The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women

BACKGROUND

Premenstrual dysphoric disorder (PMDD) was included as a provisional diagnostic category in the appendices of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R (then called late luteal phase dysphoric disorder) and remained as an appendix in DSM-IV. Our study aimed to determine the prevalence of PMDD using all four DSM-IV research diagnostic criteria in a representative sample of women of reproductive age in the United States.

METHOD

Data were collected in the homes of women between the ages of 13 and 55 years in two urban and two rural sites using a random sampling procedure developed by the National Opinion Research Center. Women completed daily symptom questionnaires and provided urine specimens each day for two consecutive ovulatory menstrual cycles (ovulation was estimated for women taking oral contraceptives) and were screened for psychiatric disorders by trained interviewers. Symptoms were counted toward a diagnosis of PMDD if they worsened significantly during the late luteal week during two consecutive ovulatory menstrual cycles, occurred on days in which women reported marked interference with functioning, and were not due to another mental disorder.

RESULTS

In the final analysis, 1246 women who had had at least one menstrual cycle and were neither naturally nor surgically menopausal nor pregnant were selected. Of the women in the study, 1.3% met criteria for the diagnosis as defined in DSM-IV.

CONCLUSIONS

The prevalence of PMDD is considerably lower than DSM-IV estimates and all but one of the estimates obtained from previous studies when all DSM-IV diagnostic criteria are considered. We suggest a new process for diagnosing PMDD based on our findings.

Perceptions of control in adults with epilepsy

That psychosocial problems are extant in epilepsy is evidenced by a suicide rate among epileptic persons five times that of the general population and an unemployment rate estimated to be more than twice that of the population as a whole. External perceptions of control secondary to repeated episodes of seizure activity that generalize to the social sphere have been implicated as causes of these problems. The hypothesis that individuals who continue to have seizures become more and more external in perceptions of control was tested by a survey mailed to a sample of individuals with epilepsy in a metropolitan area of the Midwest. Dependent variables were, scores on instruments measuring locus of control and attributional style. The independent variable was a measure of seizure control based on present age, age at onset, and length of time since last seizure. Gender, socioeconomic status, and certain parenting characteristics were included as control variables, as they are also known to affect perceptions of control. Analysis by multiple regression techniques supported the study's hypothesis when perceptions of control was conceptualized as learned helplessness for bad, but not for good, events. The hypothesis was not confirmed when perceptions of control was conceptualized as either general or health locus of control.

A design for studying the DSM-IV research criteria of premenstrual dysphoric disorder

The DSM-IV estimate that 3-5% of women have premenstrual dysphoric disorder (PMDD) is based on studies that: used non-representative samples, did not consider all research criteria, or were retrospective. In the present study, prospective data from a multiethnic sample of women were analyzed to develop an effective method of considering all DSM-IV research criteria for PMDD. One-hundred and seventeen subjects between the ages of 13 and 55 years who were neither pregnant nor menopausal were recruited from outpatient clinics at a teaching hospital for a study of changes in women's health through time. Daily urine samples were taken for two menstrual cycles, analyzed to establish phase of cycle, and correlated with daily symptom ratings. Subjects were assessed for psychiatric disorders. Four methods of symptom analysis were used. Prevalence rates ranging from 1.0% to 7.1% were determined that differed according to the method of measuring the symptom change. The group of women with PMDD did not differ from the sample as a whole on variables including age, parity and birth control pill use. When all criteria were considered as they appear in DSM-IV, prevalence estimates of the present study did not differ markedly from those in DSM-IV.

Premenstrual dysphoric disorder and risk for major depressive disorder: a preliminary study

Investigators examined whether premenstrual dysphoric disorder (PMDD) poses a risk for major depressive disorder (MDD). In an initial study, women rated premenstrual symptoms and functional impairment daily for two menstrual cycles. A semistructured diagnostic interview was given to obtain psychiatric histories and differentiate PMDD from premenstrual exacerbations of other disorders. Participants in this pilot study were eight women with PMDD and a random subgroup without PMDD (n = 9) initially. Another semistructured interview was given to diagnose psychiatric disorders occurring during a two-year follow-up interval. In all, seven of the eight women with PMDD developed MDD within two years, including all those who had never had MDD before. The odds that a woman with PMDD developed MDD were 14 times the odds that a woman without PMDD developed MDD ( p <.05). Premenstrual dysphoric disorder may be a prodrome of or causal risk factor for MDD. Preliminary evidence for the diagnostic validity of PMDD is provided.

