In a recent study published in Affective Disorders JournalA group of researchers measured the prevalence of premenstrual dysphoric disorder (PMDD) using both definitive and provisional diagnoses.
background
PMDD, a serious mental health concern, is now recognized in DSM-5 and International Classification of Diseases (ICD)-11, from a condition requiring further research in the previous Diagnostic and Statistical Manual of Mental Disorders (DSM) editions. It has evolved into a disease. The disorder is characterized by severe mental and physical symptoms related to the menstrual cycle and is now understood to have a severe impact on quality of life and is associated with increased suicide rates. Diagnosis depends on the specific timing and severity of symptoms, with DSM-5 and ICD-11 emphasizing luteal phase symptoms such as emotional changes and physical discomfort.
The diagnostic process is ideally based on evaluation of symptoms over two menstrual cycles in the future, but can vary between definite and provisional depending on how symptoms are reported. Further research is needed to better understand the etiology of PMDD, treatment efficacy, and long-term effects on physical and mental health.
About research
The researchers conducted a thorough search for observational studies that investigated the prevalence of PMDD in women from menarche to menopause according to DSM or ICD diagnostic criteria. Studies relying solely on self-diagnosis were excluded due to low reliability. We also excluded studies that focused on participants in health services, such as gynecological clinics, to avoid inflating prevalence rates. If multiple studies were conducted from the same sample, the study with the largest sample size was selected. There were no language restrictions and her Google Translate was used for non-English reports.
The search was conducted from inception to March 2021 across several databases (Embase, PsycINFO, MEDLINE, PubMed). Two authors independently reviewed study abstracts and selected relevant full texts for further examination. To ensure a comprehensive literature review, the search incorporated a variety of terms related to her PMDD.
For data analysis, two authors extracted important information such as study setting, sample size, and diagnostic method, and resolved disagreements through discussion with the third author. Each study was assessed for bias using specific risk of bias tools.
Statistical analyzes were performed using R Statistical Software and employed a random-effects model to account for between-study variation.They assessed heterogeneity using I2 We analyzed the statistics and investigated its potential sources using subgroup analysis and meta-regression. Studies were further categorized based on diagnostic method (preliminary or definitive) and use of questionnaires.
research result
In this comprehensive search, researchers identified 12,340 records, ultimately narrowing it down to 44 studies that met their criteria. These studies represented 48 independent samples and a total of 50,659 participants, ranging from 62 to 8,694 participants per sample, with an average sample size of 1151 participants. The age range of participants was 14.3 to 38.6 years. These studies are distributed around the world, with a notable number of studies coming from Asia, Europe, and North America. Most studies used DSM criteria for diagnosis, but no study used ICD-11 criteria.
The researchers noted that only a small number of studies used prospective assessment to confirm the diagnosis of PMDD. There was a significant difference in average sample size between studies with confirmed (798) and provisional (1255) diagnoses. Interestingly, one study reported no cases of PMDD in its sample. The researchers found that the pooled prevalence of PMDD was 3.2% for definitive diagnosis and 7.7% for provisional diagnosis, despite considerable heterogeneity (I2 = 99%).
Risk of bias varied between studies and scores ranged from 3 to 9. Notably, all studies were consistent in their data collection methods and obtained data directly from participants. Higher prevalence was observed in studies using provisional diagnoses, African samples, and university settings. We also observed a negative correlation between prevalence and risk of bias.
The use of questionnaires in diagnosing PMDD also influenced prevalence. Studies that used recognized questionnaires reported lower prevalence compared to studies that did not use standard questionnaires. Of the studies reporting provisional diagnoses, 22 used accepted questionnaires.
One particular study by de la Gandara Martín and de Diego Herrero in 1996 reported an unusually high prevalence of 30.5%, but it was considered an outlier and excluded from further analysis. . This adjustment reduced the pooled prevalence by 2.7% and reduced heterogeneity.
A more sophisticated analysis was obtained by focusing only on community-based samples that strictly adhered to DSM criteria, including symptom tracking over two cycles. This restriction to six samples revealed a pooled prevalence of 1.6%, with significantly lower heterogeneity (I2 = 26%). This finding emphasizes the importance of strict adherence to diagnostic criteria and sample selection when determining the prevalence of PMDD.
