Premenstrual dysphoric disorder: Prevalence, quality of life and disability due to illness among medical and paramedical students

Premenstrual Dysphoric Disorder: A Cross-Sectional Study on Prevalence and Awareness Among Medical Students

BACKGROUND

 Premenstrual dysphoric disorder (PMDD), a severe form of PMS, has been recognized recently as a mental disorder. PMDD can present with disabling physical, mental, and psychological symptoms affecting women's daily functions. Due to its overlapping nature with other disorders, the prevalence of PMDD remains unknown. This study aimed to evaluate the awareness of PMDD among medical students and to assess the prevalence of PMDD among female students.

METHODS

 This cross-sectional study included 377 medical students from King Saud bin Abdulaziz University for Health Sciences, Jeddah. PMDD awareness was assessed using a self-developed questionnaire, and prevalence among women was evaluated with the PSST. Data were analyzed using the John's Macintosh Project software, version 10.0 (JMP Statistical Discovery, LLC, Cary, NC), with chi-square, Mann-Whitney, and Kruskal's tests, considering p < 0.05 as statistically significant.

RESULTS

 Out of 377 students, there was a significant difference in recognizing PMDD as a mental disorder between 106 female students (66%) and 51 male students (27.3%). Significantly higher PMDD awareness was observed among students in the clinical years and those with medical or mental conditions. Around 40% of the students had a positive attitude toward PMDD, believing it may require medical management. Among the 150 female medical students who met the inclusion criteria for PSST assessment to screen for PMDD, 8.7% tested positive, and this was correlated with the severity of dysmenorrhea. Anxiety/tension was the most common symptom in the PMDD group, with significant impairment in social activities and home responsibilities.

CONCLUSION

 The study demonstrated a noticeable level of awareness toward PMDD among medical students, especially among women and those in the clinical years. The association between PMDD symptoms and the severity of dysmenorrhea highlights the relationship between hormonal fluctuations and PMDD manifestations. Early detection and intervention are required to improve the quality of life for women with PMDD. Further research is recommended to assess the awareness of practitioners and the general population about the diagnosis of PMDD and to explore PMDD pathophysiology.

Pain Sensitivity and Depressive Triad Mediate the Relationship Between Trauma and Stress, and Symptoms of Premenstrual Disorders

The aim of this study was to test if negative cognitive triad and subjective pain sensitivity mediate the relationship between known risk factors (trauma and stress) and the symptoms of premenstrual disorders (premenstrual syndrome [PMS] and premenstrual dysphoric disorder [PMDD]) measured both retrospectively and prospectively. The study was divided into two stages: a cross-sectional (N = 228) and a prospective diagnosis (N = 90) parts. Correlation and mediation analyses were performed. Both variables mediated the association of trauma and stress with retrospectively measured premenstrual symptoms (mediation between trauma and premenstrual symptoms through depressive triad was full). In the sample of prospectively diagnosed individuals, again, both negative cognitive triad and pain sensitivity mediated the relationship between trauma and PMS/PMDD symptoms partially, and there was full mediation between baseline stress level and premenstrual symptomatology. However, for the mean stress level during the prospective diagnosis phase, only pain sensitivity was a significant, partial mediator. The results suggest that depressive cognitive triad and subjective pain sensitivity may play an important role in the development and maintenance of premenstrual disorders. These findings can contribute to the improvement of PMDD and PMS treatment, emphasising the importance of pain management and addressing core beliefs in psychotherapy of premenstrual disorders.

Validation of the premenstrual symptoms questionnaire among Mongolian nursing school students

BACKGROUND

Premenstrual disorders (PMDs) significantly affect the daily lives of women. This study evaluated the reliability and validity of the Mongolian-translated Premenstrual Symptoms Questionnaire (PSQ) among female nursing students at the Mongolian National University of Medical Sciences.

METHODS

This cross-sectional study was conducted from February 2023 to January 2024. The PSQ was translated into Mongolian, and its reliability and validity were assessed. A total of 431 participants completed the translated PSQ along with the Premenstrual Dysphoric Disorder (PMDD) Scale, Somatic Symptom Scale (SSS-8), Patient Health Questionnaire (PHQ-9), and Beck Anxiety Inventory (BAI). Reliability was evaluated via Cronbach's alpha for internal consistency. Validity was assessed via factor analysis and correlations with external measures.

