental health issues after menopause. Reproductive-age women should enhance their contraceptive awareness to prevent unintended pregnancies and subsequent abortions. Healthcare institutions are recommended to strengthen psychological counseling for women who have undergone abortions.

References

Mulhall S, Andel R, Anstey K . Variation in symptoms of depression and anxiety in midlife women by menopausal status. Maturitas. 2018; 108:7-12. DOI: 10.1016/j.maturitas.2017.11.005. View

Huang Y, Wang Y, Wang H, Liu Z, Yu X, Yan J . Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2019; 6(3):211-224. DOI: 10.1016/S2215-0366(18)30511-X. View

Richardson S, Carr E, Netuveli G, Sacker A . Adverse events over the life course and later-life wellbeing and depressive symptoms in older people. Int Psychogeriatr. 2020; 35(5):243-257. DOI: 10.1017/S1041610220003373. View

Major B, Appelbaum M, Beckman L, Dutton M, Russo N, West C . Abortion and mental health: Evaluating the evidence. Am Psychol. 2009; 64(9):863-90. DOI: 10.1037/a0017497. View

Zhang Q, Wang N, Hu Y, Creedy D . Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study. Reprod Health. 2022; 19(1):64. PMC: 8906361. DOI: 10.1186/s12978-022-01366-1. View

Jacob L, Kostev K, Gerhard C, Kalder M . Relationship between induced abortion and the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder in Germany. J Psychiatr Res. 2019; 114:75-79. DOI: 10.1016/j.jpsychires.2019.04.022. View

Jung S, Shin A, Kang D . Menarche age, menopause age and other reproductive factors in association with post-menopausal onset depression: Results from Health Examinees Study (HEXA). J Affect Disord. 2015; 187:127-35. DOI: 10.1016/j.jad.2015.08.047. View

Biggs M, Upadhyay U, McCulloch C, Foster D . Women's Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry. 2016; 74(2):169-178. DOI: 10.1001/jamapsychiatry.2016.3478. View

Munk-Olsen T, Laursen T, Pedersen C, Lidegaard O, Mortensen P . Induced first-trimester abortion and risk of mental disorder. N Engl J Med. 2011; 364(4):332-9. DOI: 10.1056/NEJMoa0905882. View

10.

van Ditzhuijzen J, Have M, de Graaf R, van Nijnatten C, Vollebergh W . Long-term incidence and recurrence of common mental disorders after abortion. A Dutch prospective cohort study. J Psychiatr Res. 2018; 102:132-135. DOI: 10.1016/j.jpsychires.2018.04.001. View

11.

Fan P, Zhang S, Wang W, Yang Z, Tan W, Li S . The design and implementation of natural population cohort study Biobank: A multiple-center project cooperation with medical consortia in Southwest China. Front Public Health. 2022; 10:996169. PMC: 9751194. DOI: 10.3389/fpubh.2022.996169. View

12.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

13.

Stocker R, Tran T, Hammarberg K, Nguyen H, Rowe H, Fisher J . Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia. Psychiatry Res. 2021; 298:113792. PMC: 9754708. DOI: 10.1016/j.psychres.2021.113792. View

14.

Chen S, Chiu H, Xu B, Ma Y, Jin T, Wu M . Reliability and validity of the PHQ-9 for screening late-life depression in Chinese primary care. Int J Geriatr Psychiatry. 2009; 25(11):1127-33. DOI: 10.1002/gps.2442. View

15.

Chen H, Zhang R, Zheng Q, Yan X, Wu S, Chen Y . Impact of body mass index on long-term blood pressure variability: a cross-sectional study in a cohort of Chinese adults. BMC Public Health. 2018; 18(1):1193. PMC: 6196453. DOI: 10.1186/s12889-018-6083-4. View

16.

Georgakis M, Thomopoulos T, Diamantaras A, Kalogirou E, Skalkidou A, Daskalopoulou S . Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2016; 73(2):139-49. DOI: 10.1001/jamapsychiatry.2015.2653. View

17.

Tsunoda K, Matsumura K, Inano H, Hatakeyama T, Tsuchida A, Inadera H . Association of infants' feeding pattern up to 2 years postpartum with mothers' mental and physical health: the Japan Environment and Children's Study. J Affect Disord. 2023; 327:262-269. DOI: 10.1016/j.jad.2023.01.106. View

18.

Wang H, Chen M, Xin T, Tang K . Number of children and the prevalence of later-life major depression and insomnia in women and men: findings from a cross-sectional study of 0.5 million Chinese adults. BMC Psychiatry. 2020; 20(1):267. PMC: 7260797. DOI: 10.1186/s12888-020-02681-2. View

19.

Pearce M, Garcia L, Abbas A, Strain T, Schuch F, Golubic R . Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022; 79(6):550-559. PMC: 9008579. DOI: 10.1001/jamapsychiatry.2022.0609. View

20.

Scott A, Webb T, Martyn-St James M, Rowse G, Weich S . Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021; 60:101556. PMC: 8651630. DOI: 10.1016/j.smrv.2021.101556. View