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The rate of repeat abortions in Singapore has risen from 10% of all abortions in 1975 to 42% in 1982. This study sought to identify psychosocial characteristics of 100 Chinese women 15-44 years of age who requested a repeat abortion; 100 antenatal patients and 100 1st-time abortees, matched with subjects for age and race, were used as controls. There were no significant differences between cases and controls in most of the variables analyzed. Educational and socioeconomic status, personality components (extroversion, neuroticism, psychoticism), and mood were similar in women from all 3 groups. However, repeat abortees had more prior pregnancies and more living children. Repeat abortees had an average of 4.27 prior pregnancies and 1.94 living children compared with 2.07 pregnancies and 0.88 living children among antenatal patients and 2.67 pregnancies and 1.52 living children among 1st-time abortees. Contraceptive methods reported most commonly among repeat abortees included a combination of methods (27%), condom (21%), and rhythm (15%); these were the 3 methods most frequently reported by 1st-time abortees as well. The Zung Self-Rating Depression Scale was administered to all abortion patients before abortion and 6 weeks after the procedure. The mean score before abortion was 39.04 among 1st-time abortees and 41.25 among repeat abortees--well below the mean of 60 found among clinically depressed patients. 6 weeks after the procedure, the depression score had declined to 34.46 among 1st-time abortees and to 35.14 among repeat abortees.
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PMID:Psychosocial aspects of repeat abortions in Singapore--a preliminary report. 647

The coping styles 55 women who underwent abortion at the Fleming Center in North Carolina were assessed in reference to their use of avoidance and approach mechanisms. A 15-point denial subscale from the Impact of Even Scale was used to determine their dependence on avoidance mechanisms. The scale contained items such as "I tried to remove it from memory." The intrusion subscale of the Impact of Event Scale was also used. A 6-point scale, designed for the study, was used to assess their reliance on approach mechanisms and contained items such as "I tried to deal with my feelings." Anxiety and depression levels were measured by the self-rating Symptom Checklist-90, which is often used to assess depression and anxiety levels in psychiatric outpatients. The 55 women were asked to rate themselves in reference to these scales a few hours before they were scheduled for abortion and then again about 1 hour following abortion. The mean age of the women was 23.2 years, the majority were single, and 39% had 1 or more previous abortions. All the pregnancies were aborted during or before the 181th gestation week. Prior to abortion the patients showed fairly high levels of denial, anxiety, and depression. Levels of denial and intrusion were similar to those observed for bereaved individuals in other studies. Their anxiety levels were slightly higher and their depression levels slightly lower than those observed for populations of psychiatric outpatients. The reduction may have been due to relief or to the coping mechanisms used by the women. The women could not be neatly divided into avoiders and approachers; however those who tended to be high deniers were more distressed initially than low deniers. High approachers were initially more distressed than low approachers. Distress was significantly decreased after the abortion for high approachers, but not for low approachers. Following abortion, both high approachers and low approachers had similar levels of distress, ie., anxiety and depression. Perhaps the type of counseling provided for the patients immediately before abortion helped high approachers reduce their anxiety and depression level. The counselors provided the patients with abortion and birth control information and gave patients an opportunity to discuss their discision to have an abortion. This counseling approach was consistent with an approach coping style, and probably was more helpful for high approachers than for low approachers. Counseling strategies should be adapted to the coping styles of individual patients.
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PMID:Coping with abortion. 652 Mar 95

Only recently has any study evaluated the psychological and psychopathological reactions of men whose partners have chosen to have an abortion. Recent studies have shown that fatherhood causes deep personal and social changes and conflicts. It is therefore natural that an interruption of this process, such as through abortion, can inspire feelings of being partially "killed", thus bringing back childhood anxieties and feelings of castration. One study on women who had abortions showed that only 1/6 were accompanied by their partners, and that for those who face abortion as a couple, the future did not seem to hold negative consequences. A study of a number of young men emphasized the frustration of 2 desires: that of becoming a father and, consequently, of becoming a man. Another study of 50 childless young men indicated that the "lack of fatherhood" after the 1st abortion was the origin of frustration and pain that, in some cases, drove unmarried couples to discontinue their relationship. In a 4th study, of 52 women who went to an abortion clinic, 29 were accompanied by their partners. 20 partners agreed to be interviewed. Although none were asked the reason for the abortion, each explained the motivation for it. The observations show "persecution anxieties", especially with regard to the partner, depression anxieties and psychosomatic symptoms. Depression and behavioral disorders, although rarer, may also manifest themselves. The study suggests a comparison between reactions and feelings of potential fatherhood and fatherhood lost.
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PMID:[Abortion and the man. Psychological and psychopathological manifestations in the face of lost fatherhood]. 654 86

