Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
J Womens Health (Larchmt). 2022 Jan;31(1):100-109. doi: 10.1089/jwh.2020.8797. Epub 2021 Apr 1.
Premenstrual dysphoric disorder (PMDD) is a severe mood disorder that affects ∼5% of menstruating individuals. Although symptoms are limited to the luteal phase of the menstrual cycle, PMDD causes significant distress and impairment across a range of activities. PMDD is under-recognized by health care providers, can be difficult to diagnose, and lies at the intersection of gynecology and psychiatry. Thus, many patients are misdiagnosed, or encounter challenges in seeking care. The aim of this study was to examine patients' experiences with different health care specialties when seeking care for PMDD symptoms. We examined data from the 2018 Global Survey of Premenstrual Disorders conducted by the International Association for Premenstrual Disorders (IAPMD). Patients rated their health care providers (general practitioners, psychiatrists, gynecologists, psychotherapists) in three key areas related to treatment of premenstrual mood complaints: interpersonal factors, awareness and knowledge of PMDD, and whether the patient was asked to track symptoms daily. Intraclass correlations examined between- and within-person variance. Multilevel regression models predicted ratings on each provider competency item, with ratings nested within individuals to examine the within-patient effect of provider type on outcomes. The sample included 2,512 patients who reported seeking care for PMDD symptoms. Regarding interpersonal factors, psychotherapists were generally rated the highest. On awareness and knowledge of PMDD, gynecologists and psychiatrists were generally rated the highest. Gynecologists were more likely than other providers to ask patients to track symptoms daily. These findings suggest that different providers have different strengths in assessing and treating PMDD. Further, graduate and medical training programs may benefit from increased curricular development regarding evidence-based evaluation and treatment of PMDD.
经前期烦躁障碍（PMDD）是一种严重的情绪障碍，影响约 5%的经期个体。尽管症状仅限于月经周期的黄体期，但 PMDD 会在一系列活动中引起明显的痛苦和障碍。PMDD 未被医疗保健提供者充分认识，诊断困难，且处于妇科和精神病学的交叉点。因此，许多患者被误诊，或在寻求治疗时遇到挑战。本研究旨在研究患者在寻求 PMDD 症状治疗时与不同医疗专业人员的就诊经历。我们研究了国际经前期障碍协会（IAPMD）进行的 2018 年全球经前期障碍调查的数据。患者在与治疗经前期情绪投诉相关的三个关键领域对其医疗保健提供者（全科医生、精神科医生、妇科医生、心理治疗师）进行了评分：人际关系因素、对 PMDD 的认识和了解、以及是否要求患者每天记录症状。内部一致性检验考察了个体间和个体内的差异。多水平回归模型预测了每个提供者能力项目的评分，评分嵌套在个体内，以检验提供者类型对结果的个体内影响。该样本包括 2512 名报告因 PMDD 症状寻求治疗的患者。在人际关系方面，心理治疗师的评分通常最高。在对 PMDD 的认识和了解方面，妇科医生和精神科医生的评分通常最高。与其他提供者相比，妇科医生更有可能要求患者每天记录症状。这些发现表明，不同的提供者在评估和治疗 PMDD 方面具有不同的优势。此外，研究生和医学培训项目可能受益于增加关于 PMDD 的循证评估和治疗的课程开发。
