Dataset Information

Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation.

ABSTRACT:

Background

Premenstrual Dysphoric Disorder (PMDD) is a premenstrual condition that affects 3-8% of the US population, yet knowledge on treatment and consistent diagnostic testing is lacking. While research concerning the epidemiology and pharmaceutical treatments for this condition has increased, there is a lack of qualitative studies on the experiences of patients who live with this condition. The aim of this study was to explore the diagnostic and treatment experiences of PMDD patients in the U.S. healthcare system and identify barriers to diagnosis and treatment.

Methods

This study uses a feminist framework with qualitative phenomenological methods. We recruited participants who identified as having PMDD, regardless of official diagnosis, through online forums within the U.S. PMDD community. The study conducted 32 in depth interviews with participants on their experiences with PMDD diagnosis and treatment. Thematic analysis methods revealed key barriers within the diagnostic and care process including patient, provider, and societal barriers.

Results

This study presents a PMDD Care Continuum that represents the timeline of participant experiences beginning from symptom onset towards official diagnosis, treatments, and ongoing management of the condition. Participant experiences demonstrated that much of the diagnostic and treatment processes were burdened on the patient, and that successful navigation within the healthcare system was dependent on high levels of self-advocacy.

Conclusions

This was the first study to describe the qualitative experiences of patients who identified as having PMDD in the U.S. Further research is needed to refine and operationalize diagnostic criteria and treatment guidelines for PMDD.

SUBMITTER: Chan K

PROVIDER: S-EPMC10193729 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation.

Chan Kiera K Rubtsova Anna A AA Clark Cari Jo CJ

BMC women's health 20230517 1

<h4>Background</h4>Premenstrual Dysphoric Disorder (PMDD) is a premenstrual condition that affects 3-8% of the US population, yet knowledge on treatment and consistent diagnostic testing is lacking. While research concerning the epidemiology and pharmaceutical treatments for this condition has increased, there is a lack of qualitative studies on the experiences of patients who live with this condition. The aim of this study was to explore the diagnostic and treatment experiences of PMDD patients ...[more]

PMID: 37198676

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Project description:BackgroundPremenstrual dysphoric disorder (PMDD) is a common but underdiagnosed mental health problem among women of reproductive age, which complicates women's daily lives with the presence of severe psychological symptoms altering everyday functioning. This study aimed to assess the prevalence of probable PMDD, the anxio-depressive symptom severity, and well-being in women affected by PMDD across the menstrual cycle.Methods112 women with regular menstrual periods, without hormonal contraceptives were included. The study assessed the presence of probable PMDD using a DSM-5-based screening tool, a retrospective questionnaire assessment, for the detection of premenstrual symptoms. Anxio-depressive symptoms and well-being were assessed using the Beck Depression Inventory, the state subscale of the State-Trait Anxiety Inventory, and the WHO Well-Being Scale.ResultsBased on a DSM-5-based screening Tool, the sample was divided into women with probable PMDD diagnosis (PMDD group, n = 68) and women without probable PMDD diagnosis (nonPMDD group, n = 45). The PMDD group reported significantly more severe depressive (F(1; 56.2) = 19.394, p ≤ 0.001) and anxiety (F(1; 35.6) = 17.714, p ≤ 0.001) symptoms and lower well-being (F(1; 44.3) = 4.288, p = 0.04) compared to the non-PMDD group. A binomial logistic regression model was used to examine which factors predict PMDD: the model was significant (χ2(2) = 27.287, p ≤ 0.001), it explained 29.2 % of the variance in PMDD, and classified 71.4 % of the cases correctly. Anxiety (B = 0.058, S.E. = 0.022, Waldχ2(1) = 7.142, p = 0.01, OR = 1.060) and depressive (B = 0.085, S.E. = 0.031, Waldχ2(1) = 7.480, p = 0.01, OR = 1.089) symptoms predicted the likelihood of probable PMDD.ConclusionWomen even with probable PMDD experience significant affective difficulties and lower well-being, which underscore the need for attention towards psychological symptoms even in the case of probable PMDD, and consequently highlights the importance of appropriate assessment and treatment of the clinical appearance of PMDD.

Project description:Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.

Project description:RationalePremenstrual dysphoric disorder (PMDD) affects approximately 5% of menstruating individuals, with significant negative mood symptoms in the luteal phase of the menstrual cycle. PMDD's pathophysiology and treatment mechanisms are poorly characterized, but may involve altered neuroactive steroid function in the brain. Selective serotonin reuptake inhibitors (SSRIs), a first-line PMDD treatment, reportedly alter gamma-aminobutyric acid (GABA)ergic neuroactive steroid levels in PMDD.AimsThe aims of this study were to determine whether the SSRI sertraline increased serum levels of neuroactive steroids that modulate the effect of GABA at GABA-A receptors (GABAAR) and if so, whether an increase was associated with improvement in PMDD symptoms.MethodsParticipants included controls and individuals with PMDD. Serum levels of 9 neuroactive steroids were measured (3α,5α-THP; 3α5β-THP; pregnenolone; 3α,5α-androsterone; 3α,5β-androsterone; 3α,5α-A-diol; 3α5β-A-diol; 3α,5α-THDOC; 3α5β-THDOC) in the follicular and luteal phases. In the subsequent luteal phase, neuroactive steroids were measured during sertraline treatment (50 mg sertraline from approximate ovulation to menses onset) in the PMDD group. Mixed models assessed associations among diagnostic group, menstrual cycle phase, and sertraline treatment.ResultsParticipants included 38 controls and 32 women with PMDD. There were no significant differences in neuroactive steroid levels between controls and participants with PMDD in the luteal phase (p > 0.05). Within the PMDD group, sertraline treatment significantly increased serum pregnanolone levels and the pregnanolone:progesterone ratio, and decreased 3α,5α-androsterone.ConclusionsThis was the first study to assess the impact of SSRI treatment on peripheral levels of GABAergic neuroactive steroids in PMDD. Within the PMDD group, sertraline treatment was associated with a significant increase in luteal phase serum pregnanolone levels and a significantly increased pregnanolone:progesterone ratio, a novel finding. Future research should examine alterations in the metabolic pathways among GABAergic neuroactive steroids in individuals with PMDD, in a placebo-controlled design.

Dataset Information

Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation.

Background

Methods

Results

Conclusions

Publications

Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation.

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