Premenstrual dysphoric disorder and childhood maltreatment, adulthood stressful life events and depression among Lebanese university students: a structural equation modeling approach

Youth Mental Health in Crisis: Understanding the Relationship Between Mental Health and Physical Pain in Lebanon's Youth - A Scoping Review

Objectives

The mental health crisis among young adults in Lebanon, worsened by events like the Beirut Blast and economic instability, requires urgent attention. Globally, 10%-20% of individuals aged 18-29 face mental health challenges, with many also experiencing physical pain. Despite growing evidence of the bidirectional relationship between mental health and pain, this intersection remains underexplored in Lebanon, especially compared to WEIRD countries. This scoping review examines the relationship between physical pain and mental health issues-anxiety, depression, and stress-among Lebanese youth.

Methods

A systematic review of studies from January 2014 to February 2024 was conducted by screening PubMed, PsychInfo, and ScienceDirect. A total of 33 studies were included.

Results

The findings indicate a bidirectional link between mental health and physical pain. University students (36.1% of studies) were particularly impacted, and 81% of studies reported higher pain prevalence among females. Additionally, mindfulness meditation was identified as a potential protective factor, although it remains underexplored in Lebanon.

Conclusion

Addressing these gaps supports tailored interventions for Lebanese youth and enriches our understanding of mental health in non-WEIRD contexts.

Comparison of the effect of teaching coping skills and acupressure on premenstrual stress: a randomized controlled trial

BACKGROUND

Premenstrual syndrome (PMS) refers to significant clinical physical and psychological manifestations during the luteal phase of the menstrual cycle, leading to significant distress and impaired functional capacity. Given the side effects caused by pharmacotherapy, it seems logical to use non-pharmacological methods that can reduce symptoms such as menstrual stress. Thus, this study has been conducted to compare the effect of teaching coping skills and acupressure on premenstrual stress in undergraduate students of the Medical School of Azad University of Sanandaj-Iran.

METHOD

This study is an experimental study that was designed in the form of three groups (two acupressure and coping strategy groups and one control group). The participants by moderate or severe degree based on the Symptoms Premenstrual Screening Tool entered the study. Students in the coping skills training group received intervention for 5 weeks and every week for 60 min. The second intervention group received acupressure intervention for 3 months and twice a day for 60 s each time, in a sitting position, with pressure on the 6th spleen point (SP6). Data collection tools included socio-demographic and obstetric characteristics questionnaire, as well as premenstrual stress questionnaire and stress coping styles questionnaire, which were completed before and 3 months after the intervention. ANCOVA test was used for comparing the variables of premenstrual stress and coping strategy between the investigated groups, controlling the scores of premenstrual stress and coping strategy before the intervention, as well as controlling those socio-demographic variables that had a significant difference between the two groups.

RESULTS

Based on the ANCOVA test adjusted based on the age of first menstruation and pre-intervention premenstrual stress scores, the mean post-intervention premenstrual stress scores in the acupressure group [adjusted mean difference (AMD): - 20.6; 95% Confidence Interval (95% CI): - 23.1 to - 17.1; P < 0.001] and coping strategy group [AMD: - 20.5; 95% CI - 23.4 to - 16.7; P < 0.001] were significantly lower than that of the control group. Also, based on the post-hoc test, there was no statistically significant difference in terms of the mean post-intervention PMS scores between the two acupressure and the coping strategy groups [AMD: - 0.1; 95% CI - 3.5-2.9; P = 0.995]. Also, the mean post-intervention scores of task-oriented coping subscale [AMD: 30.8; 95% CI 25.6-36.1; P < 0.001] as well as avoidance-oriented coping subscale [AMD: 18.2; 95% CI 14.6-21.8; P < 0.001] were significantly higher than those of the control group, yet in terms of the emotion-oriented coping subscale [AMD: - 26.9; 95% CI - 31.1 to - 22.7; P < 0.001], the scores were significantly lower than those of the control group.

CONCLUSION

Considering the effect of learning coping strategies and applying acupressure in reducing the symptoms of premenstrual stress, it seems that equipping people with coping skills allows them to cope with stressful situations such as premenstrual syndrome and show a better and more logical response and feel less anxiety, depression, physical problems, and social problems. Furthermore, acupressure can also be used as a non-invasive method alone or as a complementary medicine in reducing the symptoms of premenstrual stress in young girls.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20230618058517N1. Date of registration: 26/06/2023. URL: https://irct.behdasht.gov.ir/search/result?query=IRCT20230618058517N1.