Much of the research on the antecedents and consequences of birth control has focused on teenagers and members of racial minority groups, but the trends in contraceptive use indicate that the danger of unwanted pregnancy exists for most women throughout the childbearing ages of 14-45, for white and middle class women as well as minority women and women from the lower socioeconomic status levels. There are basically 4 choices open to the unmarried woman who conceives: giving the child up for adoption, keeping the child without marrying, and marriage. There are little data on the mental health consequences of giving a child up for adoption, but there is no question that the experience at the very least upsetting and may cause longterm trauma. Induced abortion is less traumatic, both physically and psychologically, than carrying a pregnancy to term, however, many women suffer from longterm depression following the procedure. The social, economic, and psychological consequences of single motherhood are clearly documented for both teenagers and older women. The most frequently cited problems are delayed or truncated emotional and social activities, unemployment, and role overload resulting from the responsibility of caring for a child without the support of a spouse. The pregnant teenager who does marry has a 50% probability of divorce within 4 years, and even if the couple does stay married they suffer some adverse consequences. In 1978 Zelnick and Kantner estimated that it would be possible to reduce the number of premarital pregnancies and presumably their psychological and economic consequences by at least 40% if all sexually active young women were to use a contraceptive method and to use it consistently. If the majority of all sexually active women were to use the most reliable methods of contraception, the unwanted pregnancy rate would be reduced even more markedly. Yet, reliable contraceptive behavior involves a complex sequence of psychological and behavioral events including awareness of the risk of becoming pregnant, obtaining adequate information about contraception, making decisions about contraceptive use, acquiring contraception, and regular and consistent use of a reliable contraceptive method. The literature on the psychological antecedents of contraceptive behavior clearly characterize ineffective female contraceptors as being unaccepting of their own sexuality and having negative attitudes toward most matters pertaining to sex. Their attitudes and emotions include irrational fears about specific contraceptives, conflicting attitude and belief systems about birth control in general, and guilt. Implicit in this profile is an inability to think rationally about the high probability that unprotected sex will result in conception and an inability to engage in rational decision making about birth control. Yet, review of the prevention programs currently available reveals that the vast majority are designed to serve the self-motivated women. Given that these programs already have been demonstrated to be effective, it is time to direct attention to exploring ways to reach those women who will not adequate precautions without first experiencing changes in their attitudinal and emotional responses to sex.
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PMID:The antecedents and prevention of unwanted pregnancy. 656 48

Children who were born in the early 1980s in the Stockholm suburb that was studied had a home environment that may be described as follows. The material standards in the area were good, the dwellings were spacious and modern, the outdoor environment was pleasant for children and the municipal service facilities were well developed. The transport services to the city are frequent, comfortable and convenient. In a typical case, the parents are about 30 years old, they are of old Swedish stock and are living together, married or unmarried. They received a good education and usually also occupational training. Generally, both parents have a job outside the home. In quite a few such cases the mother has shift- or nightwork. Although both parents have jobs, the family surprisingly often has financial problems. Thus more than one family in five needed financial assistance from the authorities. The financial difficulties may be due to illness and addiction in the parents. About one in ten of the mothers has been hospitalised for a chronic somatic disease and about one in ten of the fathers is in the records for alcoholism. Criminality is also common, every sixth or seventh father having a police record. About every fourth child born in this suburb will grow up in a home where either the father or the mother is known for an addiction and/or criminality, and/or has been treated for mental illness. To conjure up and describe the atmosphere in a home in this suburb is not easy but in the present study information was obtained supporting the suspicion that many homes are characterised by insecurity, isolation and hopelessness and a serious unsatisfied need for help. Many of the mothers have grown up in rather special social conditions--for instance, in "broken homes", or with an alcoholic father or a mentally ill mother. As a result, nearly every tenth mother had been placed outside the home at an early age (in a foster-home or suchlike). In later years also, many of the mothers have had the burden of sick, malformed or mentally retarded children in their home, or have experienced the serious illness or death of some person close to them. Particularly in the period before their child's birth many women have had reason to feel anxious. About one woman in three has already had a miscarriage and/or abortion, and during pregnancy she may have suffered from serious nausea or depression. Quite a few also needed to take medicines during that time. In many families, it is reported, the man and woman have had trouble in living together, with resultant divorce situations, quarrels and assaults.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Home environment of children in a new Stockholm suburb. A prospective longitudinal study. 658 82

