Lifetime discrimination associated with greater likelihood of premenstrual dysphoric disorder

Discrimination and bladder health among women in the CARDIA cohort study: Life course and intersectionality perspectives

OBJECTIVE

This study examines whether discriminatory experiences are associated with lower urinary tract symptoms (LUTS) and their impact among 972 women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which recruited participants from 4 cities in the United States.

METHOD

Exposure to discrimination was assessed 3 times (1992-93, 2000-01, 2010-11) and averaged across assessments. Participants separately reported whether they experienced discrimination on the basis of their gender, race or color, and socioeconomic position or social class. For each social identity, discrimination was assessed in 6-7 settings (e.g., when getting a job, medical care, or housing). At different time points, women who reported discriminatory experiences for a given social identity were asked how frequently the discrimination occurred and how stressful experience(s) were. Following the 2010-11 assessment, data on LUTS and their impact were collected. Women were classified into bladder health versus mild, moderate, or severe symptoms/impact clusters.

RESULTS

More Black than White women reported discriminatory experiences across all social identities and most settings. Perceived stress of discriminatory experiences did not differ between Black and White women. In analyses stratified by race and social identity, White women reported LUTS/impact with discriminatory experiences in more settings, more frequent discriminatory experiences across settings, and each additional social identity for which discrimination was experienced. Black women reported LUTS/impact with more frequent discriminatory experiences across settings. For Black women, greater perceived stress of both gender and race discrimination were associated with LUTS/impact. For White women, only greater perceived stress of race discrimination was associated with LUTS/impact.

CONCLUSIONS

This is one of the first studies to examine discrimination in relation to LUTS/impact. Additional research is needed to better understand differences in how discriminatory experiences based on potentially intersecting identities may be related to bladder health among women.

Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7

PURPOSE

To provide recommendations for the management of premenstrual syndrome and premenstrual dysphoric disorder, collectively referred to as premenstrual disorders, based on assessment of the evidence regarding the safety and efficacy of available treatment options. An overview of the epidemiology, pathophysiology, and diagnosis of premenstrual disorders also is included to provide readers with relevant background information and context for the clinical recommendations.

TARGET POPULATION

Reproductive-aged adults and adolescents with premenstrual symptoms.

METHODS

This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluations) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.

RECOMMENDATIONS

This Clinical Practice Guideline includes recommendations on the following evidence-based treatment options for premenstrual disorders, with an acknowledgement that many patients may benefit from a multimodal approach that combines several interventions: pharmacologic agents (hormonal and nonhormonal), psychological counseling, complementary and alternative treatments, exercise and nutritional therapies, patient education and self-help strategies, and surgical management. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence. Based on review of extrapolated data from adult populations and expert consensus, it was determined that the recommendations also apply to adolescents, with a few exceptions that are noted in the Clinical Practice Guideline.

A Network Approach to Assessing the Relationship between Discrimination and Daily Emotion Dynamics

Discrimination-health research has been critiqued for neglecting the endogeneity of reports of discrimination to negative affect and the multidimensionality of mental health. To address these challenges, we model discrimination’s relationship to multiple psychological variables without directional constraints. Using time-dense data to identify associational network structures allows for joint testing of the social stress hypothesis, prominent in discrimination-health literature, and the negativity bias hypothesis, an endogeneity critique rooted in social psychology. Our results show discrimination predicts negative emotions from day-to-day but not vice versa, indicating that racial discrimination is a risk factor and not symptom of negative emotion. Furthermore, we identify sadness, guilt, hostility, and fear as a locus of interrelated emotions sensitive to racism-related stressors that emerges over time. Thus, we find support for what race scholars have argued for 120+ years in a model without a priori directional restrictions and then build on this work by empirically identifying cascading mental health consequences of discrimination.

Association of fine-particulate and acidic-gas air pollution with premenstrual syndrome risk

OBJECTIVE

Air pollution had been reported to be associated with the reproductive health of women. However, the association of particulate matter (PM) and acid gases air pollution with premenstrual syndrome (PMS) warrants investigation. This study investigated the effects of air pollution on PMS risk.

POPULATION

We combined data from the Taiwan Air Quality-Monitoring Database and the Longitudinal Health Insurance Database. In total, an observational cohort of 85 078 Taiwanese women not diagnosed as having PMS.

METHODS

Air pollutant concentrations were grouped into four levels based on the concentration quartiles of several types of air pollutants.

MAIN OUTCOME MEASURES

We then applied univariable and multivariable Cox proportional hazard regression models to assess PMS risk in association with each pollutant type.

RESULTS

Women exposed to Q4-level SO2 exhibited a 7.77 times higher PMS risk compared with those to Q1-level SO2 (95% confidence interval [CI] = 6.22-9.71). Women exposed to Q4-level NOx exhibited a 2.86 times higher PMS risk compared with those exposed to Q1-level NOx (95% CI = 2.39-3.43). Women exposed to Q4-level NO exhibited a 3.17 times higher PMS risk compared with women exposed to Q1-level NO (95% CI = 2.68-3.75). Finally, women exposed to Q4-level PM with a ≤2.5-µm diameter (PM2.5) exhibited a 3.41 times higher PMS risk compared with those exposed to Q1-level PM2.5 (95% CI = 2.88-4.04).

CONCLUSIONS

High incidences of PMS were noted in women who lived in areas with higher concentrations of SO2, NOx, NO, NO2 and PM2.5.

The impact of world assumptions on the association between discrimination and internalizing and substance use outcomes

This study investigated whether core beliefs about the world being safe and predictable (i.e. world assumptions) mediated the association between discrimination and internalizing and substance use problems among individuals from marginalized groups. Path analyses tested mediating effects of four types of world assumptions on the association between discrimination (race-, gender-, and sexual orientation-based) and anxiety, depression, alcohol and cannabis problems in college students (N = 1,181, age_mean = 19.50, SD = 1.67). Limited support for mediation by world assumptions was found: among Asian students, race-based discrimination indirectly impacted anxiety symptoms through low perceived controllability of events. Direct effects across groups and discrimination types were also found.

