OBJECTIVES: COVID-19-related stressors – including social distancing, material hardship, and increased intimate partner violence, among others – may result in a higher prevalence of depression following an elective abortion (post-abortion depression hereafter). This study examined trends in post-abortion depression in the US from 2018 to 2022, as well as correlates of treatment choices for post-abortion depression.

METHODS: 129,822 women aged 18-64 in the Komodo Healthcare Map with any elective abortion between 2018 and 2022 and had continuous enrollment 1+ years before and 6+ months after the abortion date were included. Annual prevalence of post-abortion depression was calculated from 2018 to 2022. Multinomial logistic regression was used to investigate correlates of treatment choices (no treatment, medication-only, psychotherapy-only, or both).

RESULTS: The prevalence of post-abortion depression increased from 4.9% pre-pandemic to 5.6% during the pandemic (p < 0.001). Among 6,983 women with post-abortion depression, the prevalence of women receiving both medication and psychotherapy (multimodal treatment) within 3 months after their first diagnosis of post-abortion depression increased from 16.9% in 2018 to 18.7% in 2022. Over the same period, the prevalence of women receiving psychotherapy-only grew from 22.3% to 26.6%, while that for medication-only declined from 27.9% to 26.7%. Factors associated with an increase in the odds of receiving multimodal treatment (vs. no treatment) included older ages; commercial insurance coverage; history of anxiety or depression at baseline; and being diagnosed by a nurse practitioner, physician assistant, or behavioral care practitioner (vs. physician). Similar patterns were observed for medication-only and psychotherapy-only treatments.

CONCLUSIONS: In this large, nationally representative sample of US insured population, the prevalence of post-abortion depression increased by 14.3% during the pandemic. Nonetheless, more than a quarter of women with post-abortion depression received no treatment in 2022, and only 18.7% received multimodal treatment. The study highlighted socioeconomic and provider variation in post-abortion depression treatment.