Abstract
Purpose
Suicide is a major public health concern and a leading cause of death in the United States. Psychopathology is an established risk factor for non-fatal suicidal behavior; however, it is unclear whether Premenstrual Dysphoric Disorder (PMDD), a psychiatric disorder specific to women, is correlated with these outcomes. The objective of this study was to determine if PMDD status was associated with suicidal ideation, plans, and attempts, independent of socio-demographic factors and psychiatric comorbidity.
Methods
We conducted a secondary data analysis of 3,965 American women aged 18–40 who participated in the Collaborative Psychiatric Epidemiology Survey. Descriptive statistics and forward stepwise logistic regression modeling were performed using SUDAAN software.
Results
The prevalence of non-fatal suicidal behaviors increased in a graded fashion according to PMDD status. Although the control for demographic characteristics and psychiatric comorbidity greatly attenuated the unadjusted association between PMDD and suicidal behaviors, women with PMDD remained significantly more likely than women with no premenstrual symptoms to report suicidal ideation (OR 2.22; 95 % CI 1.40–3.53), plans (OR 2.27; 95 % CI 1.20–4.28), and attempts (OR 2.10; 95 % CI 1.08–4.08). Only the likelihood of suicidal ideation was significantly elevated among women with moderate/severe premenstrual syndrome (PMS; OR 1.49; 95 % CI 1.17–1.88), compared to women with no premenstrual symptoms.
Conclusions
PMDD was strongly and independently associated with non-fatal suicidal behaviors among a nationally representative sample. These findings suggest that clinicians treating women with PMDD should assess and be vigilant for signs of non-fatal suicidal behavior, and that clinicians should evaluate and treat the premenstrual symptoms of women who express these behaviors.
Similar content being viewed by others
References
Centers for Disease Control and Prevention NCfIPaC. Understanding suicide fact sheet. 2010
Nock MK, Hwang I, Sampson NA, Kessler RC (2010) Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry 15(8):868–876
McLean J, Maxwell M, Platt S, Harris F, and Jepson R. (2008) Risk and protective factors for suicide and suicidal behaviour: a literature review. Edinborough
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington DC, p 886
Halbreich U, Borenstein J, Pearlstein T, Kahn L (2003) The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder [PMS/PMDD]. Psychoneuroendocrinology 28(Suppl 3):1–23
Clayton A (2008) Symptoms related to the menstrual cycle: diagnosis, prevalence, and treatment. J Psychiatr Pract 14(1):13–21
Yonkers KA, Pearlstein T, Rosenheck RA (2003) Premenstrual disorders: bridging research and clinical reality. Arch Womens Ment Health 6(4):287–292
Baca-Garcia E, Diaz-Sastre C, Ceverino A, García Resa E, Oquendo MA, Saiz-Ruiz J et al (2004) Premenstrual symptoms and luteal suicide attempts. Eur Arch Psychiatry Clin Neurosci 254(5):326–329
Lieb R, Isensee B, von Sydow K, Wittchen HU (2000) The Early Developmental Stages of Psychopathology Study [EDSP]: a methodological update. Eur Addict Res 6(4):170–182
Wittchen H, Becker E, Lieb R, Krause P (2002) Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med 32(1):119–132
Kessler R, Merikangas K (2004) The National Comorbidity Survey Replication [NCS-R]: background and aims. Int J Methods Psychiatr Res 13(2):60–68
Alegria M, Takeuchi D, Canino G, Duan N, Shrout P, Meng X et al (2004) Considering context, place and culture: the National Latino and Asian American study. Int J Methods Psychiatr Res 13(4):208–220
Jackson J, Torres M, Caldwell C, Neighbors H, Nesse R, Taylor R et al (2004) The National Survey of American Life: a study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res 13(4):196–207
Heeringa S, Wagner J, Torres M, Duan N, Adams T, Berglund P (2004) Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies [CPES]. Int J Methods Psychiatr Res 13(4):221–240
Pennell B, Bowers A, Carr D, Chardoul S, Cheung G, Dinkelmann K et al (2004) The development and implementation of the National Comorbidity Survey Replication, the National Survey of American Life, and the National Latino and Asian American Survey. Int J Methods Psychiatr Res 13(4):241–269
Kessler R, Abelson J, Demler O, Escobar J, Gibbon M, Guyer M et al (2004) Clinical calibration of DSM-IV diagnoses in the World Mental Health [WMH] version of the World Health Organization [WHO] Composite International Diagnostic Interview [WMHCIDI]. Int J Methods Psychiatr Res 13(2):122–139
Deuster P, Adera T, South-Paul J (1999) Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med 8(2):122–128
Kessler RC, Borges G, Walters EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 56(7):617–626
Crowne DP, Marlowe D (1960) A new scale of social desirability independent of psychopathology. J Consult Psychol 24(4):349–354
Aschengrau A, Seage GRI (2008) Essentials of epidemiology in public health, 2nd edn. Jones and Barlett Publishers, Sudbury, MA
International R. About SUDAAN. 2008; Available from: http://www.rti.org/sudaan/index.cfm
Szklo M, Nieto FJ (2004) Epidemiology beyond the basics. Jones and Barlett Publishers, Boston
Grant BF. (2004-2005) Wave 2 National Epidemiologic Survey of Alcohol and Related Conditions [NESARC]
Landén M, Eriksson E (2003) How does premenstrual dysphoric disorder relate to depression and anxiety disorders? Depress Anxiety 17(3):122–129
Endicott J, Amsterdam J, Eriksson E, Frank E, Freeman E, Hirschfeld R et al (1999) Is premenstrual dysphoric disorder a distinct clinical entity? J Womens Health Gend Based Med 8(5):663–679
Vigod SN, Frey BN, Soares CN, Steiner M (2010) Approach to premenstrual dysphoria for the mental health practitioner. Psychiatr Clin North Am 33(2):257–272
Joiner TE Jr, Brown JS, Wingate LR (2005) The psychology and neurobiology of suicidal behavior. Annu Rev Psychol 56(1):287
Steiner M, Pearlstein T (2000) Premenstrual dysphoria and the serotonin system: pathophysiology and treatment. J Clin Psychiatr 61(Suppl 12):17–21
Saunders KEA (2006) Suicidal behaviour and the menstrual cycle. Psychol Med 36(7):901
Taylor DL, Mathew RJ, Ho BT, Weinman ML (1984) Serotonin levels and platelet uptake during premenstrual tension. Neuropsychobiology 12(1):16–18
Rapkin AJ, Edelmuth E, Chang LC, Reading AE, McGuire MT, Su TP (1987) Whole blood serotonin in premenstrual syndrome. Obstet Gynecol 70(4):533–537
Hartlage SA, Arduino KE, Gehlert S (2001) Premenstrual dysphoric disorder and risk for major depressive disorder: a preliminary study. J Clin Psychol 57(12):1571–1578
Perkonigg A, Yonkers K, Pfister H, Lieb R, Wittchen H (2004) Risk factors for premenstrual dysphoric disorder in a community sample of young women: the role of traumatic events and posttraumatic stress disorder. J Clin Psychiatry 65(10):1314–1322
Pearlstein T, Steiner M (2008) Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci 33(4):291–301
Acknowledgments
This research was funded in part by NIMH training grant: 5-T32-MH014235-37 (to CEP), and the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs (to DJL).
Conflict of interest
The authors have no competing interests to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pilver, C.E., Libby, D.J. & Hoff, R.A. Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 48, 437–446 (2013). https://doi.org/10.1007/s00127-012-0548-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-012-0548-z