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Published Online: 14 December 2023

Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality

Publication: American Journal of Psychiatry

Abstract

Objective:

Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle–suicidality relationship, and how these associations vary across individuals.

Methods:

Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models.

Results:

Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality.

Conclusions:

Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 57 - 67
PubMed: 38093647

History

Received: 15 April 2023
Revision received: 12 July 2023
Revision received: 23 August 2023
Accepted: 8 September 2023
Published online: 14 December 2023
Published in print: January 01, 2024

Keywords

  1. Depression
  2. Menstrual Cycle
  3. Premenstrual Dysphoric Disorder
  4. Suicidal Thoughts
  5. Suicidality
  6. Suicide Risk

Authors

Details

Jaclyn M. Ross, Ph.D. [email protected]
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.
Jordan C. Barone, B.A.
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.
Hafsah Tauseef, M.S.
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.
Katja M. Schmalenberger, Ph.D.
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.
Anisha Nagpal, B.A.
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.
Natania A. Crane, Ph.D.
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.
Tory A. Eisenlohr-Moul, Ph.D.
Department of Psychiatry, College of Medicine, University of Illinois at Chicago.

Notes

Send correspondence to Dr. Ross ([email protected]).

Author Contributions

Dr. Ross and Ms. Barone share first authorship.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Supported by NIMH grants K99R00MH109667, RF1MH120843, R01MH122446, R01MH126940, and T32MH067631.

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