In the United States, suicide ranks as the second to seventh leading cause of death for females aged 10-54 (Heron, 2019). While individuals with depression and/or a history of suicidal ideation (SI) are known to be at higher risk, SI can fluctuate significantly over short periods of time (Kleiman et al., 2017). As a result, research has aimed to identify factors that impact acute risk within these groups. Potential risk factors have been highlighted, such as daily negative affect (Gee et al., 2020), hopelessness, and loneliness (Kleiman et al., 2017); however, it is difficult to determine whether these factors are merely correlated with SI or actually predict its occurrence. Additionally, these factors also vary over time, making them equally challenging to predict. The menstrual cycle has been suggested as a possible acute risk factor for SI following evidence of increased hospitalizations during specific menstrual cycle phases (Saunders & Hawton, 2006). Menstrual disorders, including premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME), also indicate that the menstrual cycle could trigger depressive symptoms due to enhanced hormone sensitivity (Schweizer-Schubert et al., 2021). However, prospective studies are needed to understand how SI varies with the menstrual cycle among at-risk populations and to explore whether the menstrual cycle could be a useful, time-varying predictor of acute suicide risk.
The objective of this study is to examine daily SI and other affective symptoms alongside menstrual cycle phase to explore two hypotheses: (1) the perimenstrual phase will be associated with higher SI and affective symptoms than all other phases; and (2) the periovulatory phase will be associated with the lowest SI and affective symptoms than all other phases.
Methods
A total of 38 naturally cycling women with suicidal ideation in the past month participated in the study and responded to daily text messages regarding menstrual bleeding. Based on this information, researchers calculated menstrual cycle phase using forward/backward counting. Participants rated seven items from the Adult Suicidal Ideation Questionnaire and eight items from the Daily Record of Severity of Problems each day. The researchers conducted multilevel regression analysis to compare the daily SI and affective symptoms of each participant across their different menstrual cycle phases.
Results
The study found that SI and all affective symptoms were higher in the perimenstrual phase compared with the periovulatory phase. When comparing the perimenstrual phase with the midfollicular phase, only anxiety, mood swings, rejection sensitivity, anger/irritability, and interpersonal conflict were higher during the perimenstrual phase. Daily SI was similar across the periovulatory phase, midluteal phase, and midfollicular phases.
The study concluded that daily SI and other affective symptoms peak during the perimenstrual phase and reach their lowest levels during the periovulatory phase. However, it is important to note that this study focuses on longitudinal correlations rather than causal relationships.
Implications for Practice
This study provides implications for future research as it suggests a need for further exploration of the menstrual cycle as an acute risk factor for women with ongoing suicidal ideation. A better understanding of how the menstrual cycle impacts SI and affective symptoms could provide insights into treatment development to reduce symptom fluctuations. In addition, understanding when SI severity may be at its peak can have implications for clinical practice and patient support.
Limitations
The limitations of this study include its observational nature, small sample size, and the relatively short measurement period, which affects the generalizability of the findings. Additionally, the study’s focus on longitudinal correlations means that causality cannot be inferred from the findings.
In conclusion, the study suggests that the menstrual cycle may be a predictable risk factor for acute suicide risk among at-risk populations and provides further justification for exploration of the underlying mechanisms.
