Relationship between psychosocial factors and pre-abortion psychological health: The significance of stigma

Most research in the area of abortion and mental health has examined what factors are associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive and anxiety symptoms highest just before an abortion compared to any time afterwards. This suggests that studies should also investigate what psychosocial factors relate to pre-abortion mental health. Understanding this may help in decreasing the anxiety and stress symptoms women experience pre- and post-abortion. The current study uses data from 462 women seeking abortions at three community reproductive health clinics to examine the associations of sociodemographic factors, pregnancy characteristics,  relationship context, importance of avoiding pregnancy, adverse experiences, and stigma with depressive and anxiety symptoms just before an abortion. In bivariate analyses, relationship context, adverse experiences, and perceived stigma correlated with pre-abortion depressive and anxiety symptoms, all p-values < .05. In final models that included only psychosocial factors that were significant in bivariate analyses, we found that the strongest predictor of pre-abortion depressive and anxiety symptoms was stigma. Before stigma was entered into the model, 20.5% and 20.9% of the variance in depressive and anxiety symptoms, respectively, was explained by age, when one desires one’s next pregnancy, relationship characteristics, reproductive coercion, intimate partner violence, and childhood adversities. Stigma explained an additional 24.0 % and 16.5 % of the variance in depressive and anxiety symptoms, respectively. These results suggest that reducing stigma among women seeking abortions may significantly lower pre-abortion depressive and anxiety symptoms.