Impact of childhood trauma history on premenstrual syndrome in women of reproductive age: A cross-sectional study

AIM

Premenstrual syndrome is a women's health problem affecting women of reproductive age. Early traumas may have negative effects on women's health. Childhood traumas are thought to be an important risk factor for the emergence of premenstrual syndrome. The aim of this study was to investigate the relationship between premenstrual syndrome and childhood traumas in women.

METHOD

This is a cross-sectional study. This study was conducted online between September 2023 and January 2024. The sample of the study consisted of 437 women of reproductive age, between the ages of 18-49, who did not have any obstacles to participating in the study. Personal Information Form, Premenstrual Syndrome Scale and Childhood Trauma Scale were used to collect the data. SPSS statistical program was used to analyze the data. [Correction added on 28 December 2024, after first online publication: In the preceding sentence, 'SPPS' has been corrected to SPSS.] RESULTS: The prevalence of premenstrual syndrome was 55.6%. Emotional neglect, physical abuse, emotional abuse and sexual abuse levels were found to be higher in women with premenstrual syndrome (p < 0.05). It was determined that childhood traumas increased the level of premenstrual syndrome in women (ß = 0.266). Childhood trauma explained 6.8% of the total change in premenstrual syndrome level (R2 = 0.068). Emotional neglect (ß = 0.163) and physical abuse (ß = 0.121) increased the level of premenstrual syndrome.

CONCLUSION

Childhood traumas were found to be an important factor affecting the occurrence of premenstrual syndrome and exacerbating its symptoms. Early detection of childhood traumas may prevent long-term problems that may occur in individuals.

The relationship between trauma, stress, and premenstrual symptoms: the role of attributional style and trait anger

AIMS

The aim of this study was to examine potential mediators of the relationship between traumatic experiences, perceived stress, and the subjective, retrospectively measured, intensity of symptoms of premenstrual disorders. It was hypothesised that pessimistic attributional style and trait anger mediate the said relationship.

METHODS

The study sample comprised 150 non-clinical subjects (aged 18-31; M = 21.82; SD = 2.19). Study variables were assessed with self-report questionnaires: the Premenstrual Symptoms Screening Tool (PSST); the Traumatic Experiences Checklist (TEC); the Perceived Stress Scale-4 Short Form (PSS-4); the Attributional Style Questionnaire (ASQ); and the State-Trait Anger Expression Inventory-2 (STAXI-2 - trait anger subscale). Correlation and mediation analyses were performed.

RESULTS

The symptoms of premenstrual disorders were significantly and positively associated with both trait anger and pessimistic attributional style, as well as with trauma and stress. The correlations were moderate to strong, ranging from rho = 0.57 (pessimistic attributional style and trauma) to rho = 0.85 (stress and premenstrual symptoms). Both anger and pessimistic attributional style partially mediated the relationship between trauma and premenstrual symptoms and between stress and premenstrual symptoms.

CONCLUSION

Although the design of the study does not allow to infer causality, it demonstrates strong, positive relationship between the symptoms of premenstrual disorders, trauma, stress, attributional style, and anger. The results of mediation analyses may point to some practical implications (e.g. for psychotherapeutic interventions) but further studies employing prospective methods are needed.

Understanding the Interplay Between Premenstrual Dysphoric Disorder (PMDD) and Female Sexual Dysfunction (FSD)

Premenstrual dysphoric disorder (PMDD) is a severe variant of premenstrual syndrome (PMS), categorized as a mood disorder due to marked symptoms of depression and anxiety, compounded with severe physical symptoms. Female sexual dysfunction (FSD) can manifest as low libido, difficulty achieving sexual pleasure, and dyspareunia, causing functional and psychological distress. PMDD and FSD are globally prevalent conditions with postulated biological, psychological, and social associations between them. Nevertheless, sexual dysfunction in PMDD is an important aspect of women's health that has been understudied and has notable methodological limitations. In this narrative review, we summarize the existing literature on sexual function in women with PMDD and PMS, specify the distinctions between PMDD and other general symptoms of PMS, highlight the significance of understanding sexual dysfunction in the female population, and outline some available therapeutic options. Studies show that women frequently experience debilitating sexual distress during the premenstrual phase; however, there is an essential need to formulate standardized tools for definite diagnosis. Selective serotonin re-uptake inhibitors (SSRIs) and combined oral contraceptive pills (COCPs) are approved medications for PMDD, while flibanserin and bremelanotide are effective in treating FSD. However, the potential effects of these treatment modalities on the two comorbid conditions render them inconclusive. Awareness of PMDD and FSD among clinicians and society can allow the implementation of targeted interventions to alleviate the suffering of women and enhance their quality of life.

