Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women. The Harvard Study of Moods and Cycles.
BACKGROUND
Consistent data on the prevalence and predictors of premenstrual dysphoric disorder (PMDD) in the general population are lacking.


METHODS
Premenstrual symptoms of 4164 women (aged 36-44 years) were retrospectively assessed by the Moos Premenstrual Inventory. From this original sample, 976 subjects were further interviewed at which time demographic and lifestyle characteristics, gynecologic history, and medical conditions were examined. The Structured Clinical Interview for DSM-IV Axis I disorders (SCID) was used to assess past and current psychiatric morbidity. Additionally, 513 of these women completed a prospective evaluation of premenstrual symptoms by using the Daily Rating of Severity of Problems Form (DRSP).


RESULTS
The diagnosis of PMDD was confirmed in 33 of 513 women (6.4%) who completed the prospective evaluation with daily records. Fourteen subjects (2.7%) met criteria for PMDD without a previous history of depression. PMDD was associated with lower education (odds ratio [OR]=2.3, confidence interval [CI]=1.1-4.9), a history of major depression (OR=3.6, CI=1.7-7.4), and current cigarette smoking (OR=4.1, CI=1.5-11.1). In addition, women not working outside the home were significantly less likely to meet criteria for PMDD (OR=0.2, CI=0.1-0.9).


CONCLUSIONS
Only 513 of 976 women agreed to have their symptoms documented prospectively. Symptoms were assessed over the course of one menstrual cycle.


CONCLUSIONS
This study indicates a significant prevalence of PMDD in a large community-based sample. Given the associated impairment in social and occupational functioning seen in PMDD, these prevalence data provide a strong rationale for enhanced recognition and treatment of the disorder.
Harvard Medical School, Boston, MA, USA. lcohen2@partners.org
Lee S
LS
Cohen
Claudio N
CN
Soares
Michael W
MW
Otto
Bernadette H
BH
Sweeney
Rebecca F
RF
Liberman
Bernard L
BL
Harlow
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D017697:Premenopause / Q000523:psychology*; D011293:Premenstrual Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index