Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden.
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA.
BMC Med. 2021 May 26;19(1):119. doi: 10.1186/s12916-021-01989-4.
Premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, are suggested to be correlated with suicidal behavior and accidents in cross-sectional and retrospective studies. However, prospective data are still lacking.
We performed a population-based cohort study including 1,472,379 Swedish women of reproductive age who were followed from 2001 to 2012. Within the cohort, we also performed a sibling analysis where we compared the rates of injury between full sisters. By linking to the Patient and the Prescribed Drug Registers, we identified 18,628 women with any clinical indications for premenstrual disorders in the cohort (population analysis) and 7674 women in the sibling analysis. Any injury, primarily suicidal behavior (completed suicide and suicide attempt) or accidents (e.g., fall and transportation accidents), was identified through the Patient and Causes of Death Registers as the primary outcome. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of these outcomes among women with premenstrual disorders in both population and sibling analyses using multivariable Cox proportional hazards regression.
During a maximal follow-up of 12 years (mean 9.55 years), we identified 2390 women with premenstrual disorders with any injury; 216 through suicidal behavior and 2191 through accidents. Compared to women without premenstrual disorders, women with premenstrual disorders were at increased risk of any injury (HR 1.37, 95% CI 1.31-1.42), particularly suicidal behavior (HR 2.26, 95% CI 1.97-2.59) and accidents (HR 1.32, 95% CI 1.27-1.38). Such associations somewhat attenuated yet remained significant in the sibling analysis (HRs: 1.31 for any injury, 1.86 for suicidal behavior, and 1.29 for accidents). Additional adjustment for psychiatric comorbidities minimally altered the associations with any injury and accidents in both population and sibling analyses, whereas the association with suicidal behavior was considerably attenuated to non-significance in the sibling analysis. Such risks were particularly strong within 2 years after receiving the diagnosis of premenstrual disorders and were evident among women with premenstrual disorders with and without psychiatric comorbidities.
Our findings suggest that women with a clinical indication of premenstrual disorders are at increased subsequent risk of injury, particularly accidents within the first 2 years after diagnosis.
经横断面和回顾性研究表明，经前期障碍（包括经前期综合征和经前期烦躁障碍）与自杀行为和事故有关。然而，目前仍缺乏前瞻性数据。
我们进行了一项基于人群的队列研究，纳入了 1472379 名瑞典育龄期女性，随访时间从 2001 年至 2012 年。在该队列中，我们还进行了一项同胞分析，比较了同卵双胞胎姐妹之间的受伤率。通过与患者和处方药物登记处相联系，我们在队列中确定了 18628 名有经前期障碍临床指征的女性（人群分析）和 7674 名在同胞分析中的女性。任何损伤、主要是自杀行为（完成自杀和自杀未遂）或事故（如跌倒和交通事故）都通过患者和死因登记处作为主要结果进行识别。我们使用多变量 Cox 比例风险回归模型在人群和同胞分析中估计了经前期障碍女性发生这些结果的风险比（HR）和 95%置信区间（CI）。
在最长 12 年（平均 9.55 年）的随访期间，我们在队列中确定了 2390 名经前期障碍女性有任何损伤，其中 216 名通过自杀行为，2191 名通过事故。与没有经前期障碍的女性相比，患有经前期障碍的女性受伤风险增加（HR 1.37，95%CI 1.31-1.42），尤其是自杀行为（HR 2.26，95%CI 1.97-2.59）和事故（HR 1.32，95%CI 1.27-1.38）。这种关联在同胞分析中有所减弱，但仍然具有统计学意义（HRs：任何损伤为 1.31，自杀行为为 1.86，事故为 1.29）。对精神共病的进一步调整对人群和同胞分析中与任何损伤和事故的关联影响不大，而自杀行为的关联在同胞分析中显著减弱至无统计学意义。这种风险在诊断后 2 年内尤其强烈，并且在有或没有精神共病的经前期障碍女性中均存在。
我们的研究结果表明，有经前期障碍临床指征的女性随后受伤的风险增加，尤其是在诊断后 2 年内发生事故的风险增加。
