Dysmenorrhea and Adolescent Mental Health: A School-Based Cross-Sectional Study.

Abstract

OBJECTIVE While active monitoring of adolescent menstrual and mental health is advocated, research on their possible bidirectional relationship is limited. This study examines the association between adolescent dysmenorrhea and psychological symptoms. DESIGN Cross-sectional study. SETTING 116 schools in Stockholm, Sweden. SAMPLE 1054 postmenarchal school girls (mean age 14.1 ± 0.7) randomly sampled from a population of 10 299 lower-secondary pupils in a school-based project. METHODS A self-report health survey assessed psychological symptoms using validated instruments. A multiple-choice item identified dysmenorrhea (menstrual pain affecting everyday life) and severe dysmenorrhea (dysmenorrhea that is hard to cope with). MAIN OUTCOME MEASURES Prevalence of dysmenorrhea and severe dysmenorrhea in girls with and without symptoms of depression (Beck's Depression Inventory-II score ≥ 20), anxiety (Generalised Anxiety Disorder 7-Item Scale score ≥ 10), self-injury (≥ 3 instances on a modified Deliberate Self-harm Inventory), and suicide ideation (recent serious thoughts/plans on the Paykel Suicide Scale). RESULTS Overall, 55.1% reported dysmenorrhea while 11.7% reported severe dysmenorrhea. Prevalence was 29%-34% higher among girls with psychological symptoms compared to those without. Severe dysmenorrhea was significantly more frequent among girls with any symptom (prevalence ratio [PR] 2.25; 95% CI 1.61, 3.13), depression (PR 2.60; 95% CI 1.86, 3.63), anxiety (PR 2.89; 95% CI 2.09, 4.00), self-injury (PR 1.87; 95% CI 1.29, 2.71), and suicide ideation (PR 1.75; 95% CI 1.18, 2.58) compared to girls without the same manifestations. These findings were consistent after adjustments for age, age of menarche, country of birth, and hormonal contraception. CONCLUSIONS These findings emphasise the need for integrated approaches to adolescent menstrual and mental health care.