People living with premenstrual dysphoric disorder, or PMDD, face significantly elevated rates of suicidal thoughts and behaviors, according to a new systematic review by researchers in the School of Public Health and Health Sciences.

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The study, published in the journal Administration and Policy in Mental Health and Mental Health Services Research, reviewed 18 studies involving approximately 2.6 million participants across 10 countries. Researchers found that people with PMDD consistently experienced higher rates of suicidality than the general population.

PMDD is a severe, chronic condition linked to the menstrual cycle and officially recognized as a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders in 2013. It is estimated to affect between 1.3% and 5.8% of people who menstruate.

“For a condition that is so disruptive and affects so many people [PMDD] is woefully and shockingly understudied and misunderstood,” says lead author Eliza Zhitnik, an SPHHS doctoral candidate. 

The review identifies several common risk factors associated with suicidality in people with PMDD, including major depressive disorder, anxiety disorders, bipolar disorder, impulsivity, aggression, hopelessness and hormonal factors.

Researchers also found major gaps in the current evidence base. None of the studies included in the review examined treatments specifically seeking to reduce suicidality among people with PMDD.

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Only a small number of the studies reviewed included participants with “confirmed” PMDD diagnoses based on prospective symptom tracking across multiple menstrual cycles, the standard prescribed under current diagnostic guidelines.

Senior author Jamie Hartmann-Boyce, assistant professor of health policy and management, says the research reinforces the need for future studies focused on interventions and treatments, especially for people with PMDD who also have other psychiatric conditions.

“The thing that concerns me the most is knowing that in the meantime, there are lots of people who are experiencing suicidality, who may not be getting any treatment or support for their PMDD, may not even be diagnosed with it,” she notes. 

Hartmann-Boyce says awareness is essential both for people who menstruate and may be experiencing PMDD-like symptoms—so they can seek treatment and support—and for clinicians, who must take the condition seriously.