Examining Suicidal Ideation and Capability Across the Menstrual Cycle

INTRODUCTION: Suicidal thoughts and behaviors have been linked to menarche and the perimenstrual phase of the menstrual cycle. This study examines whether acute changes in fearlessness about death (FAD) occur across the menstrual cycle. It also explores relationships between FAD and other known correlates of suicidal behaviors across the cycle. METHOD: The sample included 46 participants in good health, with natural menstrual cycles, past-month suicidal ideation, and ongoing outpatient mental health. Participants were excluded for exogenous hormone or cycle-altering medication use, nicotine use; recent pregnancy/postpartum, PMDD, chronic medical illness; recent mania, psychosis, substance misuse, or acute suicide risk requiring hospitalization. Menstrual cycle phases were determined using self-reported menses onset and ovulation dates. Participants provided daily ratings of FAD, passive and active suicidal ideation across 2 months. RESULTS: FAD was stable and showed no significant variation by cycle day or phase. However, it was significantly associated with daily feelings of depression, anger, irritability, and passive suicidal ideation. CONCLUSIONS: These findings suggest that fluctuations in affective states and suicidal ideation, not ovarian hormones, influence FAD. However, strict eligibility criteria, specifically the requirement for participants to endorse past-month suicidal ideation, may have limited our ability to observe fluctuations in FAD. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03498313.