Table 1.

Data from Studies Included in the Systematic Review

Author, year, country	Sample	Study design	Type of premenstrual disturbance	Assessment of premenstrual disturbance	Assessment of suicidality	Main findings
Alvarado-Esquivel, (2018), Mexico16	n = 437 women aged 30–40 years	Cross-sectional	Premenstrual symptoms	Symptoms related to PMS were assessed through a face-to-face interview and a questionnaire.	History of suicide attempts and suicidal ideation was assessed through a face-to-face interview and a questionnaire.	Suicide attempts were found to be significantly associated with presence of irregular periods (OR: 9.57; 95% CI: 1.23–74.44, p = 0.03) and the desire to eat certain foods or eat a lot (OR: 3.08; 95% CI: 1.04–9.15, p = 0.04). Significant associations were also found between suicidal ideation and presence of irregular periods (OR: 2.89; 95% CI: 1.10–7.55, p = 0.03), low back pain (OR: 4.57; 95% CI: 1.31–15.92, p = 0.01), desire to eat certain food or eat a lot (OR: 2.47; 95% CI: 1.10–5.57, p = 0.02), guilty feelings (OR: 2.43; 95% CI: 1.06–5.59, p = 0.03), and aggressiveness (OR: 3.19; 95% CI: 1.42–7.13, p = 0.005).
Baca-Garcia et al. (2004), Spain17	n = 125 women who attempted suicide, n = 83 female blood donor controls	Case–control study	PMDD and PMS	Participants were asked about their menstrual cycles, and PMS and PMDD were assessed using DSM-IV criteria. The Mini-International Neuropsychiatric Interview (M.I.N.I. V 4.0) was used to make DSM-IV diagnoses.18	Women in the case group had recently attempted suicide, and this was used as the measure of suicidality.	There was a significant difference between the frequency of PMDD in the case and control group (54% vs. 6%, p ≤ 0.001). No significant differences were found in the incidence of PMS in suicide attempters with PMDD compared with controls with PMDD. Suicide attempters without PMDD had a comparable frequency of PMS as blood donors without PMDD.
Birtchnell and Floyd (1975), England19	n = 107 women who attempted suicide and n = 110 controls	Case–control study	Premenstrual symptoms	Participants completed a simple questionnaire inquiring about menstruation.	Women in the case group had recently attempted suicide, and this was used as the measure of suicidality.	No significant differences were found between the case and control groups in the incidence of premenstrual emotional disturbance (48.6% vs. 58.2% of case and control participants, respectively; χ2 = 1.460).
Chaturvedi et al. (1995), India20	n = 296 women aged 15–45 years	Cross-sectional study	Premenstrual symptoms	The Premenstrual Assessment Form (PAF) was used to measure distress during the premenstrual period.21	The PAF was used to identify participants who expressed suicidal ideas and death wish.	Women who reported suicidal ideas during the premenstrual phase significantly more often reported experiencing irritability, mood swings, sense of losing control, depression, and water retention during the premenstrual period (p < 0.001).
de Carvalho et al. (2018), Brazil22	n = 727 women aged 21 and 32 years	Cross-sectional study as part of a larger cohort study (“Psychosocial and Biological Factors in Bipolar Disorder: A Population-Based Cohort of Young Adults”).	PMDD	PMDD was assessed using the Mini International Neuropsychiatric Interview version Plus (M.I.N.I.-Plus), translated to Brazilian Portuguese.18,23	Current suicide risk was assessed through the M.I.N.I-Plus.	Women with PMDD were two to three times more likely to report suicide risk when compared with women without PMDD. Women with PMDD were at significant risk of current suicide (OR: 1.98; 95% CI: 1.33–2.96, p = 0.002).
Hong et al. (2012), Korea24	n = 2499 women aged 18–64 years	Cross-sectional cohort study as part of the larger Korean Epidemiologic Catchment Area (KECA) study	PMDD	The 12-month PMDD diagnostic module of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) was used to assess PMDD based on DSM-IV criteria.25	The Korean version of the Composite International Diagnostic Interview (K-CIDI) was used to assess lifetime and 1-year suicidality (ideation, plan, and attempt).26	Lifetime prevalences of suicide attempts (OR: 3.72; 95% CI: 1.71–8.10), suicidal ideation (OR: 3.99; 95% CI: 2.37–6.73), and suicide plans (OR: 4.43; 95% CI: 2.16–9.06) were significantly associated with PMDD once adjustments for age were made. Twelve-month prevalence of suicide attempts (OR: 6.17; 95% CI: 1.19–32.01), suicidal ideation (OR: 6.94; 95% CI: 3.45–13.96), and plans (OR: 7.29; 95% CI: 1.83–29.03) were significantly associated with PMDD as well. Once adjustments for psychiatric disorders were made, lifetime and 12-month prevalence of suicidal ideation were still significantly associated with PMDD (OR: 2.60; 95% CI: 1.47–4.61 and OR: 3.74; 95% CI: 1.70–8.24, respectively), while associations between PMDD and suicide attempt and plan did not hold.