Relationships of premenstrual dysphoric disorder to major depression and anxiety disorders: a re-examination

Clarifying the relationships of premenstrual dysphoric disorder (PMDD) to depressive and anxiety disorders may contribute to the understanding of risk factors and etiologies associated with the disorders. A current belief is that women with PMDD have a higher percentage of past psychiatric disorders than women without the disorder, an assumption that may be premature. This review carefully examines existing literature on the nature of the relationships between PMDD and major depression and anxiety disorders. A re-evaluation of the literature and the resulting implications for risk factors and etiology, as well as for obstetric and gynecological practice, are provided.

Symptom patterns of premenstrual dysphoric disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders-IV

Premenstrual dysphoric disorder was included in an appendix of DSM-III-R (revised third edition of the Diagnostic and Statistical Manual of Mental Disorders) and DSM-IV to facilitate systematic research. Items contained in its set of research criteria were considered tentative. Only one previous study of premenstrual symptoms specifically addressed symptoms of premenstrual dysphoric disorder, and it did not use DSM-IV criteria. In the present study, prospectively measured symptoms of 99 women were analyzed using exploratory principal components analysis with orthogonal rotation on all 24 items derived from the 11 symptoms listed in DSM-IV. Variation was found across phases of cycle and groups, with five factors predominating: (1) anger/irritability, (2) depressed mood, (3) anxiety/tension, (4) decreased energy and interest with physical symptoms, and (5) eating problems.

Black-white differences in the psychosocial outcomes of epilepsy

The present study tested the hypothesis that the stigma of being disabled and that of minority ethnic status yield more negative psychosocial outcomes for black than white persons with epilepsy. Black (n=55) and white (n=53) urban participants from a larger sample were matched for socioeconomic status and seizure frequency. Differences in these and key demographic variables were tested using chi(2) and t-tests and found to be non-significant. Group differences in psychosocial outcome variables were analyzed with the following results: (1) white subjects were more likely to have considered suicide and to have higher scores on the family background scale of the Washington Psychosocial Seizure Inventory (WPSI); (2) black subjects had significantly lower scores on the Beck Hopelessness Scale and significantly more optimistic attributional styles; and (3) no between-group differences were found on other psychosocial measures. The nature of family and community supports may determine intergroup differences.

Rural and urban Midwestern United States contraception practices

To address a paucity of demographic data on rural United States contraception practices, 370 randomly selected menstruating women, age 13-55 years, living in rural and urban Illinois and Missouri answered interview questions. Women with relatively few children and living in urban areas were likely to practice contraception more than those with relatively few children and living in rural areas, p < 0.01. In Illinois, more rural (23%) than urban (2%) women chose sterilization, p < 0.01. Single status was more frequent in Chicago (41%) and rural Missouri (32%) than in rural Illinois (19%), p < 0.002, and extant research links single status with risk for HIV and other sexually transmitted diseases (STDs). Condom use did not differ significantly by locale, p > 0.05. Urban-rural differences in contraception practices may be a function of life style choices (e.g. urban women may practice contraception to postpone having children, whereas rural women may practice contraception to prevent having more children after families are complete). Results do not strongly support that locale differences in contraception practices are a function of concern about contracting STDs.

Attributional style and locus of control in adults with epilepsy

Little agreement exists on how attributional style and locus of control relate to one another. Some consider the two to be interchangeable; others say that they overlap but are not identical. This study of the perceptions of control (conceptualized as attributional style and locus of control) of 144 adults with epilepsy, measured via a mailed survey, lends support to the latter notion. Attributional style for bad events, but not for good events, could be predicted by length of time that participants had been seizure free. Locus of control could not be predicted. Differences in the nature of the two concepts and how they develop within individuals are examined to explain how changes in seizure control would effect one but not the other. Implications for other medical conditions are discussed.

[Association of physical activity with fatigue and functional capacity in patients with rheumatoid arthritis]

BACKGROUND

Patients with rheumatoid arthritis (RA) tend to be less physically active. Physical activity has been shown to have a positive impact on disease activity and quality of life and is recommended by the European League Against Rheumatism (EULAR) as an integral component of standard treatment.

OBJECTIVE

A cross-sectional analysis of RA patients was carried out assessing disease activity, functional capacity and fatigue associated with physical activity.

