Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
BMC Med. 2022 Feb 21;20(1):60. doi: 10.1186/s12916-022-02275-7.
Childhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored.
To evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression.
At a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11-1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21-2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs.
Our findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.
童年期虐待和忽视与经前期障碍（PMD）有关，包括经前期综合征（PMS）和经前期烦躁障碍（PMDD）。然而，其他不良童年经历（ACEs）和 ACEs 的累积数量与 PMD 的关系仍有待探讨。
为了评估 ACEs 的累积数量和类型与 PMD 的关系，我们对 Stress-And-Gene-Analysis（SAGA）队列中接受 PMD 和 ACEs 评估的月经妇女亚组进行了横断面分析（N=11973）。通过改良 ACE-International 问卷评估了 13 种 ACEs 的累积和个体暴露情况。使用改良的经前期症状筛查工具来确定 PMD 的可能病例，进一步分为 PMS 和 PMDD。使用泊松回归估计与不同 ACEs 相关的 PMD 的患病率比（PR）。
在平均年龄为 34.0 岁（标准差（SD）9.1）的人群中，3235 人（27%）符合可能的 PMD 标准，其中 2501 人（21%）为 PMS，734 人（6%）为 PMDD。ACEs 的数量与 PMD 呈线性相关（完全调整后的 PR 为每增加 1 个 ACE 增加 1.12，95%CI 为 1.11-1.13）。具体来说，与没有 ACE 的女性相比，有 4 个或更多 ACE 的女性发生 PMD 的 PR 为 2.46（95%CI 2.21-2.74）。与 PMS 相比，PMDD 的相关性更强（差异的 p 值<0.001）。在没有 PTSD、焦虑或抑郁、童年剥夺以及社会支持水平较低的女性中，ACEs 与 PMD 的关联更强（交互作用的 p 值<0.001）。所有类型的 ACEs 均与 PMD 呈正相关（PR 范围为 1.11 至 1.51）；性虐待、情感忽视、家庭暴力、家庭成员的精神疾病、同伴和集体暴力与其他 ACE 无关。
我们的研究结果表明，童年期不良经历与 PMD 呈剂量依赖性相关。如果前瞻性数据得到证实，我们的研究结果支持对暴露于 ACE 的女孩进行早期干预，以降低 PMD 和成年后其他疾病的风险。