Keye et al. (1986), USA27	n = 68 women presenting for evaluation of premenstrual complaints, n = 34 gynecology patients, n = 50 women seeking treatment at a Sex and Marital therapy clinic	Cross-sectional	Premenstrual symptoms	A detailed history of premenstrual complaints was taken from women accepted for the study. Participants also charted their symptoms on a calendar for 1 month, checking a box if a particular symptom was experienced. When possible, patients' husbands were also asked to record their daily behavior during the month.	The Minnesota Multiphasic Personality Inventory was used to measure emotional distress.28	75% of the women with premenstrual symptoms had thought of committing suicide compared with 17% of women from the gynecology clinic, while 21% of the women in the former group had attempted suicide in the past compared with 3% of the control group (p < 0.01).
Lee et al. (2006), Malaysia29	n = 2411 female students aged 12–19 years	Cross-sectional descriptive study	PMS	Participants were given a questionnaire that inquired about menstruation and PMS.	Suicidal behaviors (feeling sad or hopeless, seriously considering attempting suicide, and making a suicide plan and/or attempt in the past 12 months) were explored through the survey.	PMS was not significantly associated with suicide attempt (p = 0.440). A significant association was found between PMS and having seriously considered suicide (p = 0.007) as well as having made suicidal plans (p = 0.021).
Pilver et al. (2013), USA11	n = 3965 women aged 18–40 years.	Secondary data analysis of a subsection of participants from larger cohort study (Collaborative Psychiatric Epidemiology Survey)	PMDD and PMS	PMDD status (PMDD, moderate/severe PMS, or no premenstrual symptoms) was determined using the “Premenstrual Syndrome” module of the WMH-CIDI, based on DSM-IV criteria.30	Lifetime suicide attempt(s), ideation, and plans were assessed binarily. Participants read descriptions of behavior and relayed to the interviewer whether they had ever done the action. Positive response = 1, negative response = 0.	Women with PMDD were at increased risk of suicide attempt (OR: 2.10; 95% CI: 1.08–4.08), ideation (OR: 2.22; 95% CI: 1.40–3.53), and plans (OR: 2.27; 95% CI: 1.20–4.28) when compared with women with no premenstrual symptoms. Women with moderate-to-severe PMS had a greater likelihood of suicidal ideation (OR: 1.49; 95% CI: 1.17–1.88) in comparison with women with no premenstrual symptoms.
Shams-Alizadeh et al. (2018), Iran10	n = 120 women who had attempted suicide and n = 120 control women, all aged 13–40 years.	Case–control study	PMDD and PMS	Diagnosis of PMDD and PMS was obtained through a clinical interview led by an experienced psychiatrist, based on DSM-5 criteria.	Women in the case group had recently attempted suicide, and this was used as the measure of suicidality.	The case group had a significantly higher frequency of PMDD when compared with the control group (p = 0.001). No significant differences were found in the frequency of PMS between the case and control groups (p = 0.294).
Soydas et al. (2014), Turkey31	n = 70 outpatients with PMDD and n = 78 healthy controls, all aged between 18 and 40 years	Cross-sectional	PMDD	PMDD diagnosis was determined after a psychiatric examination and assessment through the Structured Clinical Interview for DSM-IV Axis I Disorders.32 The Premenstrual Syndrome Scale (PMSS) was used to measure the severity of PMDD symptoms.33 All participants had a psychiatric examination by a senior psychiatrist.	SCID-I, translated into Turkish.32,34	History of suicide attempt was found to be significantly higher in the PMDD group when compared with the healthy control group (χ2 = 27.78, p = 0.024).
Thin (1968), England35	n = 100 women who had attempted suicide (Group I), n = 57 women hospitalized with organic medical conditions (Group II), n = 68 healthy women (Group III), aged 15–44 years.	Cross-sectional	Premenstrual symptoms	Premenstrual symptoms were assessed using a questionnaire. Participants were requested to classify symptoms as “significant” (“present for at least one whole day before six or more periods during the preceding year”) or “insignificant.”	Women in Group I had recently attempted suicide, and this was used as the measure of suicidality.	The highest incidence of premenstrual symptoms was found in Group I (women who attempted suicide) when compared with Groups II and III (nonattempters; p < 0.01). Psychological premenstrual symptoms were found to be more common in Group I compared with Groups II and III.
Wittchen et al. (2002), Germany12	n = 1488 women aged 14–24 years	Prospective-longitudinal community study part of the Early Developmental Stages of Psychopathology study.	PMDD	Premenstrual syndromes were assessed using the PMDD module of the Munich-Composite International Diagnostic Interview, considering DSM-IV criteria.36	M-CIDI was used to assess suicide attempt and ideation.	Women with PMDD reported significantly higher rates of previous suicide attempts (OR: 4.4; 95% CI: 2.0–9.7, p < 0.001) when compared with non-PMDD control participants. However, no significant differences were found between suicidal ideation in the PMDD and non-PMDD group.

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines; PMDD, premenstrual dysphoric disorder; PMS, premenstrual syndrome.