Cyclical Exacerbation of Suicidal Ideation in Female Outpatients: Prospective Evidence from Daily Ratings in a Transdiagnostic Sample
Year: 2022
Type: preprint
Study design: Observational Study
Abstract: Suicide is the fourth leading cause of death among females of reproductive age. The menstrual cycle is a plausible yet understudied trigger for acute suicide risk. Cross-sectional studies have demonstrated greater frequency of suicide attempts and deaths in the weeks before and after the onset of menses compared to other cycle phases. Here, we prospectively examine the impact of the cycle on suicidal ideation (SI) and related symptoms (depression, hopelessness, guilt, rejection sensitivity, interpersonal conflict, anxiety, mood swings, anger/irritability). Thirty-eight naturally-cycling outpatients aged 18-45 recruited for past-month SI reported SI severity and other symptoms across an average of 40 days. Participants were excluded for hormone use, pregnancy, irregular cycles, prospectively-confirmed premenstrual dysphoric disorder, serious medical illness, and BMI >29.9 or <18. Medication use was covaried. Cyclical worsening of symptoms was evaluated using phase contrasts in multilevel models. Most symptoms, including SI, were significantly worse in the perimenstrual phase than in all other phases. Additionally, anger/irritability was higher in the midluteal than in the midfollicular phase, and several symptoms of depression were higher in the midfollicular than in the periovulatory phase. Otherwise, symptoms did not significantly differ between the midluteal, midfollicular, and periovulatory phases. Females with SI may be at risk for perimenstrual worsening of SI and related symptoms. Findings are consistent with research examining borderline personality disorder symptom fluctuation over the cycle, which demonstrated midluteal exacerbation of interpersonal symptoms and delayed worsening of depressive symptoms. These findings highlight the importance of assessing cycle phase for improved prediction of suicide risk.
Author: Tory A. Eisenlohr-Moul
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W4401040848