Perceived Racial/Ethnic Discrimination and Mental Health: a Review and Future Directions for Social Epidemiology

PURPOSE OF REVIEW

Recent literature on racial or ethnic discrimination and mental health was reviewed to assess the current science and identify key areas of emphasis for social epidemiology. Objectives of this review were to: 1) Determine whether there have been advancements in the measurement and analysis of perceived discrimination; 2) Identify the use of theories and/or frameworks in perceived discrimination and mental health research; and 3) Assess the extent to which stress buffers are being considered and evaluated in the existing literature.

RECENT FINDINGS

Metrics and analytic approaches used to assess discrimination remain largely unchanged. Theory and/or frameworks such as the stress and coping framework continue to be underused in majority of the studies. Adolescents and young adults experiencing racial/ethnic discrimination were at greater risk of adverse mental health outcomes, and the accumulation of stressors over the life course may have an aggregate impact on mental health. Some growth seems evident in studies examining the mediation and moderation of stress buffers and other key factors with the findings suggesting a reduction in the effects of discrimination on mental health.

SUMMARY

Discrimination scales should consider the multiple social identities of a person, the context where the exposure occurs, how the stressor manifests specifically in adolescents, the historical traumas, and cumulative exposure. Life course theory and intersectionality may help guide future work. Despite existing research, gaps remain in in elucidating the effects of racial and ethnic discrimination on mental health, signaling an opportunity and a call to social epidemiologists to engage in interdisciplinary research to speed research progress.

Reverberations of Racism and Sexism Through the Subjective Sexualities of Undergraduate Women of Color

Young women of color (among others) face both subtle and overt discrimination on a regular basis, but few studies have examined relations between discrimination and sexual outcomes using quantitative tools. We surveyed 154 self-identified undergraduate women of color to examine connections between race- and sex-based discrimination and subjective sexual well-being (i.e., condom use self-efficacy and sexual life satisfaction) and also tested whether sexual autonomy mediated these relations. When examined individually, each form of discrimination was related negatively to condom use self-efficacy and sexual life satisfaction, such that as women reported more discrimination, they reported poorer sexual well-being. However, when examining both racism and sexism as joint predictors, only racism remained significant and there were no racism × sexism interaction effects. In a path model, sexual autonomy mediated the relation between racism and each measure of subjective sexual well-being; racism was negatively related to sexual autonomy, which in turn was positively related to both condom use self-efficacy and sexual life satisfaction. These findings are consistent with the broader literature on the negative impact of discrimination on various aspects of mental and physical health. They also reinforce the position that redressing social inequality is a vital component of promoting individual health.

Effect of Melissa officinalis Capsule on the Intensity of Premenstrual Syndrome Symptoms in High School Girl Students

BACKGROUND

Several studies are conducted on Premenstrual Syndrome (PMS). However, a few herbal surveys exist on the treatment of PMS in Iran. Due to the sedative effects of Melissa officinalis (M. officinalis), this question comes to mind that "can it be used in the treatment of PMS symptoms?"

OBJECTIVES

The current study aimed to assess the effect of M. officinalis capsule on the intensity of PMS in high-school girls.

MATERIALS AND METHODS

A double-blind randomized, placebo-controlled trial was performed on 100 high school girls from 2013 to 2014. The intervention group (n = 50) received 1200 mg of M. officinalis essence daily from the first to the last day of their menstrual cycle for three consecutive cycles. The second group (n = 50) received the placebo. The premenstrual symptoms screening tool was used to assess the intensity of PMS symptoms in the two groups before and one, two, and three months after the intervention. The data were analyzed using paired t-test and repeated measures analysis of variance.

RESULTS

The results of repeated measures test revealed a significant reduction (P < 0.001) in PMS symptoms. Overall, the mean score of PMS intensity in the intervention group was 42.56 + 15.73 before the intervention and changed to 32.72 ± 13.24, 30.02 ± 12.08, and 13.90 ± 10.22 at the three consecutive months after the intervention, respectively (P = 0.001).

CONCLUSIONS

M. officinalis capsules were effective in reduction of the PMS symptoms. Yet, application of this medication requires further investigations.

Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues

Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.

Premenstrual syndrome and comorbid depression among medical students in the internship stage: a descriptive study

OBJECTIVE

Premenstrual syndrome (PMS) is a cluster of physical and emotional changes that typically begins several days before the menstrual period that disappears quickly after menstruation. It seems that co-occurrence of depression increases the risk and severity of this syndrome. In this cross-sectional research, we evaluated an association between PMS and depression in medical students.

METHODS

A hundred female medical students of Shahid Beheshti University of Medical Sciences that were available assigned for research. They were divided into two groups after administration of demographic questionnaire and PMS questionnaire made by researchers based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Technical Revision; group with or without PMS diagnosis. Then, they completed Beck's Depression Inventory.

RESULTS

From 100 participants, 55% (n = 55) met the PMS criteria and 45% had no PMS. In the PMS group 30% (n = 17) had no depression; 38% (n = 21) had mild depression; 23% (n = 13) had moderate depression; and 7% (n = 4) had severe depression. In the group with no PMS 60% (n = 27) had no depression; 20% (n = 9) had mild depression; 17% (n = 8) had moderate depression; 2% (n = 1) had severe depression. The rate of depression was significantly higher in PMS group (p = 0.04).

CONCLUSION

In this research, PMS had an elevated frequency in medical students. In students with PMS, rate of depression was higher than students without PMS.