Human Development and Family Studies, 16 D FCS Building, Bowling Green State University, Bowling Green, Ohio 43402, USA.
Br J Psychiatry. 2011 Sep;199(3):180-6. doi: 10.1192/bjp.bp.110.077230.
Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians.
To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome.
After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios.
Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour.
This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.
鉴于最近发表的关于堕胎和心理健康的定性综述存在方法学上的局限性，因此需要进行定量综合，以更准确地代表已发表的文献，并为临床医生提供更清晰的认识。
衡量堕胎与不良心理健康指标之间的关联，并根据比较组（无堕胎、意外怀孕分娩、已分娩妊娠）和特定结局计算亚组效应。次要目的是计算每个结局的人群归因风险（PAR）统计数据。
在应用基于方法的选择标准和提取规则以尽量减少偏倚之后，该样本包括 22 项研究、36 项效应测量和 877181 名参与者（163831 人经历过堕胎）。使用原始研究中的调整后优势比计算随机效应汇总优势比，并从汇总优势比中得出 PAR 统计数据。
经历过堕胎的女性心理健康问题的风险增加了 81%，近 10%的心理健康问题发生率归因于堕胎。当将堕胎与足月妊娠进行比较，以及当结局涉及物质使用和自杀行为时，亚组估计的风险增加最强。
本综述提供了世界文献中与堕胎相关的心理健康风险的最大定量估计。对传统综述的结论提出质疑，结果显示堕胎后心理健康问题的风险中度至高度增加。与循证医学的原则一致，这些信息应告知堕胎服务的提供。
