Suicidal Ideation Common in Women Seeking Treatment for Premenstrual Dysphoric Disorder

In our clinic, we see many women who present with suicidal ideation emerging or worsening during the premenstrual phase of the menstrual cycle.  Although previous studies have reported an association between Premenstrual Dysphoric Disorder (PMDD) and suicidal ideation, most of these studies have not confirmed the diagnosis using prospective ratings and DSM diagnostic criteria.  A recent study from Wikman and colleagues assesses the prevalence of suicidal ideation in women with PMDD confirmed using more stringent criteria..

In this study, the participants were 110 women recruited to participate in a randomized placebo-controlled clinical trial for the treatment of PMDD between January 15, 2017 and October 19, 2019. The diagnosis of PMDD was confirmed using prospective daily ratings in line with DSM-5 criteria. Current suicidal ideation was measured using the MADRS-S administered during the late luteal phase of the menstrual cycle.  

Suicidal ideation was reported during the late luteal phase by nearly 40{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of the women with confirmed PMDD (n = 43, 39.1{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33}).  Current suicidal ideation was more common in women reporting previous psychological treatment for PMDD (OR 5.63, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 1.07-29.49).  In addition, higher depressive symptoms during the late luteal phase were associated with suicidal ideation  (OR 1.17, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 1.10-1.25).  In contrast, higher ratings of self-rated health were associated with lower odds ratios for current suicidal ideation (OR 0.98, 95{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} CI 0.96-0.99).

In this population seeking treatment for PMDD, suicidal ideation is very common, affecting about 40{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of the women.  This study is distinct from prior studies examining the association between PMDD and suicidal ideation; in the current study, the diagnosis of PMDD was confirmed prospectively according to DSM diagnostic criteria and suicidal ideation was measured concurrently.  While the study does not assess suicidal ideation in a community sample of women with PMDD, the findings of this study suggest that suicidal ideation is common among women seeking treatment for PMDD.  

Ruta Nonacs, MD PhD

Wikman A, Sacher J, Bixo M, Hirschberg AL, Kopp Kallner H, Epperson CN, Comasco E, Sundström Poromaa I. Prevalence and correlates of current suicidal ideation in women with premenstrual dysphoric disorder. BMC Womens Health. 2022 Feb 11;22(1):35.

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