RESULTS

The internal consistency of the Mongolian PSQ was 0. 945. Factor analysis supported the tool's construct validity, which revealed a one-factor structure consistent with that of the original Japanese PSQ. The PSQ had strong positive correlations with the PMDD Scale (r = 0.760), SSS-8 (r = 0.640), PHQ-9 (r = 0.580), and BAI (r = 0.620), which indicated good convergent validity.

CONCLUSION

The Mongolian-translated PSQ is a reliable and valid tool for assessing premenstrual symptoms in female nursing students. These findings suggest that the PSQ is a useful tool for screening PMDs in this population.

Development and validation of the premenstrual dysphoric disorder scale in Indian females

Background

Premenstrual dysphoric disorder is a mood disorder that has been recognized in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) as a subcategory of depressive disorders. The disorder has a high prevalence rate, and yet no uniform measure is standardized on the Indian population.

Aim

This study aimed to develop a scale to assess premenstrual dysphoric disorder that can be used for screening and for clinical use and that is standardized on the Indian population.

Methods

This study used cross-sectional research design and collected data through social media platforms from a sample of 300 females, out of which 38 were excluded for pregnancy, mental health conditions, substance use, and oral contraceptive use.

Results

The scale was analyzed using SPSS 21.0 for descriptive statistics, internal consistency, and convergent, content (factor analysis), and divergent validity. Results showed a high reliability of 0.90 and a concurrent validity of 0.76 and 0.64 against PSTT and BDI. Factor analysis revealed four factors, namely, affective and cognitive functioning, daily life and occupational functioning, somatic symptoms, and interpersonal anger. The sensitivity and specificity of the scale were found to be 86 (86%) and 66 (66%), respectively.

Conclusion

The scale developed in this study was found reliable and valid for use on the Indian population. It has high sensitivity and can be used as a screening measure for premenstrual dysphoric disorder.

Combined mind-body intervention for premenstrual dysphoric disorder: A randomized controlled trial

In this study, we aimed to examine the effectiveness of relaxation training in women with PMDD through a randomized controlled design. Sixty-three women were recruited and randomized to relaxation training or control groups. The outcome measurements, administered at baseline and post-training, included the Premenstrual Symptoms Screening Tool (PSST), Hospital Anxiety and Depression Scale (HADS), Nottingham Health Profile (NHP), and Sheehan Disability Scale (SDS). The intervention group received 12 sessions of relaxation training, including progressive muscle relaxation and guided imagination. While there were significant differences within the group in the relaxation training group, no significant differences were found in the control group. Relaxation training had a positive effect on reducing premenstrual symptoms, anxiety, depression and disability and improving quality of life in women with PMDD. More research is necessary to recommend relaxation training as a primary and long-term treatment and to understand how it should be included in a comprehensive treatment plan.

Premenstrual Syndrome's Impact on Work-Related Quality of Life Among Jordanian Nurses

Introduction Premenstrual syndrome (PMS) is a regular clinical condition that affects most women during their reproductive years. Its related symptoms may be linked to a decrease in women's quality of life. Female nurses may be more susceptible to PMS due to the demanding nature of their job. The importance of nurses' jobs and how their quality of life will affect patients and themselves in parallel make female nurses a population that is worth investigating. Our objective is to estimate the level of PMS among Jordanian nurses and assess the potential impact of PMS on work-related quality of life among them. Methods A cross-sectional study was conducted on 210 nurses who completed a questionnaire regarding demographic data, menstrual characteristics, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality-of-Life Scale (WRQoL). The nurses were classified as having or not having PMS according to the PSST. Results The prevalence of PMS was 60.5%, the results showed a significantly lower mean WRQoL score for nurses with PMS (mean = 65.47, SD = 15.38) compared to nurses without PMS (mean = 70.54, SD = 14.47). The multivariable regression model revealed that the adjusted odds ratios for age, combined oral contraceptive pill (COCP) use, family history, severe dysmenorrhea, job and career satisfaction, and stress at work were 0.90 (95% CI = 0.84, 0.96), 5.18 (95% CI = 1.33, 20.17), 2.52 (95% CI = 1.23, 5.18), 11.78 (95% CI = 2.48, 56.02), 0.92 (95% CI = 0.85, 0.99), and 1.20 (95% CI = 1.01, 1.42), respectively. Conclusion PMS is quite prevalent among Jordanian nurses, with a negative impact on their work-related quality of life. Healthcare managers might implement special regulations for female nurses with PMS to improve their work-related quality of life. This research suggests that PMS is a substantial factor in the low work-related quality of life among Jordanian nurses.