MATERIAL AND METHODS

Physical activity, functional capacity and the global fatigue index (GFI) were examined using standardized questionnaires: the international physical activity questionnaire short form (IPAQ-SF), the functional questionnaire Hannover (FFbH) and the multidimensional assessment of fatigue (MAF). The data were evaluated using SPSS 26 (IBM, Armonk, NY, USA). The level of significance was tested with bivariate and partial correlations and nonparametric tests.

RESULTS

In total 164 patients were included in the study. The majority of the patients were female (127/164; 77%) and the median age of the cohort was 58.3 years (range 21-86 years). The median duration of disease-related symptoms at inclusion was 169 months (range 0-713 months). Physical activity was low in 39%, moderate in 37% and high in 24%. Patients reporting higher levels of physical activity reported significantly lower GFI (p < 0.001), functional limitations (p < 0.001) and disease activity (p = 0.045) scores than those with less physical activity.

CONCLUSION

Physical activity in RA patients was significantly correlated with functional capacity and levels of fatigue. In order to reduce the proportion of patients with low physical activity, the possibilities for functional training should be expanded and the patients should be encouraged to undertake sporting activities.

Using qualitative data to examine disparities in cancer outcomes: Results from interviews with African American (AA) and white (W) patients regarding health beliefs and perceptions of chemotherapy

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Background: Prior data indicate African Americans are less likely to receive appropriate and timely therapy for breast, colon, and lung cancers. The reasons for this may involve differences in how AA patients (pts) perceive the risks and benefits of available therapies. In general, little is known about the beliefs of pts, and about AA’s in particular, toward the risks and benefits of chemotherapy. Methods: Semi-structured qualitative interviews are being conducted on pts who have been referred to receive chemotherapy for breast, colon, and lung cancer. Results: To date, 18 patients have been interviewed: 9AA, 9W; median age 61 (range 35–77); 11 lung, 4 breast, 3 colon (11 for adjuvant therapy and 7 with metastatic disease). Pts provided their beliefs on the role of chemotherapy. Many described the advantages of chemotherapy indicating the possibility of cure or remission. Others expressed a degree of skepticism about the curative intent of chemotherapy. Many indicated an expectation of moderate to severe side effects that may have lasting effects on the body. Trust in one’s physician and the role of religion/spirituality are also emerging themes. One AA pt described that chemotherapy was a way for physicians to experiment on patients. Others believed that trust in one’s physician was implicit and essential. Many indicated a belief in God but few believed that his/her religious beliefs affected his/her approach to treatment. Conclusions: Consistent with the health beliefs’ model, perceived benefits and perceived barriers (one’s belief about the tangible and psychological costs of the advised action) shape pts’ perceptions of chemotherapy. In this ongoing analysis, the perceived benefits are tempered by a degree of skepticism. The perceived barriers include concerns about the overall impact of chemotherapy on the body and spirit rather than specific short-term side effects. Also, belief in the use of chemotherapy as an experiment is potentially consistent with some African American patients’ perceptions.

No significant financial relationships to disclose.

Establishing the diagnostic validity of premenstrual dysphoric disorder using rasch analysis

Premenstrual Dysphoric Disorder (PMDD) has remained in appendices of the last two editions of The Diagnostic and Statistical Manual of Mental Disorders due to lack of empirical study. Items included in its set of research criteria are considered tentative pending evidence of diagnostic validity. The present study attempts to establish the construct validity of the PMDD criteria using the Rasch method to analyze the validity of individual items as contributors to the diagnosis, in contrast to the usual but less precise approach of using an external validator to establish the diagnostic utility of psychiatric conditions. Analysis of which items best differentiate participants with and without PMDD provides an idea of the relative ability of these items to distinguish PMDD. It is recommended that the areas of anger/irritability, depressed mood, and problems in interpersonal functioning be expanded in further studies and corresponding items added to symptom checklists.

