Thursday, December 14, 2023

Suicidal Symptoms May Worsen for Some Women Before, During Menses

Women who experience suicidal thoughts and behaviors may experience worsening symptoms in the days before and during menses, though the symptom changes vary significantly among individuals, according to a study published today in The American Journal of Psychiatry.

“Females (assigned female at birth) are three times more likely than individuals assigned male at birth to report suicidal ideation, suicidal planning, or a suicide attempt,” wrote Jaclyn Ross, Ph.D., of the University of Illinois at Chicago and colleagues. “Accumulating evidence shows that ovarian hormone fluctuations modulate imminent suicide risk for many females, resulting in increased likelihood of suicide attempts and deaths during the premenstrual and menstrual weeks.”

Ross and colleagues analyzed data provided by women aged 18 to 45 with 21- to 35-day menstrual cycles who were receiving outpatient mental health care and had experienced past-month suicidal ideation. For inclusion in the study, the women could not be pregnant or planning to become pregnant, nor could they be taking hormonal medications.

All participants completed daily electronic surveys through which they reported when menses began and psychiatric symptoms each menstrual cycle. The surveys asked the study participants to report suicidal thoughts and planning, as well as feelings of anxiety, depression, hopelessness, agitation, and more. The participants also provided urine samples, which allowed the authors to identify when ovulation occurred each cycle.

A total of 119 participants provided data covering two menstrual cycles. Findings included the following:

  • Many participants experienced worsening psychiatric symptoms, suicidal ideation, and suicidal planning during the perimenstrual period (the days immediately before and after the onset of menses).
  • Suicidal planning was more likely to occur during the perimenstrual period compared with other phases of the menstrual cycle.
  • Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust predictors of suicidal ideation and behaviors worsening during the perimenstrual period.
  • Symptom changes in response to the menstrual cycle varied significantly across the study participants. The authors wrote that this finding underscores the importance of understanding individual differences in hormone sensitivity.

“These findings highlight the need for more intensive, longitudinal research on the mechanisms underlying and the prevention of suicidality across the cycle,” the authors wrote. “[I]ntervention efforts may benefit from strategies that specifically target depressive symptoms as they fluctuate across the cycle, given their powerful role in the cycle-suicidality relationship.”

For related information, see the Psychiatric News article “Depression After Hormonal Contraception Initiation Linked to PPD.”

(Image: Getty Images/iStock/hsyncoban)

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