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Author ' s response to reviews The course of mental health after miscarriage and induced abortion : A five-year follow-up study

The course of mental health after miscarriage and induced abortion: A five-year follow-up study. Cover letter for the revised version of an article for BMC Women's Health ("The course of mental health after miscarriage and induced abortion: A longitudinal, five-year follow-up study"). Reviewer 1: 1) The reviewer writes: "See the above comment regarding lack of control for prior and subsequent pregnancy outcomes. This should at least be briefly mentioned in the discussion of the study's limitations". Response: We agree that this is an important point. In fact, we did institute some controls for a few of the possible confounding factors but not for all the mental health outcomes, and not at all time points. However, we found no statistically significant effects of prior miscarriages or induced abortions on the IES scores or the scores on feelings related to the pregnancy termination event from T1 to T3. Nor did we find any statistically significant effects of childbirth events between T1 and T4 on the HADS anxiety and depression scores at T4 (mentioned in two of our former articles, the article published in Psychosomatic Medicine in 2004, and in an article in press in Acta Obstetricia et Gynecologica Scandinavica). Another study, with a much larger sample, might have minimized these confounding factors. In the revised paper, we have made the following changes. On page 22, we have added: "Another limitation of the study is the lack of control for all prior and subsequent pregnancy outcomes. We did apply controls for a few of these possible confounding factors, but did not detect any statistically significant effect of prior miscarriages or induced abortions on scores for IES or feelings at T1, T2, or T3. Nor did we observe any statistically significant effect of childbirth events between T1 and T4 on the HADS anxiety and depression scores at T4. This finding should be tested in a study with a larger sample and extended to include the effects of subsequent miscarriages and abortions." 2) The reviewer writes: "Regarding the discussion of anxiety associated with abortion, the recent study by Cougle is especially important and should at least be cited, and possibly discussed". Response: We agree that the study by Cougle should be cited in the discussion of anxiety after induced abortion. On page 18, we have now included: "In both groups, the HADS anxiety scores were high relative to those of the general population. This was …