Research paperMenarche, menstrual problems and suicidal behavior in Chinese adolescents
Introduction
Adolescence is an important period, in which the girls go through the critical changes of both physiology and psychology (Ravi et al., 2015). Menarche is a vital milestone marking the maturation of reproductive system for women, which is one of the most important changes happening during adolescence for the females (Ajah et al., 2015). Age at menarche has advanced in the last 3 decades. For example, the mean age at menarche fell from 13.41 years to 12.47 years in China from 1985 to 2010 (Song et al., 2014). Similar tendency has been observed in other countries (Hosokawa et al., 2012). Early menarche has an impact on adolescents depression (Black and Klein, 2012). Menstrual problems are very common in adolescent girls, including dysmenorrheal, heavy bleeding, oligomenorrhea, amenorrhea, menorrheagia, and irregular cycle (Nur Azurah et al., 2013, Ravi et al., 2015). A study based on a sample of 3783 adolescents in Italy shows that the prevalence of irregular length is 8.3% (De Sanctis et al., 2014). Menstrual problems can impact quality of life and increase risk of mental health problems (Nur Azurah et al., 2013). Besides, the experience of adolescence, like emotion abuse and emotional neglect, physical abuse, and sexual abuse, is associated with Premenstrual Dysphoric Disorder (PMDD) of adult females (Soydas et al., 2014).
Suicide is a common death cause worldwide and there were more than 800,000 deaths in 2012. Suicide is the second leading cause of death globally in the age of 15–29 (World Health Organization, 2014). Suicidal behavior is prevalent among youths, especially in female adolescents, and is a significant predictor of future suicide attempt and suicide death (King et al., 2014). Among adolescents many factors including female gender, advancing age, parents’ divorce/widow, and mood disorders can increase possibility of suicide attempt (Cluver et al., 2015, Park et al., 2015). Many psychological factors, like the behavioral problems and hopelessness, are associated with adolescent suicidal behavior (Kovess-Masfety et al., 2015, Shilubane et al., 2013). Whether the using the checklist completed by parents or self-report by the adolescents, it suggests that Chinese parents and adolescents have high agreement on adolescent emotional and behavior problems, which are very common psychological problems among Chinese adolescents (Wang et al., 2014). For female adolescents, advancing age, living without their parents, having depression, poor self-reported health, drug abuse, sexual coitus, and expressing about unhappiness, suicidal ideation and plan can increase the risk of suicide attempt (Chin and Choi, 2015, Cluver et al., 2015). Suicide risk begins to increases in the early adolescence around menarche. However, little is known about the association between age at menarche and menstrual problems and suicidal behavior in adolescents.
To our knowledge, only a couple of studies have examined the relationship between menstruation and suicidal behavior (Baca-Garcia et al., 2004, Pilver et al., 2013), but it is not conclusive. PMDD was associated with suicidal behaviors (Pilver et al., 2013). However, another study showed that PMDD might not be associated with suicide acts (Baca-Garcia et al., 2004).
Female adolescents with menstrual disorder, such as dysmenorrheal, are more inclined to have depression and anxiety (Balik et al., 2014), both of which can increase the risk of suicide (Balazs et al., 2013). Hormone change during menstrual cycle is associated with suicidal behavior, and the level of sex hormone may impact brain activity for emotion regulation (Merz et al., 2012), and estrogens may affect depression and depressive-like behavior (Borrow and Cameron, 2014).
In the current study involving a community sample of 5831 female adolescents in China, we aim to examine the associations between menarche, menstrual problems and suicidal behavior, including suicidal ideation, plan and attempt. We hypothesize that earlier menarche and menstrual problems are associated with increased risk for suicidal behavior in adolescents.
Section snippets
Study design and participants
This study was one part of an epidemiological survey on physical and psychological health in eight public high schools of Lijin County, Yanggu County, and Zoucheng County in Shandong province, China. In the eight public high schools, five schools were junior high schools, three were senior high schools, and the participants were 7th −11th graders. With approval of the principals of the eight target schools, all students from 7th grade and 10th grade of target schools were recruited to
Sample characteristics
A total of 11,836 students participated in the survey and 5 students returned questionnaires in blank. Of the 11,831 remaining students, 5,831were girls (49.1%) and were included for the current analysis. The mean age of female adolescents was 15.02±1.44 years, 955 were 7th graders (mean age: 12.79±0.53), 801 8th graders (mean age: 13.82±0.63), 752 9th graders (mean age: 14.79±0.61), 2444 10th graders (mean age: 15.75±0.61), and 861 11th graders (mean age: 16.76±0.72).
