Steinberg JR, et al. - Researchers investigated if first-trimester first abortion or first childbirth is associated with an increase in women’s initiation of a first-time prescription for an antidepressant. Higher tendency for using antidepressants was noted for women who have abortions compared with those who do not have abortions. However, additional findings suggested that increased use of antidepressants was not attributable to having had an abortion but to differences in risk factors for depression.

Methods

• Data was linked and a cohort of women was identified from Danish population registries who were born in Denmark between January 1, 1980, and December 30, 1994.
• This study included 396,397 women; of these women, 30 834 had a first-trimester first abortion and 85,592 had a first childbirth.
• They determined first-time antidepressant prescription redemptions and used them as indication of an episode of depression or anxiety; incident rate ratios (IRRs) were calculated comparing women who had an abortion vs women who did not have an abortion and women who had a childbirth vs women who did not have a childbirth.

Results

• Analysis of data of 396,397 women was performed; 17,294 (4.4%) had a record of at least 1 first-trimester abortion and no children, 72,052 (18.2%) had at least 1 childbirth and no abortions, 13,540 (3.4%) had at least 1 abortion and 1 childbirth, and 293,511 (74.1%) had neither an abortion nor a childbirth.
• A record of first antidepressant use was observed in a total of 59,465 (15.0%).
• In the basic and fully adjusted models, women who had a first abortion demonstrated a higher risk of first-time antidepressant use compared to women who had not had an abortion.
• However, no statistical differences were observed in the fully adjusted IRRs that compared women who had an abortion with women who did not have an abortion in the year before the abortion (IRR, 1.46; 95% CI, 1.38-1.54) and the year after the abortion (IRR, 1.54; 95% CI, 1.45-1.62) (P=.10); the fully adjusted IRRs decreased as time from the abortion increased (1-5 years: IRR, 1.24; 95% CI, 1.19-1.29; >5 years: IRR, 1.12; 95% CI, 1.05-1.18).
• Findings suggested lower fully adjusted IRRs that compared women who gave birth with women who did not give birth in the year before childbirth (IRR, 0.47; 95% CI, 0.43-0.50) compared with the year after childbirth (IRR, 0.93; 95% CI, 0.88-0.98) (P < .001); the fully adjusted IRRs increased as time from the childbirth increased (1-5 years: IRR, 1.52; 95% CI, 1.47-1.56; >5 years: IRR, 1.99; 95% CI, 1.91-2.09).
• The strongest risk factors associated with antidepressant use in the fully adjusted model across all women in the sample included having a previous psychiatric contact (IRR, 3.70; 95% CI, 3.62-3.78), having previously obtained an antianxiety medication (IRR, 3.03; 95% CI, 2.99-3.10), and having previously obtained antipsychotic medication (IRR, 1.88; 95% CI, 1.81-1.96).