Suicide Risk and the Menstrual Cycle: a Review of Candidate RDoC Mechanisms

Abstract

Purpose of review: Risk for suicidal behavior may fluctuate across the menstrual cycle. Here, we use the RDoC framework to review potential mechanisms by which the cycle may increase acute suicide risk. Findings: The menstrual cycle impacts the majority of RDoC constructs linked to suicide risk, particularly among hormone-sensitive women, such as those with premenstrual dysphoric disorder or premenstrual exacerbation of a psychiatric disorder. Despite this, there are no published studies examining suicidal ideation, planning, or behavior longitudinally across the cycle. Summary: More work is needed to understand how hormone sensitivity may relate to both trait and state suicide risk. Intensive multilevel investigations of cyclical hormone effects on suicide risk through specific RDoC mechanisms are suggested. This is a fertile research area and may provide key insights regarding the mechanisms of acute suicide risk.

Suicidality in women with Premenstrual Dysphoric Disorder: a systematic literature review

“…Previous reviews have provided an overview of what is known about PMDD, including the epidemiology and treatment options (Hantsoo and Epperson 2015 ; Cunningham et al 2009 ; Sepede et al 2016 ), alongside reviewing the potential mechanisms by which the menstrual cycle may increase suicide risk (Owens and Eisenlohr-Moul 2018 ). However, to date, no review has focussed specifically on reviewing the available data for experiences of suicidality in women PMDD, despite the importance of understanding the risks for this particular subgroup.…”

Psychological and neurobiological aspects of suicide in adolescents: Current outlooks

“…Changes in the levels of the hormone are crucial for some individuals during suicidal behavior, especially in females. There is very interesting research regarding the menstrual cycle studying how feminine hormones fluctuate, thus affecting female behavior, which increases the risk for suicide ( Owens and Eisenlohr-Moul, 2018 ). Association between premenstrual dysphoric disorder and suicide ( Shams-Alizadeh et al., 2018 ) had been associated, and levels of some hormones in the reproductive cycle of females are risk factors for suicide.…”

“…In adolescences, females that were under hormonal contraception had shown a positive association between hormonal contraception and suicide. It concerns that conclusion from several studies indicated that adolescent females would have the highest risk of commit suicide under this hormonal contraception ( Hughes and Majekodunmi, 2018 ; Owens and Eisenlohr-Moul, 2018 ; Skovlund et al., 2018 ).…”

Understanding menstrual cycle effects on suicide will require prospective studies of suicidal thoughts and behaviors in premenstrual disorders

“…In order to prevent suicide, it is critical to identify time-varying factors that predict acute changes in risk, allowing for targeted intervention in the days and weeks where individuals are most vulnerable. Ample cross-sectional data indicate that some individuals experience menstrual cycle-related changes in suicidal behavior and associated risk factors [ 2 ], suggesting that hormone fluctuations across the menstrual cycle may be one predictable time-varying trigger for acute increases in suicide risk. In a field that has largely fallen short of identifying such triggers, the present study makes an important contribution by highlighting a vulnerable group who may experience a reliable pattern of change in risk.…”