The burden of major depressive disorder in the Middle East and North Africa region, 1990-2019

BACKGROUND

Major depressive disorder (MDD) is one of the leading causes of disability. We aimed to report the MDD-attributable prevalence, incidence and years lived with disability (YLDs) in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex and socio-demographic index (SDI).

METHODS

Publicly available data on the burden of MDD were retrieved from the Global Burden of Disease (GBD) study 2019 for the 21 countries in MENA. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals.

RESULTS

In 2019, MDD had an age-standardised point prevalence of 3322.1 and an incidence rate of 4921.7 per 100,000 population in MENA. Furthermore, there were 4.1 million YLDs in 2019. However, there were no substantial changes in the MDD burden over the period 1990-2019. In 2019, Palestine had the highest burden of MDD. The highest prevalence, incidence and YLDs attributable to MDD were found in the 35-39 age group. In 2019, the YLD rate in MENA was higher than the global rate for almost all age groups. Furthermore, there was a broadly negative association between the YLD rate and SDI.

CONCLUSION

The study highlights the need to prevent the disorder using a multidisciplinary approach and for the provision of cost-effective treatments for those affected, in order to increase their quality of life.

Mediating effect of suicidal ideation in the association between child abuse and premenstrual syndrome among female adults

INTRODUCTION

Premenstrual symptoms encompass a range of physical, emotional, and behavioral changes that cyclically occur before menstruation. Childhood abuse has been associated with subsequent mental health challenges, yet its relationship with exacerbating premenstrual symptoms remains an understudied area. Furthermore, suicidal ideation often emerges from traumatic backgrounds such as child abuse, creating another layer of complexity. Given the rising suicide rates in Lebanon, and the concurrent increase in reported child abuse cases, this research focuses on the role of suicidal ideation as a mediator between child abuse and premenstrual syndrome.

METHODS

This cross-sectional study involved 915 female university students in Lebanon. Participants completed an online questionnaire encompassing demographic details, health lifestyle, the Premenstrual Symptoms Screening Tool (PSST), Columbia-Suicide Severity Rating Scale (C-SSRS), and Child Abuse Self Report Scale (CASRS-12). The mediation analysis was conducted using PROCESS MACRO v3.4 model 4; three pathways derived from this analysis: pathway A from the independent variable to the mediator, pathway B from the mediator to the dependent variable, Pathway C indicating the direct effect from the independent to the dependent variable.

RESULTS

The results of the mediation analysis showed that suicidal ideation mediated the association between all types of child abuse and the presence of PMS. Higher psychological (Beta = 0.21; p < 0.001), neglect (Beta = 0.02; p = 0.017), physical (Beta = 0.19; p < 0.001) and sexual (Beta = 0.20, p < 0.001) child abuse were significantly associated with higher suicidal ideation, which was significantly associated with the presence of PMS (Beta = 0.38, p = 0.001; Beta = 0.57, p < 0.001; Beta = 0.45, p < 0.001; and Beta = 0.50, p < 0.001) respectively. Finally, higher psychological (Beta = 0.17, p < 0.001), physical (Beta = 0.11, p = 0.024), but not sexual (Beta = 0.07, p = 0.198) child abuse was directly and significantly associated with the presence of PMS, whereas higher neglect (Beta = -0.06, p = 0.007) was significantly associated lower odds of having PMS.

CONCLUSION

This study highlights the mediating role of suicidal ideation in the complex association between different types of childhood abuse and premenstrual symptoms. The findings emphasize the need for trauma-informed care and tailored interventions to address the diverse impact of these factors. Recognizing the intricate relationships between child abuse, suicidal ideation, and PMS can aid healthcare providers in comprehensively addressing young women's mental and reproductive well-being. Trauma-informed care, tailored interventions and awareness of potential connections between childhood maltreatment are essential in managing these complex challenges.

Prevalence of premenstrual syndrome and its associations with dietary and other lifestyle factors among university female students in Dubai: A cross-sectional study

BACKGROUND

Premenstrual syndrome is a relatively prevalent condition that affects a significant number of menstruating women worldwide. It can range from mild to severe and may interfere with daily activities.

OBJECTIVE

This study aims to investigate the prevalence of premenstrual syndrome and its associated factors among female university students in Dubai.

DESIGN

This study was designed as a cross-sectional study.

METHODS

The analysis for this study involved 217 female university students (aged ⩾18 years old) who completed a self-reported online questionnaire. Participants were recruited through simple random sampling, and the study received ethical approval from the Zayed University Ethical Committee.

