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Suicidal thoughts, behaviors related to hormone-sensitive brain disorder

A new global study published in BMC Psychiatry reports that 34% of people with premenstrual dysphoric disorder have attempted suicide.

The study is the largest of its kind to examine rates of suicidal thoughts and behaviors among people diagnosed with the disorder by a health care provider based on daily symptom ratings, the only reliable method currently available.

Tory Eisenlohr-Moul;  expert guide
Tory Eisenlohr-Moul, an assistant professor of psychiatry at the UIC School of Medicine. (Photo by Jenny Fontaine)

Because previous studies of suicide and ideation have relied on less valid self-report measures of premenstrual dysphoric disorder, which is commonly called PMDD, the new findings offer the strongest scientific evidence to date that the disorder likely contributes independently of suicidal thoughts and actions. .

“We have discovered an extremely concerning rate of suicidal ideation and attempts among people with PMDD, highlighting the need to take this problem seriously,” said Tory Eisenlohr-Moul, an assistant professor of psychiatry at the University of Illinois Chicago and lead author. main of the study. to study. “These findings offer powerful evidence that the link between PMDD and suicide is independent of depression, post-traumatic stress disorder, or other mental health conditions known to increase ideation and attempts.”

Premenstrual dysphoric disorder is a cyclical hormone-based disorder that affects approximately 1 in 20 women of reproductive age who were assigned female at birth. The condition is often underdiagnosed, misdiagnosed, or dismissed entirely by medical professionals, despite patient reports of debilitating anxiety, hopelessness, and a variety of physical symptoms in the two weeks before menstruation.

To better understand PMDD, the researchers analyzed data from the Global Survey on Premenstrual Disorders, which included 3,153 people from more than 56 countries and more than 2,000 responses. The survey was conducted by the International Association for Premenstrual Disorders, Me v PMDD and Vicious Cycle to help understand the extent of PMS and the impact of PMDD.

Analysis of information provided by the 599 respondents who reported a previous daily diagnosis of PMDD based on ratings from a health care provider (23% of respondents) revealed that 34% had attempted suicide during an episode of PMDD. On average, patients waited 12 years and saw about six providers before receiving an accurate diagnosis of PMDD.

The data also showed high lifetime rates of active suicidal ideation (72%), planning (49%), intention (42%), and preparation (40%) for an attempt, and nonsuicidal self-harm (51%). between patients. with diagnoses of PMDD. Low-to-moderate income, a history of major depression or post-traumatic stress disorder, and nulliparity (never giving birth) were predictors of lifetime active suicidal ideation and attempts. Older age and borderline personality disorder were additional predictors of lifetime attempts.

Rates of self-injurious thoughts and behaviors were also broken down between people with PMDD only and those with PMDD who also reported receiving at least one other mental health diagnosis, such as depression. Even among those who had never received another mental health diagnosis, the rates were high: 67% reported active suicidal ideation, compared to 74% who also had psychological comorbidity, for example.

Prevalence of self-injurious thoughts and behaviors in patients with prospectively confirmed PMDD, subdivided by psychiatric comorbidity status. (Image: Tory Eisenlohr-Moul, et al., BMC Psychiatry)

Eisenlohr-Moul said she would expect to see a much larger difference in rates between categories if the thoughts and behaviors were due only, or even mostly, to other underlying mental health problems. Her data suggests to her that women who are neurobiologically sensitive to hormonal changes, as in the case of PMDD, may be at higher risk for suicidal thoughts and behaviors.

“One of the big challenges with PMDD is that the medical community has been slow to not only understand this condition, but even believe that it exists,” said Eisenlohr-Moul, who also chairs the IAPMD clinical advisory board. “Providers and communities often dismiss patient concerns, in part because women’s complaints are less likely to be taken seriously than men’s, but also because of persistent and even sexist stigma and misconceptions about menstruation in general.

“PMDD is not a hormonal imbalance. It is a neurobiological sensitivity to natural and normal changes in progesterone and estrogen levels,” she said.

“Our study reveals just how destructive PMDD is,” said Sandi MacDonald, co-founder and executive director of the International Association of Premenstrual Disorders. “This is a galvanizing movement in women’s health. PMDD is a perfect storm where #MeToo and #TimesUp meet mental health awareness and suicide prevention.”

Although PMDD has been included in the Diagnostic and Statistical Manual of Mental Disorders since 2013 as a major depressive disorder, there is still no recommended standard screening for suicidal ideation in patients with the condition.

The BMC Psychiatry study, “Lifetime Prevalence of Self-Injurious Thoughts and Behaviors in a Global Sample of 599 Patients Reporting a Confirmed Prospective Diagnosis with Premenstrual Dysphoric Disorder,” is co-authored by UIC’s Madeline Divine, Melissa Wagner-Schuman, Alyssa Kania, Sabina Raja, Jordan Barone and Jaclyn Ross. Katja Schmalenberger, Laura Murphy, and Brett Buchert of the International Association for Premenstrual Disorders and Adam Bryant Miller of the University of North Carolina at Chapel Hill are also co-authors.

The research was supported by grants from the National Institute of Mental Health (R00MH109667, RF1MH120843, R01MH122446, and K01MH116325). The International Association for Premenstrual Disorders has received funding through a PCORI Eugene Washington Commitment Award (EA20240).

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