Prevalence, Risk Factors, and Treatments for Suicidality in People Living with Premenstrual Dysphoric Disorder (PMDD): A Systematic Review

Abstract

In 2013, premenstrual dysphoric disorder (PMDD) was officially recognized as a psychiatric diagnosis. It is estimated to affect 1.3% to 5.8% of people who menstruate. Previous evidence has suggested an association between PMDD and suicidality. We set out to systematically review the most up-to-date evidence on prevalence, risk factors, and treatments for suicidality in people living with PMDD. We searched PubMed and PsycInfo (07/2024) and CENTRAL (08/2024) for primary empirical studies available in English published from 2013 onwards; concepts included: people who menstruate; discussion of PMDD; and suicidality-related data (outcomes, prevalence, risk-factors). Evidence was narratively synthesized and grouped by outcome and then within-outcome by population. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal. Eighteen studies were included (n = approximately 2,600,000). MMAT assessments flagged issues with 70% of studies. Across studies reviewed, eight suicidality-related indicators/outcomes were significantly associated with PMDD and/or PMDs. Prevalences ranged across indicators: 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. Common suicidality-related risk factors included: other psychiatric comorbidities; scoring highly on personality tests measuring impulsivity, aggression, and feelings of hopelessness; and hormonal factors. No identified studies evaluated treatments for suicidality in people with PMDD. The field of PMDD research requires consistent definition of PMDD and suicidality-related indicators/outcomes to facilitate research, diagnosis and treatment. Despite clinical and methodological heterogeneity, evidence is clear that people with PMDD are at increased risk of suicidality, signaling a need for research on interventions in this population.