RESULTS

All participants reported that they experienced at least one premenstrual syndrome symptom with different levels of severity. The prevalence rate of psychological, physical, and behavioral symptoms was 83.0%, 79.4%, and 76.6%, respectively. The most frequently reported premenstrual psychological symptoms were loss of control (69.6%). Most reported physical premenstrual symptoms included lethargy/fatigue/decreased energy (56.7%); premenstrual syndrome symptoms interfered with participants' daily routines (45.2%). Normal body mass index, no smoking, milk consumption, cruciferous vegetables, fruits, animal foods, fish oil supplements, and no fast-food consumption were all significant factors associated with decreasing premenstrual syndrome.

CONCLUSIONS

Premenstrual syndrome is a common menstrual disorder among university students that interferes with their daily routines. Dietary habits and other lifestyle factors were highly related to premenstrual syndrome. Therefore, health promotion programs are highly recommended to encourage healthy diets and lifestyles for females as early as adolescence at the school level.

A neural network computational structure for the fractional order breast cancer model

The current study provides the numerical performances of the fractional kind of breast cancer (FKBC) model, which are based on five different classes including cancer stem cells, healthy cells, tumor cells, excess estrogen, and immune cells. The motive to introduce the fractional order derivatives is to present more precise solutions as compared to integer order. A stochastic computing reliable scheme based on the Levenberg Marquardt backpropagation neural networks (LMBNNS) is proposed to solve three different cases of the fractional order values of the FKBC model. A designed dataset is constructed by using the Adam solver in order to reduce the mean square error by taking the data performances as 9% for both testing and validation, while 82% is used for training. The correctness of the solver is approved through the negligible absolute error and matching of the solutions for each model's case. To validates the accuracy, and consistency of the solver, the performances based on the error histogram, transition state, and regression for solving the FKBC model.

The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions

The aim of this narrative review is to consolidate knowledge on the role of the hypothalamic-pituitary-adrenal (HPA) axis in depression pathophysiology at different reproductive stages across the female lifespan. Despite growing evidence about the impact of gonadal hormones on mood disorders, no previous review has examined the interaction between such hormonal changes and the HPA axis within the context of depressive disorders in women. We will focus on HPA axis function in depressive disorders at different reproductive stages including the menstrual cycle (e.g., premenstrual dysphoric disorder [PMDD]), perinatally (e.g., postpartum depression), and in perimenopausal depression. Each of these reproductive stages is characterized by vast physiological changes and presents major neuroendocrine reorganization. The HPA axis is one of the main targets of such functional alterations, and with its key role in stress response, it is an etiological factor in vulnerable windows for depression across the female lifespan. We begin with an overview of the HPA axis and a brief summary of techniques for measuring HPA axis parameters. We then describe the hormonal milieu of each of these key reproductive stages, and integrate information about HPA axis function in depression across these reproductive stages, describing similarities and differences. The role of a history of stress and trauma exposure as a contributor to female depression in the context of HPA axis involvement across the reproductive stages is also presented. This review advances the pursuit of understanding common biological mechanisms across depressive disorders among women. Our overarching goal is to identify unmet needs in characterizing stress-related markers of depression in women in the context of hormonal changes across the lifespan, and to support future research in women's mental health as it pertains to pathophysiology, early diagnosis, and treatment targets.

Childhood adversity predicts stronger premenstrual mood worsening, stress appraisal and cortisol decrease in women with Premenstrual Dysphoric Disorder

Background

Lifetime traumatic events are prevalent in women with Premenstrual Dysphoric Disorder (PMDD) and predict stronger premenstrual symptom intensities. Less is known about the unique effects of childhood adversity on PMDD. This study aims to investigate the menstrual cycle related course of mood, stress appraisal and cortisol activity over time and the effects of childhood adversity - by controlling for recent stressful life events - on the cyclicity of these outcomes.

Methods

Fifty-two women with PMDD completed questionnaires on childhood adversity and stressful life events during the past 12 months. Momentary negative and positive affect, stress appraisal, and saliva-cortisol were assessed within an Ambulatory Assessment (AA) design over four consecutive days during both the follicular and the late luteal phase. This AA was repeated after five months, resulting in two measurement bursts.

Results

Women with PMDD showed expected cycle related variations in mood and stress appraisal, whereby these effects weakened over time. No cortisol cyclicity was identified. Higher childhood adversity was linked to stronger increases in negative affect and stress appraisal, and stronger decreases in positive affect from the follicular toward the late luteal phase. Women with higher childhood adversity exhibited lower cortisol levels during the late luteal phase compared to the follicular phase whereas no such cyclicity was found in women with lower childhood adversity.