The English language and Scandinavian literatuare include an ample discussion of the problem of negative psychological and psychiatric sequelae of abortion. However, most works are based on an epistemologically incorrect methodology, being limited to a statistical comparison of the absence and presence of sequelae. The present study is based on a specially prepared clinical evaluation scale, investigating 11 women, 18 months after abortion, all with negative psychological sequelae. In 6 women, psychiatric sequelae were encountered. A considerable incidence of depression and profound emotional disturbance was evident. A clinical comparison using the same scale between the sequelae 20 days and 18 months after abortion revealed increased disturbance in 7 women. It is emphasized that the psychological sequelae following a hospital abortion should be considered iatrogenic and a direct result of the introduction of hospital abortions, a barbarous bloodletting indicative of the self-destructive dominance of technology and ideology. (author's modified)
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PMID:[Negative psychological sequelae and psychiatric sequelae of abortion obtained in a hospital: possible application of an evaluation scale]. 662

Cases of fatal poisoning with cupric compounds are relatively rare in everyday life and are not covered much in forensic literature. A case was encountered of fatal poisoning with a blue vitriol solution introduced into the uterine cavity in order to interrupt a pregnancy. A 39-year-old woman brought to the hospital by ambulance complained of pain in the lumbar region and profuse bloody genital discharge, which had appeared 3 days earlier. She believed she was 2 months pregnant and denied artificial interruption of the pregnancy. Upon examination, her condition was grave: a weak pulse of 80; blood pressure 100/60. The abdomen was soft, the liver and spleen not enlarged. Pasternak symptom was negative. The uterus was soft, painless and enlarged to 9 weeks of pregnancy. The uterine cervix was clean, the orifice closed. Discharge was profuse and bloody. The diagnosis was that she was 9 weeks pregnant and had a missed criminal abortion. Scraping out the uterus and corresponding therapy to control bleeding were ineffective. An operation was performed--extirpation of the uterus. However, despite the steps taken, the bleeding did not stop, and the patient's condition continued to worsen. 10 hours after being admitted to the hospital, she died. During forensic investigation, diffused, violet-colored cadaverous spots were discovered. Extensive subcutaneous hemorrhage was detected around the areas of injection. The skin covering was edematous; when pressed with a finger, areas of depression remained. There was about 250 ml of watery blood in the abdominal cavity. Internal organs were anemic. There were multiple subpleural, subepicardial, subcapsular, intraorgan and intramuscular micro- and macro-punctate hemorrhages; bleeding into the mucosa of the gastrointestinal tract and urinary tracts; and cerebral and pulmonary edema. Forensic histological examination showed acute circulatory disturbance with perivascular and peridiapedetic hemorrhage; concentrations of aggregated and hemolyzed erythrocytes in the small vessels and capillaries; cerebral, pulmonary and stromatic edema. In the kidneys there was coaugmentation of renal glomeruli; epithelial necrosis of part of the coiled ducts; lower epithelium in places had pigment grains; primarily in openings of straight ducts there were pigment cylinders; extreme plethora of the surrounding area, and infiltration from annular cells and polynuclears. Forensic chemical analysis showed 12.8 mg of copper; 6.6 mg in the uterus and 5.6 mg in the kidneys. From data obtained it can be concluded that the patient died from cupric compound poisoning, complicated by interruption of the pregnancy and uterine hemolytic hemorrhage. It was later established that during the month before being admitted to the hospital the patient introduced a solution of blue vitriol into the uterine cavity to interrupt the pregnancy.
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PMID:[Fatal poisoning with blue vitriol]. 663 45

