Eisenlohr-Moul Tory, Divine Madeline, Schmalenberger Katja, Murphy Laura, Buchert Brett, Wagner-Schuman Melissa, Kania Alyssa, Raja Sabina, Miller Adam Bryant, Barone Jordan, Ross Jaclyn
Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, Chicago, IL, 60612, USA.
International Association for Premenstrual Disorders, Boston, MA, USA.
BMC Psychiatry. 2022 Mar 19;22(1):199. doi: 10.1186/s12888-022-03851-0.
Suicide is the second leading cause of death among Americans ages 10 to 34, with alarming recent increases in suicide rates among those assigned female at birth. A large body of evidence points to menstrual cycle influences on self-injurious thoughts and behaviors (STBs), suggesting that neurobiological hormone sensitivities, such as in premenstrual dysphoric disorder (PMDD), may drive suicide risk in females. However, existing studies of STBs in PMDD use cross-sectional self-report measures of PMDD with poor validity. As a first step to establish accurate prevalence rates of STBs in PMDD, we examined the lifetime prevalence of STBs in a large global survey of patients reporting a diagnosis of PMDD based on daily ratings.
Individuals with self-reported PMDD symptoms were invited to an online survey through online support groups for PMDD and social media posts from PMDD awareness accounts. Participants reported demographics, whether they had been diagnosed with PMDD by a healthcare provider using daily ratings, STBs using the Columbia Suicide Severity Rating Scale, and history of lifetime comorbid psychiatric diagnoses.
Of 2,689 survey completers, 599 (23%) reported a diagnosis with PMDD based on two months of daily ratings and were included in analyses. We observed high rates of lifetime active suicidal ideation (72%), planning (49%), intent (42%), preparing for an attempt (40%), and attempt (34%), as well as non-suicidal self-injury (51%). The majority (70%) of the sample reported at least one lifetime comorbid psychiatric diagnosis. Predictors of lifetime active suicidal ideation included nulliparity, low-to-moderate (vs. high) income, and history of diagnosis with major depression or post-traumatic stress disorder. Predictors of lifetime attempts among those reporting lifetime active ideation included older age, nulliparity, lower income, and history of diagnosis with post-traumatic stress disorder or borderline personality disorder.
These data indicate high rates of STBs among those reporting prospective diagnosis of PMDD and highlight the need for prospective research on mechanisms and prevention of STBs in PMDD. Clinical practice guidelines for PMDD should accommodate comorbidities and recommend frequent screenings for STB risk. STBs should be considered for inclusion in future iterations of the DSM PMDD diagnostic criteria.
自杀是10至34岁美国人的第二大死因，近期出生时被指定为女性的人群自杀率惊人地上升。大量证据表明月经周期会影响自我伤害性想法和行为（STB），这表明神经生物学激素敏感性，如经前烦躁障碍（PMDD）中的激素敏感性，可能会增加女性的自杀风险。然而，现有关于PMDD中STB的研究使用的是PMDD的横断面自我报告测量方法，有效性较差。作为确定PMDD中STB准确患病率的第一步，我们在一项基于每日评分报告诊断为PMDD的患者的大型全球调查中，研究了STB的终生患病率。
通过PMDD在线支持小组和PMDD认知账户的社交媒体帖子，邀请有自我报告PMDD症状的个体参加在线调查。参与者报告了人口统计学信息、他们是否被医疗保健提供者根据每日评分诊断为PMDD、使用哥伦比亚自杀严重程度评定量表的STB以及终生共病精神疾病诊断史。
在2689名完成调查的人中，599人（23%）根据两个月的每日评分报告诊断为PMDD，并被纳入分析。我们观察到终生有活跃自杀意念（72%）、计划（49%）、意图（42%）、准备自杀尝试（40%）和自杀尝试（34%）以及非自杀性自我伤害（51%）的发生率很高。大多数（70%）样本报告至少有一种终生共病精神疾病诊断。终生有活跃自杀意念的预测因素包括未生育、低收入到中等收入（与高收入相比）以及有重度抑郁症或创伤后应激障碍的诊断史。在报告终生有活跃意念的人群中，终生自杀尝试的预测因素包括年龄较大、未生育、收入较低以及有创伤后应激障碍或边缘性人格障碍的诊断史。
这些数据表明，在报告前瞻性诊断为PMDD的人群中，STB的发生率很高，并强调需要对PMDD中STB的机制和预防进行前瞻性研究。PMDD的临床实践指南应考虑共病情况，并建议对STB风险进行频繁筛查。STB应被考虑纳入未来版的《精神疾病诊断与统计手册》PMDD诊断标准中。
