Tory Eisenlohr-Moul;  specialist guide

Suicidal thoughts, behaviors related to a hormone-sensitive brain disorder

A new global study published in BMC Psychiatry reports that 34% of people with PMDD 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 healthcare provider based on daily symptom assessments, the only reliable method currently available.

Tory Eisenlohr-Moul, assistant professor of psychiatry at UIC College of Medicine. (Photo by Jenny Fontaine)

Given that previous studies of suicide and ideation have relied on less valid self-reported measures of premenstrual dysphoric disorder, commonly known as PMDD, the new findings offer the strongest scientific evidence to date that the disorder is likely a independent contributor to suicidal thoughts and actions. .

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

Premenstrual dysphoric disorder is a cyclical hormonal disorder that affects approximately 1 in 20 women of childbearing age who were designated 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, researchers analyzed information from the Global Survey of 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 vs PMDD and Vicious circle to help understand the extent of PMS and the impact of PMDD.

Analysis of information provided by the 599 respondents who reported a prior diagnosis of PMDD based on daily assessments by 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 rates of lifetime active suicidal ideation (72%), planning (49%), intending (42%) and preparing (40%) for an attempt, and nonsuicidal self-harm (51%) in patients. with PMDD diagnoses. Low to moderate income, a history of major depression or post-traumatic stress disorder, and nulliparity—never having given birth—were predictors of active lifetime suicidal ideation and attempts. Older age and borderline personality disorder were additional predictors of lifetime attempts.

Rates of self-harming thoughts and behaviors were also broken down between those with only PDD and those with PDD who also reported having at least one other mental health diagnosis, such as depression. Even among those who had never had any other mental health diagnosis, the rates were high: 67% said they had active suicidal ideation, compared to 74% who also had a psychological comorbidity, for example.

Prevalence of self-harm thoughts and behaviors in people 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 solely, or even primarily, due to other underlying mental health conditions. The data suggests to him that women who are neurobiologically sensitive to hormonal changes, as in the case of PMDD, may be at increased risk for suicidal thoughts and behaviors.

“One of the great challenges of PMDD is that the medical community has not only been slow to understand this condition, but even to believe that it exists,” said Eisenlohr-Moul, who is also chairman of the advisory board. IAPMD clinic. “Providers and communities often ignore 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 gendered stigma and misconceptions. on 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 for Premenstrual Disorder. “This is a galvanizing movement for women’s health. PMDD is a perfect storm where #MeToo and #TimesUp, meet mental health awareness, meet suicide prevention.

While 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 disease.

The BMC Psychiatry study, “Lifetime prevalence of self-harming thoughts and behaviors in a global sample of 599 patients reporting a prospectively confirmed diagnosis with PMDDis co-written 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 Disorder 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 Disorder received funding through a Eugene Washington PCORI Engagement Award (EA20240).

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