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Soc Psychiatry Psychiatr Epidemiol. 2013 Mar;48(3):437-46. doi: 10.1007/s00127-012-0548-z. Epub 2012 Jul 3.

Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample.

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Division of Biostatistics, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA.



Suicide is a major public health concern and a leading cause of death in the United States. Psychopathology is an established risk factor for non-fatal suicidal behavior; however, it is unclear whether premenstrual dysphoric disorder (PMDD), a psychiatric disorder specific to women, is correlated with these outcomes. The objective of this study was to determine if PMDD status was associated with suicidal ideation, plans, and attempts, independent of socio-demographic factors and psychiatric comorbidity.


We conducted a secondary data analysis of 3,965 American women aged 18-40 who participated in the Collaborative Psychiatric Epidemiology Survey. Descriptive statistics and forward stepwise logistic regression modeling were performed using SUDAAN software.


The prevalence of non-fatal suicidal behaviors increased in a graded fashion according to PMDD status. Although the control for demographic characteristics and psychiatric comorbidity greatly attenuated the unadjusted association between PMDD and suicidal behaviors, women with PMDD remained significantly more likely than women with no premenstrual symptoms to report suicidal ideation (OR 2.22; 95% CI 1.40-3.53), plans (OR 2.27; 95% CI 1.20-4.28), and attempts (OR 2.10; 95% CI 1.08-4.08). Only the likelihood of suicidal ideation was significantly elevated among women with moderate/severe premenstrual syndrome (PMS; OR 1.49; 95% CI 1.17-1.88), compared to women with no premenstrual symptoms.


PMDD was strongly and independently associated with non-fatal suicidal behaviors among a nationally representative sample. These findings suggest that clinicians treating women with PMDD should assess and be vigilant for signs of non-fatal suicidal behavior, and that clinicians should evaluate and treat the premenstrual symptoms of women who express these behaviors.

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