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Premenstrual Disorders May Increase Suicide Risk, Especially Among Young Women, Study Warns
The risk of mortality was not higher for women with vs without PMD overall but was particularly elevated for young women and for suicide across age of PMD diagnosis.
Women who received a diagnosis of premenstrual disorder (PMD) before 25 years of age were found at a more than than 2-fold higher risk of all-cause mortality and death from natural causes and nearly a 4-fold greater risk of death from suicide, according to findings from a Swedish population-based matched cohort study of more than 406 000 women.
The study, undertaken to estimate the association of PMDs with overall and cause specific mortality among women of reproductive age, found that having PMD was not associated with an increased risk of overall mortality but that having the disorder vs not having it was associated with a greater risk of death from nonnatural causes, including twice the risk of death from suicide.
The elevated risk of suicide was consistent among women with PMDs across age groups, according to study authors writing in JAMA Network Open. Those results, they said, corroborate the team’s earlier research that found a diagnosis of PMD was associated with greater risk of a suicide attempt. “However, to our knowledge, the current study is the first report to illustrate the increased risk of completed suicide,” Marion Opatowski, PhD, from the unit of integrative epidemiology at the Institute of Environmental Medicine at the Karolinska Institutet, Sweden, and colleagues wrote.
To create the study cohort, Opatowski and colleagues tapped Swedish national health and population registers, identifying and compiling inpatient, outpatient, and drug dispensing data for a total of 67 748 women of reproductive age who had a first diagnosis of PMD from 2001 to 2018, according to the study. They then matched these women in a ratio of 5:1 with 338 740 women without PMD, for a final cohort numbering 406 488 women.
Reproductive age was defined as between age 15 years, when 96% of Swedish women commence menarche, to age 52 years, the average age of menopause among Swedish women.
Participants were followed until death, emigration, or December 31, 2018, whichever came first. Investigators defined the primary outcomes as dates of death and underlying causes, which were retrieved from the National Cause of Death Register.
FINDINGS
The researchers reported a mean age of 35.8 years at diagnosis of PMD. The average follow-up period among all participants was 6.2 years (range 1 to 18 years). During that time Opatowski et al recorded deaths among 367 women with PMD and 1958 without the disorder (8.4 and 9.1 deaths per 10 000 person years, respectively).
Their analysis found no increase in overall mortality risk for women with vs without PMD (aHR, 0.91; 95% CI, 0.82-1.02). The risk for death from unnatural causes, however, was greater among study participants with PMD compared with those without (HR, 1.59; 95% CI, 1.25-2.04). Moreover, that risk was nearly 2 times greater for death from suicide (aHR, 1.92; 95% CI, 1.43-2.6), according to the findings, and was consistent regardless of age at PMD diagnosis.
There was a slightly lower risk for all-cause mortality after accounting for demographics and comorbidities, the investigators reported, which was seen mainly among women diagnosed with PMDs at the somewhat older ages between 45 to 51 years (HR, 0.79; 95% CI, 0.64-0.97). In contrast, among women diagnosed before the age of 25 years, the risk of all-cause mortality was more than doubled (HR, 2.51; 95% CI, 1.42-4.42).
Results of the analysis of associations between PMD and death from natural causes mirrored those for all-cause mortality: the overall risk was lower (HR, 0.73; 95% CI, 0.62-0.84) but for women diagnosed before age 25 years, was 2.5-times higher (HR, 2.59; 95% CI, 1.21-5.54).
Although the higher risk of death from suicide was found regardless of age at PMD diagnosis (Pinteraction =.68) the most pronounced elevation was seen among the younger women who received a diagnosis before they turned 25 (HR, 3.84; 95% CI, 1.18-12.45).
Among women younger than 25 years who died, approximately one-third of the deaths...were due to suicide.
“This nationwide, population-based, matched cohort study with follow-up for up to 18 years fills an important gap in the understanding of all-cause and cause-specific mortality among women with PMDs. The use of national registers enabled complete follow-up and comprehensive information on death and its causes.”
In a discussion of their study’s limitations, Opatowski et al note the potential for misclassification of death related to reliance on the National Cause of Death Register, which may include some small inaccuracies and the absence of data on some potential confounding factors (eg, smoking status, body mass index). They also call for studies with longer follow-up to better capture long-term consequences given the relatively young age of the cohort and the mean follow-up of just 6.2 years.
Those limitations notwithstanding, the researchers concluded that their findings support “the importance of careful follow-up for young women with premenstrual disorders and highlight the need to develop suicide prevention strategies for all women with premenstrual disorders.”
