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Psychosocial and psychological interventions for prevention of postnatal depression: systematic review

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7507.15 (Published 30 June 2005) Cite this as: BMJ 2005;331:15

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Postpartum Depression May Be Related to Unresolved Prior Pregnancy Losses

Dear Editor,

Self-reports and clinical experience suggest that unresolved feelings
about a prior pregnancy loss, involuntary or voluntary, may play an
important role postpartum depression.(1) The explanation offered is that
feelings and conflicts about the prior loss that were once successfully
repressed are aroused by the birth of a subsequent child.

If prior pregnancy loss is a risk factor for postpartum depression,
it could be a very useful tool for screening higher risk patients may
provide helpful directions for more useful interventions. It does not
appear, however, that this possible association has ever been
statistically tested. Perhaps Professor Lee could review the studies she
examined to verify or correct this observation.

The possible connection between pregnancy loss and postpartum
depression is indirectly supported by numerous studies linking pregnancy
loss with higher risk of subsequent adverse psychological problems. For
example, women with a history of abortion are more likely to use emotional
altering substances during subsequent pregnancies(2,3) and depression(4)
and general anxiety disorder.(5)

Both miscarriage and abortion are associated with a significant
increased risk of suicide.(6) Also, a small record based study in
Denmark,(7) and a larger study in California, have also shown
significantly elevated rates of psychiatric admissions(8) and outpatient
psychiatric treatment(9) following induced abortion. The latter also found
that patterns of pregnancy outcomes effected subsequent admission rates.

Sincerely,

David C. Reardon, Ph.D.
Elliot Institute

(1) Burke T, Reardon DC. Forbidden grief: the unspoken pain of
abortion. Springfield (IL): Acorn Books, 2002.

(2) Coleman PK, Reardon DC, Cougle J. Substance use among pregnant
women in the context of previous reproductive loss and desire for current
pregnancy.
Br J Health Psychol. 2005; 10:255-68.

(3) Coleman PK, Reardon DC, Rue VM, Cougle J. A history of induced
abortion in relation to substance use during subsequent pregnancies
carried to term. Am J Obstet Gynecol. 2002;187(6):1673-8.

(4) Cougle JR, Reardon DC, Coleman PK. Depression associated with
abortion and childbirth: a long-term analysis of the NLSY cohort. Med Sci
Monit. 2003 Apr;9(4):CR105-12.

(5) Cougle JR, Reardon DC, Coleman PK. Generalized anxiety following
unintended pregnancies resolved through childbirth and abortion: a cohort
study of the 1995 National Survey of Family Growth. J Anxiety Disord.
2005;19(1):137-42.

(6) Gissler G, Hemminki E, Lonnqvist J. Suicides after pregnancy in
Finland: 1987-94: register linkage study. BMJ. 1996; 313:1431-4.

(7) David H, Rasmussen N, Holst E. (1981). Post-abortion and
postpartum psychotic reactions. Fam Plann Perspect. 1981 Jan-Feb; 13(1):
32-4.

(8) Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG.
Psychiatric admissions of low income women following abortion and
childbirth. Can Med Assoc J. 2003; 168(10):1253-7.

(9) Coleman PK, Reardon DC, Rue VM, Cougle J. State-funded abortions
versus deliveries: a comparison of outpatient mental health claims over 4
years. Am J Orthopsychiatry. 2002 Jan;72(1):141-52.

Competing interests:
The Elliot Institute's mission includes researching the impact of abortion and raising public awareness of abortion's risks.

Competing interests: No competing interests

07 July 2005
David Reardon
Director
Elliot Institute 62791-7348