Approximately half of all pregnancies among American women are unintended, and four in 10 of these pregnancies end in induced abortion (Finer, et al., 2006). The fact that abortion is such a common medical procedure makes understanding the relationship of abortion to mental health and health behavior of high significance for the public's health. Several studies conducted in recent years have reported an association between a history of induced abortion and a wide range of negative mental health consequences. These studies, which are often based on secondary analyses of public use data sets, have not examined the contribution of pregnancy outcome to risk for negative mental health outcomes in the context of other variables that have been shown to be related to both risk for unintended pregnancy and abortion as well as negative health outcomes, including substance abuse. The overall aim of this proposal is to begin to undertake that examination, with a focus on substance abuse as the outcome variable. Research on the contribution of pregnancy outcome to substance use and abuse in the context of other risk factors in the lives of women can provide an important piece of the needed knowledge base. There is a well-established high comorbidity between mental health disorders and substance abuse in women, and one of the most recognized predictors of certain types of pathology and substance abuse in women is a history of abuse, with childhood sexual abuse emerging as a distinctive form of childhood adversity associated with future negative outcomes. The National Comorbidity Survey Baseline (NCS-1) and National Comorbidity Survey Replication (NCS-R) are two large-scale data sets that contain variables related to history of abuse, reproductive outcomes, psychiatric disorders, and substance abuse. The proposed program of research seeks to conduct a series of secondary data analyses which will utilize both of these data sets in order to further explore the relationship between induced abortion and substance abuse. The key consideration is whether or not induced abortion influences future psychological functioning above and beyond the effect of other forms of trauma or key personality variables.
The aims of the study are to answer four questions: (1) Is there an association between induced abortion and subsequent substance abuse? (2) If such an association is detected, is the association mediated by other psychiatric disorders? (3) When childhood sexual abuse is included as a covariate, is the relationship among induced abortion, psychiatric disorders, and substance abuse diminished? (4) Does a tendency towards risky behavior account for variance that is left over between induced abortion and substance abuse that is not accounted for by other variables? ? ? ? ?
