Objective:

Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle–suicidality relationship, and how these associations vary across individuals.

Methods:

Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models.

Results:

Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality.

Conclusions:

Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.

中文翻译：

---

预测自杀意念和计划的急性变化：症状中介因素和月经周期在有自杀倾向的女性精神病门诊患者中的作用的纵向研究

 客观的：

横断面和初步纵向研究结果表明，周期性卵巢激素波动会影响急性自杀风险。作者对有自杀倾向的女性进行了首次分析，以调查哪些日常症状与自杀意念和计划想法相关、月经周期在日常症状变化中的作用、症状的日常波动如何调节月经周期与自杀之间的关系，以及这些症状如何影响自杀倾向。关联因人而异。

 方法：

过去一个月有自杀意念的自然循环精神病门诊患者（N = 119）提供了精神症状的每日评级（抑郁、绝望、焦虑、不知所措、激动、快感缺失、无价值、拒绝敏感性、愤怒、感知负担和人际冲突），自杀意念，以及至少一个月经周期的自杀计划。症状评级被分解为特征（以人为中心的平均值）和状态（以人为中心的每日平均偏差）组成部分。确定了与月经开始和排卵（尿液黄体生成激素水平激增）相关的五个周期阶段。假设在多级结构方程模型中进行了检验。

 结果：

几乎所有的精神症状都与日常自杀意念的波动相关，而有限的一组症状（抑郁、绝望、排斥敏感和感知到的负担）预示着人体内自杀计划的增加。许多患者表现出围经期精神症状恶化、自杀意念和自杀计划。抑郁症状（抑郁、绝望、感知负担和快感缺乏）是预测经期自杀倾向加剧的最有力的统计中介因素。

 结论：

历史上，对月经周期和自杀的研究一直受到小型横截面样本的限制。这项研究提供了第一个证据，表明在大量具有自杀意念的女性跨诊断样本中测量自杀倾向的日常相关性，有助于了解月经周期影响急性自杀风险的途径。