Diagnostic validity of premenstrual dysphoric disorder: revisited

The World Health Organization (WHO) and American Psychiatric Association (APA) have recognised premenstrual dysphoric disorder (PMDD) as an independent diagnostic entity, legitimising the distress and socio-occupational impairment experienced by affected women. However, the biological validity of this diagnosis remains inexplicit. This illness has also been criticised for a feminist-led, sympathetic reaction to the modern cultural challenges of urban, literate, employed, high-functioning women. This article systematically reviews existing literature on PMDD using the criteria established by Robins and Guze for the validity of a psychiatric diagnosis (clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study). Despite the early recognition of premenstrual syndrome (PMS) in the 1950s, the research has encountered challenges due to two groups of proponents viewing it with psychologising bias and medicalising bias. PMDD is currently understood as the most severe form of PMS, characterised by the presence of psychological features. Recent evidence suggests that PMDD perhaps has neurodevelopmental underpinnings (attention deficit hyperactive disorder, adverse childhood experiences) affecting the fronto-limbic circuit that regulates the emotions. In addition, the affected individuals exhibit an increased sensitivity to gonadal hormonal fluctuations as observed during premenstrual, pregnancy, and perimenopausal phases of life. The prevalence is comparable between high-income countries and low- and middle-income countries (LAMIC), refuting the notion that it mostly affects modern women. Instead, a greater prevalence is observed in LAMIC. Despite the fact that educated women possess knowledge regarding the importance of getting help, there is a prevalent issue of inadequate help-seeking behaviour. This can be attributed to the perception of seeking help as an isolating experience, which is influenced by profound internalised stigma and discrimination in the workplace. Future studies must aim to develop culturally validated assessment tools and more research to understand the life course of the illness, in addition to systematically examining for more biological validators (animal models, genetics, imaging, neurotransmitters).

Effectiveness of Persian Golnar on Excessive Menstrual Bleeding in Women with Abnormal Uterine Bleeding, Compared to Tranexamic Acid: A Triple-Blind, Randomized Equivalence Trial

Introduction

Abnormal uterine bleeding (AUB) is a major healthcare problem in females of reproductive age and impacts women's health and quality of life (QoL). This study aimed to test the equivalence of Persian Golnar (PG) and tranexamic acid (TA) for the treatment of excessive menstrual bleeding.

Method

A triple-blind randomized equivalence trial with parallel design and block randomization technique was performed. A total of 80 patients with AUB were randomly allocated to receive either PG or TA for three consecutive menstrual cycles. Blood loss was measured by the Pictorial Blood Loss Assessment Chart (PBAC). Hematological evaluations were done before the intervention and after treatment. QoL and premenstrual dysphoric disorder (PMDD) as secondary outcomes were assessed using the menorrhagia questionnaire (MQ) and Premenstrual Symptoms Screening Tool (PSST). Statistical analysis was performed using an independent t-test, paired t-test, χ2 test, Mann-Whitney test, and Wilcoxon signed-rank test.

Results

Seventy-six women completed the 12-week follow-up. Both PG and TA groups experienced a significant reduction in blood loss. Furthermore, the serum level of hemoglobin in the PG group enhanced significantly (P < 0.001). QoL and PMDD scores were significantly improved in both groups (P< 0.001).

Conclusion

The findings of the current trial supposed that the Golnar product is as effective as tranexamic acid in controlling bleeding and enhancing the quality of life and premenstrual symptoms.