Suicidal ideation, plan and attempt in female adolescents
As shown in Table 1, the
Discussion
The main findings of this study are: (1) Earlier menarche (≤11 years) was associated with increased risk of suicidal ideation and menarche at 12 years was associated with suicide plan. (2) Very irregular menstrual cycle was significantly associated with suicidal ideation, independent of demographics, hopelessness, and internalizing and externalizing behavioral problems; (3) Short menstrual period (≤4 days) was associated with suicide plan.
The association between earlier menarche and suicidal
Role of funding source
This study was supported in part by the National Natural Science Foundation of China (30972527), and Outstanding Youth Program Fund from Shandong University School of Public Health (JC201301).
Conflict of interest
None.
Acknowledgement
Thanks for the staffs in Centers of Disease Control and Prevention and staffs in eight schools of Lijin, Yanggu, and Zoucheng, Shandong Province.
References (46)
- et al.
Suicide attempts among women during low estradiol/low progesterone states
J. Psychiatr. Res.
(2010) - et al.
Is there a relationship between mood disorders and dysmenorrhea?
J. Pedia. Adolesc. Gynecol.
(2014) - et al.
Estrogenic mediation of serotonergic and neurotrophic systems: implications for female mood disorders
Prog. Neuropsychopharmacol. Biol. Psychiatry
(2014) - et al.
Child and adolescent suicide attempts, suicidal behavior, and adverse childhood experiences in South Africa: a prospective study
J. Adolesc. Health
(2015) - et al.
Ovarian steroid effects on serotonin 1A, 2A and 2C receptor mRNA in macaque hypothalamus
Brain Res Mol. Brain Res.
(1999) - et al.
Decreased voluntary activity and amygdala levels of serotonin and dopamine in ovariectomized rats
Behav. Brain Res
(2012) - et al.
Follicle-stimulating hormone (FSH), current suicidal ideation and attempt in female patients with major depressive disorder
Psychiatry Res.
(2013) - et al.
Suicidal ideation and mental health disorders in young school children across Europe
J. Affect Disord.
(2015) - et al.
Insomnia symptoms, behavioral/emotional problems, and suicidality among adolescents of insomniac and non-insomniac parents
Psychiatry Res.
(2015) - et al.
The quality of life of adolescents with menstrual problems
J. Pedia. Adolesc. Gynecol.
(2013)
Characteristics of menstruation-related problems for adolescents and premarital women in Korea
Eur. J. Obstet. Gynecol. Reprod. Biol.
Anger in women with premenstrual dysphoric disorder: its relations with premenstrual dysphoric disorder and sociodemographic and clinical variables
Compr. Psychiatry
Agreement between parents and adolescents on emotional and behavioral problems and its associated factors among Chinese school adolescents: a cross-sectional study
BMC Psychiatry
Manual for the Youth Self-Report and 1991 Profile
Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge of menstrual pattern and contraceptive adherence
Patient Prefer Adherence
Premenstrual symptoms and luteal suicide attempts
Eur. Arch. Psychiatry Clin. Neurosci.
Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk
J. Child Psychol. Psychiatry
The measurement of pessimism: the hopelessness scale
J. Consult Clin. Psychol.
Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients
Am. J. Psychiatry
The serotonin transporter genotype modulates the relationship between early stress and adult suicidality in bipolar disorder
Bipolar Disord.
Early menarcheal age and risk for later depressive symptomatology: the role of childhood depressive symptoms
J. Youth Adolesc.
Menstrual problems and health-seeking behaviour in Hong Kong Chinese girls
Hong. Kong Med J.
Suicide attempts and associated factors in male and female korean adolescents a population-based cross-sectional survey
Community Ment. Health J.
Cited by (45)
Bidirectional associations between sleep problems and suicidal thought/attempt in adolescents: A 3-wave data path analysis
2024, Journal of Affective DisordersMenstrual pain mediated the association between daytime sleepiness and suicidal risk: A prospective study
2023, Journal of Affective DisordersPatterns of sleep problems and internalizing and externalizing problems among Chinese adolescents: A latent class analysis
2022, Sleep MedicineCitation Excerpt :This study used secondary data from the baseline and 1-year follow-up surveys of the Shandong Adolescent Behavior and Health Cohort (SABHC)−a longitudinal study on adolescents’ behavior and health in Shandong Province, China. Details about SABHC have been described elsewhere [25,26]. In brief, a total of 11,831 adolescents (7th to 11th graders) participated in the baseline survey.
Depressive symptoms as a mediator between perceived social support and suicidal ideation among Chinese adolescents
2022, Journal of Affective DisordersAssociations between pain and depressive symptoms: A longitudinal study of Chinese adolescents
2022, Journal of Affective Disorders