Hum. Reprod. Advance Access originally published online on December 13, 2006
Human Reproduction 2007 22(3):878-884; doi:10.1093/humrep/del450
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Psychiatric outcomes following medical and surgical abortion
1 Department of Psychiatry 2 Department of Obstetrics, Gynecology and Reproductive Sciences and the Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 3 Department of Psychiatry, University of Massachusetts Medical School and UMassMemorial HealthCare, Worcester, MA, USA 4 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA 5 Medical and Laboratory Directory, Planned Parenthood of Western Pennsylvania, Pittsburgh, PA, USA
6 To whom correspondence should be addressed at: Department of Psychiatry, Women's Behavioral HealthCARE, University of Pittsburgh, 3811 O'Hara Street, Oxford 410, Pittsburgh, PA 15213, USA. Tel: +1412 246 5248; Fax: +1412 246 6960; E-mail: sitdk{at}upmc.edu
BACKGROUND: Hypercortisolaemia is associated with certain depressive disorders. Mifepristone has possible antidepressant properties related to its anti-glucocorticoid activity. To explore the possible mood effects of mifepristone, we examined the mood outcomes after surgical and medical (mifepristone–misoprostol) abortion. The objectives were to determine post-abortion depression risk, evaluate risk factors for post-abortion depression and to explore the relationship between cortisol and depression.
METHODS: We enrolled 47 surgical and 31 medical abortion patients. Women were assessed pre-abortion and 1 month post-abortion with the Edinburgh Postnatal Depression Scale (EPDS) and salivary cortisol levels. RESULTS: Pre-abortion, 36% (17/47) of surgical and 35% (11/31) of medical patients had high depression risk (EPDS 
10; (
2 = 0.31, df = 1, P = 0.58). At follow-up, 17% (7/42) of surgical and 21% (5/24) of medical patients had an EPDS 10 (2 = 0.18, df = 1, P = 0.67). The decline post-abortion in the women with EPDS 10 was significant (P = 0.01). Women with past psychiatric history (Fisher's exact P = 0.05) or anxiety disorders (Fisher's exact P = 0.005) had elevated risk for post-abortion depression. Change in cortisol levels was not correlated with change in EPDS (r = 0.10, P = 0.28).
CONCLUSIONS: Most patients experienced post-abortion mood improvement. Mifepristone did not offer additional antidepressant effects. The lack of correlation between cortisol and depression could represent hypersuppression of the hypothalamic-pituitary-adrenal (HPA) axis or insufficient mifepristone dose to alter HPA axis activity.
Key words: biomarker/depression/mifepristone/salivary cortisol
This research was presented in June 2005 at the 45th Annual New Clinical Drug Evaluation Unit (NCDEU) Meeting in Boca Raton, Florida, sponsored by the US National Institutes of Health and the National Institute of Mental Health. Preliminary data from this study were presented in paper sessions at the 3rd International Conference on Reproductive Disruptions, Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI in 2005, and at the Marce Society International Scientific Meeting on Perinatal Health, Oxford, UK in 2004.
Submitted on August 11, 2006; resubmitted on October 5, 2006; accepted on October 25, 2006.