Suicidal Risk in Women with Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Systematic Review and Meta-Analysis

Abstract

Purpose: Women with premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) experience substantial functional impairment and decreased quality of life. While previous research has highlighted a relationship between premenstrual disturbances and suicide risk, no meta-analysis has been conducted to quantitatively assess the findings. Methods: A systematic review and meta-analysis was conducted by searching the literature in three databases (Pubmed, PsycINFO, and EMBASE) on July 15, 2020. Studies that assessed the relationship between suicidality (attempt, ideation, and/or plan) and premenstrual disturbance (PMDD, PMS, and/or premenstrual symptoms) were included. Results: Thirteen studies were included in the qualitative review ( n = 10 included in meta-analysis). Results revealed that women with PMDD are almost seven times at higher risk of suicide attempt (OR: 6.97; 95% CI: 2.98–16.29, p < 0.001) and almost four times as likely to exhibit suicidal ideation (OR: 3.95; 95% CI: 2.97–5.24, p < 0.001). Similarly, women with PMS are also at increased risk of suicidal ideation (OR: 10.06; 95% CI: 1.32 to −76.67, p = 0.03), but not for suicide attempt (OR: 1.85; 95% CI: 0.77 to −4.46, p = 0.17). Conclusions: Women with PMDD and PMS are at higher risk of suicidality compared with women without premenstrual disturbances. These findings support routine suicidal risk assessments for women who suffer from moderate-to-severe premenstrual disturbance. Furthermore, psychosocial treatments for women diagnosed with PMS/PMDD should consider and target suicidality to minimize risk and improve well-being.

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

“…A recent meta-analysis of data from prior studies with varied methodologies. Affirmed that PMDD and PMS are both associated with increased risk of reporting SI [ 4 ]. The process of isolating dynamic risk factors related to increased vulnerability to suicide is critically important to the implementation of suicide prevention strategies.…”

“…Epidemiological studies have concluded that the prevalence of premenstrual symptoms causing clinically significant interference or distress may be as high as 13-18% [3] and comparable with other depressive disorders [3]. PMS has been significantly associated with an increase in suicidal ideation (SI) but not suicide attempts in a recent meta-analysis [4]. Premenstrual dysphoric disorder (PMDD), a severe Open Access *Correspondence: kdeligian1@northwell.edu form of PMS with strictly defined criteria codified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders Version 5 [2], has additionally been associated with SI, plans to suicide, and suicide attempts in meta-analyses [4,5].…”

“…PMS has been significantly associated with an increase in suicidal ideation (SI) but not suicide attempts in a recent meta-analysis [ 4 ]. Premenstrual dysphoric disorder (PMDD), a severe form of PMS with strictly defined criteria codified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders Version 5 [ 2 ], has additionally been associated with SI, plans to suicide, and suicide attempts in meta-analyses [ 4 , 5 ].…”

Brain Activation During Processing of Depression Emotion in College Students With Premenstrual Syndrome in China: Preliminary Findings

“…PMS causes various symptoms in women, commonly including affective symptoms, behavioral symptoms, and difficulty concentrating, impairing their quality of normal life ( 7 , 8 ). Among them, women with PMS had difficulty in regulating their emotions ( 9 ), such as prominent depression ( 10 ), making them at higher risk of suicidality ( 11 ).…”

Investigation of coping behaviors and premenstrual syndrome among university students

“…Given that effective symptoms related to PMS and PMDD can make women more prone to suicidal thoughts, plans, and, in severe cases, attempts, this is an issue that needs to be addressed seriously by health professionals (Prasad et al, 2021 ). Women’s health-related quality of life is severely influenced by PMS, interfering with the development of nations by impairing daily activities (Tolossa & Bekele, 2014 ; Direkvand-Moghadam et al, 2014 ).…”