In an unusual commentary, one of the Journal of Psychiatric Research's editors-in-chief and a co-author warned that the 2009 paper, which has been widely cited by legislators and advocates to argue that abortion raises a woman's risk of mental illness and to push for laws requiring providers to tell women that, in fact "does not support assertions that abortions led to psychopathology."

Led by Priscilla Coleman, a professor of Human Development and Family Studies at Bowling Green State University in Ohio, the study used data from the Harvard-based National Comorbidity Survey, which assesses the prevalence of mental illness in the United States. She and her co-authors concluded that there is a link between past abortions and mental illness.

In 2010 Julia Steinberg of the University of California, San Francisco, and Lawrence Finer of the nonprofit Guttmacher Institute published their own analysis of the same data from the comorbidity survey. They identified a number of errors in the Coleman paper, including statistical ones.

The Guttmacher Institute is a non-profit research and education group that advocates for reproductive rights, including access to abortion.

The U.S. Supreme Court legalized abortion in 1973 but opponents have sought, particularly at the state level, to impose restrictions on the procedure.

Steinberg said that the biggest problem in the original Coleman study was that "many of the incidents of mental illness she included came before the abortion." That cast doubt on whether abortion triggered mental illness. Instead, women with mental illness might have been more likely to have an unwanted pregnancy and terminate it.

"Determining the 'effects of abortion' is not possible unless it can be established that the diagnoses occurred after the abortion," said Steinberg. "For many women, psychiatric illnesses occurred before the abortion."

Last July Coleman acknowledged the statistical errors, but that was far from the end of the battle. A letter from Steinberg and Finer in the March issue of the Journal of Psychiatric Research reiterates the criticism about including episodes of mental illness over a woman's entire lifetime.

In a published response, Coleman conceded that she had used lifetime estimates of mental illness, rather than only episodes after an abortion. It "is certainly true" that this makes it difficult to figure out whether the abortion or the mental illness came first, she wrote.

CAUSAL LINK?

In an email Tuesday from London, where she had addressed members of Parliament "about the abortion and mental health association," Coleman said that "the pattern of results" -greater incidence of mental illness among women who have had an abortion - "did not change much" when she made the statistical corrections. Moreover, she wrote, "we never made assertions of causality."

The title of her paper included the phrase "the effects of abortion."

Coleman's arguments did not sway the journal. In an unusual step, a commentary co-authored by Alan Schatzberg, an editor-in-chief and professor of psychiatry at Stanford University School of Medicine, concludes that the criticism of the Coleman study "has considerable merit."

Her analysis "does not support assertions that abortions led to psychopathology," it continued, and using lifetime diagnoses of mental illness is "flawed." Studies of abortion and mental illness "should consider only mental disorders subsequent to the pregnancy."

Despite these problems the paper has not been retracted. "The ultimate decision to retract is made by the publisher using preset procedures including an independent committee," Schatzberg said in an email to Reuters.

Journal publisher Elsevier "has specific policies and procedures for evaluating and instituting any possible retraction decisions. Authors are also free to request a retraction." Editors can also initiate the process leading to a retraction.

Critics say the paper is flawed enough to be excised from the scientific literature. "This is not a scholarly difference of opinion; their facts were flatly wrong. This was an abuse of the scientific process to reach conclusions that are not supported by the data," said Steinberg. "The shifting explanations and misleading statements that they offered over the past two years served to mask their serious methodological errors."

Another concern has been whether Coleman fully disclosed any possible conflicts of interest. In a presentation she gave in 2011 to the American Association of Pro-Life Obstetricians and Gynecologists, she said, "I have a plan to develop a new non-profit organization devoted to understanding and publicizing the real risks of abortion. I would like to bring together many credentialed scientists with a research program pertaining to the physical, psychological, and/or relational effects of abortion on women and their families."

Advocates on both sides of the abortion debate disagree on whether the strongly worded commentary, plus a letter to the editor pointing out serious mistakes in the 2009 study, will affect policy.

Thirty-five states require pre-abortion counseling, according to the Guttmacher Institute.

Of those, nine include only negative psychological consequences, such as depression, anxiety, post-traumatic stress disorder, suicidal thoughts or other forms of mental illness. Courts have thrown out some of these requirements, including South Dakota's that abortion providers tell women that the procedure "increased risk of suicide ideation and suicide."

LOWER-QUALITY STUDIES

There is no shortage of studies on abortion and mental illness. But expert analyses have found that many are as poorly done as the 2009 paper. Two reviews of the science, one by the American Psychological Association, found that higher quality studies were much less likely to find adverse psychological effects from abortion than lower-quality studies were.

Opponents of legalized abortion believe there are enough studies linking the procedure to mental illness to support state laws mandating that women be told of that risk. Kansas requires a doctor to say that "after having an abortion, some women suffer from a variety of psychological effects ranging from malaise, irritability, difficulty sleeping, to depression and even posttraumatic stress disorder."

Texas tells women that some "have reported serious psychological effects after their abortion," including depression, anxiety, suicidal thoughts and behavior, flashbacks, and substance abuse. West Virginia says that many women "suffer from Post-Traumatic Stress Disorder Syndrome following abortion," and can experience suicidal thoughts or acts, depression, fear and anxiety, and alcohol and drug abuse.

The 2009 study was "not alone in driving legislation" requiring pre-abortion counseling that includes a mental health warning, said Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council, a non-profit group that opposes abortion rights. "A number of other authors have reached the same conclusion, so my read is that it's very solid."

Many of those studies compare mental health after abortion to mental health after childbirth. But the crucial comparison, argued Schatzberg, is between women with unwanted pregnancies who aborted or gave birth. To compare women with wanted pregnancies who gave birth to women with unwanted pregnancies who aborted can be misleading.

For the journal that published the controversial 2009 paper to essentially disown it can "help put a spotlight on the issue and encourage states to revisit their existing materials to ensure that they are accurate," said Elizabeth Nash, a policy expert at Guttmacher. "States give the misinformation the same weight as the empirical evidence. The problem is that when states include inaccurate information, a woman reading the materials does not have the information she needs to make an informed decision."

(Editing by Michele Gershberg and Cynthia Osterman)

• A Permanent Economic Emergency