The MMPI depression scale and a subjective depression test were administered to 80 patients who had aborted between 1 and 5 days before they were interviewed at 2 hospitals in Chile. A higher level of depression was found among patients who aborted, particularly in patients who had self inflicted abortions, than in the control group. Abortion is illegal in Chile and is condemned by the church; therefore, the study results may have been influenced by the cultural environment. Psychotherapy for women who abort is recommended. (author's modified)
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PMID:[Post-abortion depression: study of cases and controls]. 666 67

An attempt is made to identify and document the problems of comparative evaluation of the more recent studies of psychiatric morbidity after abortion and to determine the current consensus so that when the results of the joint RCGP/RCOG study of the sequelae of induced abortion become available they can be viewed in a more informed context. The legalization of abortion has provided more opportunities for studies of subsequent morbidity. New laws have contributed to the changing attitudes of society, and the increasing acceptability of the operation has probably influenced the occurrence of psychiatric sequelae. The complexity of measuring psychiatric sequelae is evident from the many terms used to describe symptomatology and behavioral patterns and from the number of assessment techniques involved. Numerous techniques have been used to quantify psychiatric sequelae. Several authors conclude that few psychiatric problems follow an induced abortion, but many studies were deficient in methodology, material, or length of follow-up. A British study in 1975 reported a favorable outcome for a "representative sample" of 50 National Health Service patients: 68% of these patients had an absence of or only mild feelings of guilt, loss, or self reproach and considered abortion as the best solution to their problem. The 32% who had an adverse outcome reported moderate to severe feelings of guilt, regret, loss, and self reproach, and there was evidence of mental illness. In most of these cases the adverse outcome was related to the patient's environment since the abortion. A follow-up study of 126 women, which compared the overall reaction to therapeutic abortion between women with a history of previous mild psychiatric illness and those without reported that a significantly different emotional reaction could not be demonstrated between the 2 groups. In a survey among women seeking an abortion 271 who were referred for a psychiatric opinion regarding terminations of pregnancy were compared with 82 patients referred directly to a gynecological department. Termination caused little psychiatric disturbance provided the patient wanted an abortion. Cases of severe psychiatric outcome in the form of psychosis, severe depression, and schizophrenia have been reported. The outcome for women who were refused an abortion and the effects on the children born as a result have been discussed in several studies. In 1 survey, 24% of 249 women who were refused abortion were significantly disturbed after 18 months. Many studies comment on the value of counseling in the abortion decision, but few comparison studies have actually evaluated abortion counseling. A large amount of previously reported research on the psychiatric indications of abortion may be unreliable because women seeking abortions on mainly social grounds used to have to show psychiatric disturbance in order to obtain a legal abortion.
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PMID:Psychiatric sequelae of induced abortion. 670 3

The significance of pregnancy for adolescent women is usually related to unconscious motivations. Some teenagers faced with the problem choose to abort, and others do not. Psychological status, contraceptive and sexual habits, attitudes towards pregnancy and environmental influences were studied in 50 teenagers who chose abortion. These young women were matched for age and parity with a control group of 50 who elected to carry their pregnancies to term. The results point to significant differences between the 2 groups, particularly as to the meaning of pregnancy and the decision-making process. The teenagers who chose abortion seemed more independent and self-assured, made their decisions basically by themselves and had a more realistic view of pregnancy. The teenagers who chose to carry their pregnancies to term appeared more submissive and less capable of integrating various elements of reality into their decision making. Their choices seemed strongly influenced by the partner, family and friends. Because of these outside influences, the patient may perceive her decision to be externally determined, leaving her more susceptible to guilt feelings and allowing her to avoid full consideration of the implications of immediate child-bearing. Interpersonal relationships and the patient's personality were viewed as the major influences on pregnancy resolution. Future studies should shed light on the meaning of adolescent pregnancy as a contemporary sociologic phenomenon and address the following questions: How can adolescents' needs be met in ways other than pregnancy? What are their needs and the fears, anxieties and feelings of loneliness and depression that early sexual activity has not been able to allay?
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PMID:The significance of pregnancy among adolescents choosing abortion as compared to those continuing pregnancy. 671 70


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