p53 as a marker of prognosis in African American (AA) women with breast cancer

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Background: Prior reports suggest that p53 may be of prognostic value in AA women with breast cancer. However, it remains to be determined whether p53 status would add prognostic value beyond the commonly used factors of stage and Intrinsic Subtype Classification (subtype). We evaluated p53 status as a prognostic factor among AA women treated at an urban community hospital. Methods: Cox proportional hazards regression models [results reported as hazard ratios (HR) with 95% confidence intervals (CI)] were used to select and evaluate prognostic factors [including stage, age, tumor grade of differentiation (grade), p53 status, subtype, & ER/PR status] for all-cause mortality in 331 consecutively treated AA women with breast cancer [42 months follow-up] and known subtype [luminal A = ER+, &/or PR+, & HER2-; luminal B = ER+, &/or PR+, & HER2+; HER2+ = ER-, PR-, & HER2+; basal = ER-, PR-, HER2-, cytokeratin (CK) 5/6+ &/or HER1+; & unclassified = negative for all 5 markers] and p53 [Pab1801 antibody] immunohistochemical status. Results: Tumors in 28% of women were p53+ and there were no chemotherapy and radiation treatment differences according to p53 status. However, 59% of p53+ women were ER/PR negative [Odds Ratio (OR), 0.37; 95% CI, 0.22–0.54; p=0.0003] and hence endocrine therapy was significantly less frequent in p53+ women [OR, 0.40; 95% CI, 0.23–0.69; p=0.0008]. p53+ tumors were also significantly more likely to be grade 3 [OR, 4.35; CI, 1.33–14.14; p=0.013]. Baseline prognostic factors were: stage [(II-IV/I) HR, 2.29; 95% CI, 1.86–2.81; p<0.0001]; age [HR, 1.003 per year; 95% CI, 0.99–1.02; p=0.697]; grade [(high/low) HR, 1.70; 95% CI, 1.22–2.37; p=0.0008]; p53 status [(±) HR, 1.76; 95% CI, 1.15–2.72; p=0.012]; subtype [(all other/luminal A) HR, 1.33; 95% CI, 1.14–1.55; p=0.0004]; ER/PR status [(±) HR, 0.47; 95% CI, 0.32–0.69; p=0.0001]. Cox multivariable models indicated that p53 status [HR, 1.59; 95% CI, 1.01–2.51; p=0.044] remained a significant prognostic factor when considered with stage [HR, 2.20; 95% CI, 1.71–2.84; p<0.001] and subtype [HR, 1.24; 95% CI, 1.04–1.49; p=0.016] and the other above-mentioned factors. Conclusions: Study results indicate that p53 status should be included with stage and subtype as markers to assess prognosis in AA women with breast cancer.

No significant financial relationships to disclose.

Beliefs and concerns African American (AA) and white (W) patients (pts) with breast, lung, and colon cancer bring to bear on the decision to undergo chemotherapy

9076

Background: AA have poorer stage-specific survival for breast, colon and lung cancer than whites and are also less likely to receive therapy for these cancers. This study seeks to explore the set of beliefs and concerns patients with primarily resected breast, lung, and colon cancer bring to bear on the decision to receive chemotherapy. Methods: Semi-structured interviews were conducted and recorded by a non-physician, African-American interviewer on patients with colon, breast, and lung cancer referred to medical oncology for chemotherapy. Grounded theory methods were used to analyze and code the interview transcripts. Results: A total of 27 interviews were conducted (17AA, 10W) including pts with breast (5), colon (6) and lung cancer (16). All but 7 of the pts were referred for adjuvant therapy. Three major themes emerged: (1) Patient versus physician control in decision making; (2) Absolute trust in one's physician versus qualified trust; (3) Major role of God in the decision making process versus a partnership or minimal role of God. In terms of decision-making, roughly equal portions of AA and W (53% vs 54%) expressed a patient centered locus of control. In the area of trust, AA were less likely to express an absolute trust in their physicians (59% vs. 80%). Finally, with respect to the role of God, AA were more likely to express a major role of God for their cancer and treatment (41% vs. 7%). Very few pts viewed the opinion or advice of family or friends as important and while many expressed concerns about the side-effects of therapy, very few identified that as being an important factor in their decision to undergo therapy. Conclusions: Issues of locus of control, physician trust and the role of God were areas identified as important in the chemotherapy decision-making process and for which variability existed among the pts interviewed. Analysis of these interviews informed the incorporation of validated measures of decision-making, physician trust, and the role of God as a locus of control in an ongoing close-coded survey of a similar cancer population.

No significant financial relationships to disclose.

Factor structure and dimensionality of the multidimensional health locus of control scales in measuring adults with epilepsy

External locus of control has been implicated in the development of psychosocial problems in epilepsy, and adults with epilepsy exhibit scores that are more external than those of the normative sample of the Multidimensional Health Locus of Control (MHLC) scales. Although the MHLC scales has the potential to be quite useful in the assessment and treatment of adults with epilepsy, it has not been assessed psychometrically using data from persons with epilepsy. The present study examined the internal consistency, factor structure, and construct validity of the scales using data from a survey of 143 adults with epilepsy. Results from reliability analysis, confirmatory factor analysis, and Rasch analysis supported the hypothesized three-factor structure of the measure, which was internally reliable and factorially valid.