Prevalence and correlates of current suicidal ideation in women with premenstrual dysphoric disorder

Abstract

Background Although previous studies report an association between Premenstrual Dysphoric Disorder (PMDD) and suicidal ideation, most studies have only established a provisional and retrospective diagnosis of PMDD fundamentally invalidating the diagnosis. Therefore, the aim of this study was to describe the prevalence and to explore correlates of current suicidal ideation in the late luteal phase in women with prospectively assessed and confirmed PMDD. Methods Participants were 110 women who attended the pre-randomization baseline visit of two randomized placebo-controlled clinical trials between January 15, 2017 and October 19, 2019. PMDD was diagnosed prospectively in line with DSM-5 criteria. Current suicidal ideation was measured by the MADRS-S in the late luteal phase. Descriptive statistics were presented and logistic regression analyses were carried out to explore the association between psychosocial and health characteristics and current suicidal ideation, presenting unadjusted odds ratios (OR) and 95% confidence intervals (CI). Results Current suicidal ideation was reported by nearly 40% of women with confirmed PMDD (n = 43, 39.1%). Previous psychological treatment for PMDD and higher depressive symptoms in the late luteal phase were positively associated with current suicidal ideation (OR 5.63, 95% CI 1.07–29.49, and OR 1.17, 95% CI 1.10–1.25, respectively), whereas higher ratings of self-rated health were associated with lower odds ratios for current suicidal ideation (OR 0.98, 95% CI 0.96–0.99). Conclusions A substantial proportion of women with confirmed PMDD report current suicidal ideation in the late luteal phase. Results point to a need for better awareness and screening of suicidal ideation in women with PMDD.

Clinical correlates of women endorsing premenstrual suicidal ideation: a cross-sectional study

“…Depression appeared to play a key role in predicting PMSI. Congruent with our findings, other research has shown that more severe depressive symptoms in the luteal phase and psychiatric co-morbidity, especially a depression diagnosis, are associated with the suicidal risk linked to premenstrual symptoms [ 24 , 25 ]. In contrast, a recent systematic review found that psychiatric co-morbidities did not account for SI associated with premenstrual symptoms [ 26 ].…”

Altered visual cortex excitability in premenstrual dysphoric disorder: Evidence from magnetoencephalographic gamma oscillations and perceptual suppression

“…However, in 2-5% of women, these fluctuations result in disabling psychiatric problems, also known as premenstrual dysphoric disorder (PMDD) [7,8]. Over the past decades, PMDD has attracted the attention of both clinicians and the scientific community [9], as it is associated with substantial disruption of women's everyday activities, inability to work and high risks of suicide [10][11][12].…”

Effects of acute estradiol and progesterone on perimenstrual exacerbation of suicidal ideation and related symptoms: a crossover randomized controlled trial

“…However, the E2 and P4 withdrawal mechanism tested in the present study can be contrasted with those observed in prototypical PMDD (i.e., luteal phase confinement of significant affective symptoms), which is robustly triggered not by proximal hormone withdrawal [ 23 ] but rather by the delayed effects of periovulatory steroid surges [ 22 ]. It should be noted that, despite the fact that suicidality was not included in the diagnostic criteria for DSM-5 PMDD, and despite luteal phase confinement of symptoms in PMDD, recent studies have demonstrated a high prevalence of SI (40% current [ 60 ], 71% lifetime) and suicide attempts (34% lifetime [ 61 ]) among patients with prospectively-diagnosed PMDD. Given that perimenstrual suicidality is also commonly present in PMDD (i.e., E2 and P4 surge-related perimenstrual symptoms), E2 and P4 withdrawal probably represents just one of several steroid change triggers that are capable of increasing suicidality among hormone-sensitive individuals.…”