Prevalence, risk factors, and treatments for suicidality in people living with Premenstrual Dysphoric Disorder (PMDD): a systematic review

Background Premenstrual dysphoric disorder (PMDD) is a chronic condition estimated to affect 1.3% to 5.8% of people who menstruate. A small but rapidly growing body of research shows that suicidality appears to be comparatively common among those with PMDD versus unaffected people. The purpose of this systematic review is to provide an update on the evidence for prevalence, risk factors, and treatments for suicidality in people living with PMDD. Methods PubMed and PsycInfo were searched on July 5, 2024 and CENTRAL on August 12, 2024, which produced 1,185 references. Included studies must have been primary empirical studies available in English which were published from 2013 onwards and included: people who menstruate; discussion of PMDD regardless of whether study authors identify which participants have PMDD; outcomes or data related to suicidality. Data was narratively synthesized. The quality appraisal process and risk of bias assessment was done via the Mixed Methods Appraisal Tool. Results Eighteen studies were included, comprised of 20 references, representing approximately 2,600,000 participants. Findings showed that eight types of suicidality as defined in the literature were significantly associated with PMDD and PMDs. Prevalences ranged across many types of suicidality: 16%-30.47% for suicidality, 26%-86% for suicidal ideation, 11.5%-41.5% for suicide planning, and 7.1%-60.7% for suicide attempts. Risk factors for suicidality in people with PMDD were also evaluated. Some common risk factors included: Major Depressive Disorder; other psychiatric comorbidities; scoring highly on personality tests that measured traits such as impulsivity, aggression, and feelings of hopelessness; hormonal pathogenesis. Treatments for suicidality in people with PMDD did not appear among the included studies. MMAT assessments flagged issues with 14 of the 20 (70%) references. Conclusion There is a clear association between suicidality and PMDD, but the heterogeneity of existing research obfuscates concrete conclusions around prevalence, risk factors, and treatments. More work needs to be done to refine the diagnostic criteria for PMDD to account for the complexities of this condition. The research suggests that screening for suicidality should be conducted regularly for those with potential, provisional, and confirmed PMDD.