Robinson Gail Erlick, Stotland Nada L, Russo Nancy Felipe, Lang Joan A, Occhiogrosso Mallay
Departments of Psychiatry, University of Toronto, Toronto, Ontario, Canada M M5G2C4.
Harv Rev Psychiatry. 2009;17(4):268-90. doi: 10.1080/10673220903149119.
The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an "abortion trauma syndrome" or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.
本综述的目的是识别并阐述用于支持人工流产会导致“流产创伤综合征”或精神疾病这一说法的研究中的方法学问题。在确定评估此类研究时需考虑的关键方法学问题后，我们通过批判性地审视近期实证研究来说明这些问题，这些研究在立法和司法证词中被广泛引用，以支持人工流产存在不良精神后遗症的观点。近期用于断言流产与后续精神障碍之间存在因果关系的研究存在诸多方法学问题，包括但不限于：样本和对照组选择不当；相关变量的概念化和控制不足；结果测量的质量差且缺乏临床意义；统计分析不恰当；以及解释错误，包括因果效应的错误归因。相比之下，我们回顾了一些近期避免了这些方法学错误的主要研究。流产后精神障碍最一致的预测因素仍然是既往存在的疾病，而这些疾病又与遭受性虐待和亲密暴力密切相关。让研究人员、临床医生和政策制定者了解如何恰当地评估关于流产结果的研究的方法学质量至关重要。此外，不仅需要方法学上合理的研究来评估流产的心理结果，还需要评估现有立法的影响以及社会态度和行为对流产女性的影响。
