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Br J Psychiatry. 2018 Dec 20:1-8. doi: 10.1192/bjp.2018.262. [Epub ahead of print]

A population-based study of the frequency and predictors of induced abortion among women with schizophrenia.

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Assistant Professor,Interdisciplinary Centre for Health and Society,University of Toronto Scarborough and Dalla Lana School of Public Health, University of Toronto and Department of Psychiatry, University of Toronto; and Adjunct Scientist, Women's College Research Institute, Women's College Hospital and Institute for Clinical Evaluative Sciences,Ontario,Canada.
Professor,Lawrence S. Bloomberg Faculty of Nursing,University of Toronto; and Scientist, Li Ka Shing Knowledge Institute,St. Michael's Hospital, Ontario,Canada.
Professor,Department of Psychiatry,University of Toronto; Scientist, Institute for Clinical Evaluative Sciences; and Psychiatrist and Director of Health Outcomes and Performance Evaluation (HOPE), Centre for Addiction and Mental Health,Ontario,Canada.
Associate Professor,Department of Psychiatry,University of Toronto; and Scientist, Women's College Research Institute, Women's College Hospital and Institute for Clinical Evaluative Sciences,Ontario,Canada.



Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia.AimsWe examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk.


In a population-based, repeated cross-sectional study (2011-2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15-44 years (n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion.


Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5-17.5 v. 12.8-13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16-1.54). They also had higher abortion ratios (592-736 v. 321-341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96-2.59). Younger age (<25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39-2.44), multiparity (aRR 2.17, 95% CI 1.66-2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34-3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47-2.34) were associated with increased abortion risk.


These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.Declaration of interestNone.


Schizophrenia; induced abortion; population-based study


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