Elsevier

Journal of Affective Disorders

Volume 209, February 2017, Pages 53-58
Journal of Affective Disorders

Research paper
Menarche, menstrual problems and suicidal behavior in Chinese adolescents

https://doi.org/10.1016/j.jad.2016.11.027Get rights and content

Highlights

  • Adolescents with early menarche (≤11 years) were significantly more likely to report suicidal ideation, and with menarche at 12 years were significantly more likely to report suicide plan.

  • Very irregular menstrual cycle was independently associated with suicidal ideation.

  • Short menstrual period (≤4 days) was significantly associated with suicide plan.

Abstract

Background

Menarche is the first menstrual cycle. Menstrual problems, such as dysmenorrheal menorrhagia, oligomenorrhea, and irregular cycle are common in female adolescents. This research aims to examine the associations between age at menarche and menstrual problems and suicidal behavior among Chinese female adolescents.

Methods

An epidemiological survey of 5831 female adolescents from eight high schools of three counties of Shandong province, China, was conducted. A self-administered paper-and-pencil questionnaire was used to collect information. Logistic regression analyses were used to examine the association between menstruation and suicidality.

Results

The mean age of the sample was 15.02 (SD=1.44) years. Of the sample, 5,231 (90.0%) had experienced their first menstrual cycle, and 23.2%, 10.4%, and 4.5% of the sample reported having had suicidal ideation, plan and attempt, respectively. In multivariate models, menarche at ≤11 years was associated with increased risk of suicidal ideation (OR=1.41, 95%CI: 1.10–1.81) and menarche at 12 years was associated with suicide plan (OR=1.23, 95%CI: 1.00–1.51). Irregular menstrual cycle was significantly associated with increased risk of suicidal ideation (OR=1.40, 95%CI: 1.05–1.86) and menstrual period less than or equal to 4 days was significantly associated with increased risk of suicide plan (OR=1.32, 95%CI: 1.06–1.66).

Limitations

This cross-sectional study cannot establish the causal directions between menstrual problems and suicidality in adolescents.

Conclusions

Our study suggests that earlier menarche, irregular menstrual cycle and short menstrual period are associated with suicidal behavior in female adolescents. Further research is warranted to examine the causal relationship between menstrual problems and suicidal behavior in 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)

  • S.Y. Shin et al.

    Characteristics of menstruation-related problems for adolescents and premarital women in Korea

    Eur. J. Obstet. Gynecol. Reprod. Biol.

    (2005)
  • E. Soyda Akyol et al.

    Anger in women with premenstrual dysphoric disorder: its relations with premenstrual dysphoric disorder and sociodemographic and clinical variables

    Compr. Psychiatry

    (2013)
  • J. Wang et al.

    Agreement between parents and adolescents on emotional and behavioral problems and its associated factors among Chinese school adolescents: a cross-sectional study

    BMC Psychiatry

    (2014)
  • T.M. Achenbach

    Manual for the Youth Self-Report and 1991 Profile

    (1991)
  • L.O. Ajah et al.

    Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge of menstrual pattern and contraceptive adherence

    Patient Prefer Adherence

    (2015)
  • E. Baca-Garcia et al.

    Premenstrual symptoms and luteal suicide attempts

    Eur. Arch. Psychiatry Clin. Neurosci.

    (2004)
  • J. Balazs et al.

    Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk

    J. Child Psychol. Psychiatry

    (2013)
  • A.T. Beck et al.

    The measurement of pessimism: the hopelessness scale

    J. Consult Clin. Psychol.

    (1974)
  • A.T. Beck et al.

    Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients

    Am. J. Psychiatry

    (1990)
  • F. Benedetti et al.

    The serotonin transporter genotype modulates the relationship between early stress and adult suicidality in bipolar disorder

    Bipolar Disord.

    (2014)
  • S.R. Black et al.

    Early menarcheal age and risk for later depressive symptomatology: the role of childhood depressive symptoms

    J. Youth Adolesc.

    (2012)
  • S.S. Chan et al.

    Menstrual problems and health-seeking behaviour in Hong Kong Chinese girls

    Hong. Kong Med J.

    (2009)
  • Y.R. Chin et al.

    Suicide attempts and associated factors in male and female korean adolescents a population-based cross-sectional survey

    Community Ment. Health J.

    (2015)
  • Cited by (45)

    • Patterns of sleep problems and internalizing and externalizing problems among Chinese adolescents: A latent class analysis

      2022, Sleep Medicine
      Citation 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.

    View all citing articles on Scopus
    View full text