Conclusion

Childhood adversity appears to show independent deteriorating effects on premenstrual mood worsening and stress appraisal in women with PMDD. The observed cortisol cyclicity in women with higher childhood adversity may point to different neuroendocrine subtypes of PMDD in relation to childhood trauma and requires further systematic research.

A computational stochastic procedure for solving the epidemic breathing transmission system

This work provides numerical simulations of the nonlinear breathing transmission epidemic system using the proposed stochastic scale conjugate gradient neural networks (SCGGNNs) procedure. The mathematical model categorizes the breathing transmission epidemic model into four dynamics based on a nonlinear stiff ordinary differential system: susceptible, exposed, infected, and recovered. Three different cases of the model are taken and numerically presented by applying the stochastic SCGGNNs. An activation function 'log-sigmoid' uses twenty neurons in the hidden layers. The precision of SCGGNNs is obtained by comparing the proposed and database solutions. While the negligible absolute error is performed around 10-06 to 10-07, it enhances the accuracy of the scheme. The obtained results of the breathing transmission epidemic system have been provided using the training, verification, and testing procedures to reduce the mean square error. Moreover, the exactness and capability of the stochastic SCGGNNs are approved through error histograms, regression values, correlation tests, and state transitions.

Associations between Diet and Changes in Pain Levels among Young Women with Premenstrual Syndrome-A Preliminary Study during the COVID-19 Pandemic

The aim of this study was to investigate the association between PMS (premenstrual syndrome)-related pain among young women following a particular type of diet during the COVID-19 pandemic. This was compared to the period before the pandemic. Furthermore, we aimed to determine whether the increase in the intensification of pain was correlated to their age, body weight, height and BMI, and whether there are differences in PMS-related pain between women who differ in their diet. A total of 181 young female Caucasian patients who met the criteria for PMS were involved in the study. Patients were divided according to the kind of diet they had followed during the last 12 months before the first medical evaluation. The rise in pain score was evaluated according to the Visual Analog Scale before and during the pandemic. Women following a non-vegetarian ("basic") diet had a significantly higher body weight in comparison to those on a vegetarian diet. Furthermore, a significant difference was noted between the level of intensification of pain before and during the pandemic in women applying a basic diet, a vegetarian and an elimination diet. Before the pandemic, women from all groups felt weaker pain than during the pandemic. No significant difference in the intensification of pain during the pandemic was shown between women with various diets, nor was there a correlation between intensification of pain and the girl's age, BMI, their body weight and also height for any of the diets applied.

Top 100 Cited Papers on Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Bibliometric Study

BACKGROUND

Premenstrual syndrome/premenstrual dysphoric disorder is a serious condition affecting women worldwide, causing clinically significant distress or interference. Therefore, solving these diseases has become the utmost concern worldwide, culminating in numerous studies. In this study, we performed bibliometric analysis on the 100 most cited papers with the aim of identifying research hot spots and trends in this field.

METHODS

We screened the Science Citation Index Expanded (SCIE) of Web of Science (WOS) to identify the top 100 cited studies on PMS/PMDD. Next, we analyzed relevant literature from various journals, countries/regions, institutions, authors, and keywords. Finally, we used VOSviewer and Citespace software to generate knowledge maps and identify hot spots and trends.

RESULTS

The top 100 highly cited studies were published in 55 journals, between 1999 and 2017, across 24 countries/regions around the world. Most articles were published in Obstetrics and Gynecology, whereas Psych neuroendocrinology had the largest average number of citations per paper. The United States had the highest number of publications, followed by England, Canada, and Sweden. The top three institutions that published the highly cited literature were the University of Pennsylvania, Yale University, and National Institute of Mental Health (NIMH). Obstetrics, Gynecology, Psychiatry, and Reproductive Biology were the main research directions, whereas the top 10 Co-occurrence of Keywords included double-blind, fluoxetine, efficacy, prevalence, epidemiology, phase sertraline treatment, depression, progesterone, placebo, and placebo-controlled trial. Results from cluster analysis indicated that more comprehensive epidemiology and steroid pathogenesis have gradually become the hot spots and trends.

CONCLUSION

These findings demonstrated that bibliometric analysis can intuitively and rapidly reveal the frontiers and hot spots of research in PMS/PMDD. Notably, epidemiology, steroid pathogenesis, GABAA receptor delta subunits, and double-blind placebo-controlled trials are potential areas of focus for future research.