Archives of Women's Mental Health

, Volume 22, Issue 5, pp 605–611 | Cite as

Clinical and psychometric features of psychiatric patients after a suicide attempt in relation with menstrual cycle phases

  • Athanasia PapadopoulouEmail author
  • Vasiliki Efstathiou
  • Christos Christodoulou
  • Rossetos Gournellis
  • Charalabos Papageorgiou
  • Athanassios Douzenis
  • Manolis Markianos
Original Article


There is evidence that frequency of suicide attempts of fertile women is related to the menstrual cycle phases, while the influence of hormonal and psychiatric features has been hypothesized. This study aims to explore the distribution and possible differences in clinical characteristics of women who attempted suicide in relation to menstrual cycle. Seventy fertile female psychiatric patients, hospitalized in psychiatric department after a suicide attempt, were studied. Depression was assessed using Beck Depression Inventory, suicide intent with the Suicide Intent Scale, and aggression using the Buss–Perry Aggression Questionnaire. A profile of psychopathology was obtained by using Symptom Check List SCL-90-R. Attempts were more frequent during the last 4 days of luteal phase and during the 4 days of menses, with 59% of attempts to occur during these 8 days. Patterns of number of attempts and cycle phase were similar for subgroups regarding diagnosis, violent/non-violent mode of suicide attempt, and one or repeated attempts. Although attempts were unequally distributed during the cycle, none of the psychiatric features assessed in the present study were related to the higher frequency of attempts during premenstrual/menstrual days, indicating the need to include additional aspects of suicidal behavior in future studies.


Suicide attempt Menstrual cycle Depression Suicide intent Aggression Violence 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. Baca-Garcia E, Diaz-Sastre C, Ceverino A, Garcia Resa E, Oquendo MA, Saiz-Ruiz J, de Leon J (2004) Premenstrual symptoms and luteal suicide attempts. Eur Arch Psychiatry Clin Neurosci 254:326–329. CrossRefPubMedGoogle Scholar
  2. Baca-Garcia E, Diaz-Sastre C, Ceverino A, Perez-Rodriguez MM, Navarro-Jimenez R, Lopez-Castroman J, Saiz-Ruiz J, Leon J, Oquendo MA (2010) Suicide attempts among women during low estradiol/low progesterone states. J Psychiatr Res 44:209–214. CrossRefPubMedGoogle Scholar
  3. Baca-Garcia E, Diaz-Sastre C, Ceverino A, Saiz-Ruiz J, Diaz FJ, de Leon J (2003) Association between the menses and suicide attempts: a replication study. Psychosom Med 65:237–244CrossRefGoogle Scholar
  4. Baca-Garcia E, Sanchez-Gonzalez A, Gonzalez Diaz-Corralero P, Gonzalez Garcia I, de Leon J (1998) Menstrual cycle and profiles of suicidal behaviour. Acta Psychiatr Scand 97:32–35CrossRefGoogle Scholar
  5. Beck AT, Schuyler D, Herman I (1974) Development of suicidal intent scales. Charles Press PublishersGoogle Scholar
  6. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571CrossRefGoogle Scholar
  7. Bernal M, Haro JM, Bernert S, Brugha T, de Graaf R, Bruffaerts R, Lépine JP, de Girolamo G, Vilagut G, Gasquet I, Torres JV, Kovess V, Heider D, Neeleman J, Kessler R, Alonso J, ESEMED/MHEDEA Investigators (2007) Risk factors for suicidality in Europe: results from the ESEMED study. J Affect Disord 101:27–34. CrossRefPubMedGoogle Scholar
  8. Brundin L, Erhardt S, Bryleva EY, Achtyes ED, Postolache TT (2015) The role of inflammation in suicidal behaviour. Acta Psychiatr Scand 132:192–203. CrossRefPubMedPubMedCentralGoogle Scholar
  9. Buss AH, Perry M (1992) The aggression questionnaire. J Pers Soc Psychol 63:452–459CrossRefGoogle Scholar
  10. Caykoylu A, Capoglu I, Ozturk I (2004) The possible factors affecting suicide attempts in the different phases of the menstrual cycle. Psychiatry Clin Neurosci 58:460–464. CrossRefPubMedGoogle Scholar
  11. Dalca IM, McGirr A, Renaud J, Turecki G (2013) Gender-specific suicide risk factors: a case-control study of individuals with major depressive disorder. J Clin Psychiatry 74:1209–1216. CrossRefPubMedGoogle Scholar
  12. Dalton K (1959) Menstruation and acute psychiatric illnesses. Br Med J 1:148–149CrossRefGoogle Scholar
  13. Derogatis L (1977) SCL-90-R: administration, scoring and procedures manual-I for the R (evised) version. Johns Hopkins University School of Medicine. Baltimore/MDGoogle Scholar
  14. Ekeberg Ø, Jacobsen D, Sørum Y, Aass G (1986) Self-poisoning and the menstrual cycle. Acta Psychiatr Scand 73:239–241CrossRefGoogle Scholar
  15. Evans J, Salamonsen LA (2012) Inflammation, leukocytes and menstruation. Rev Endocr Metab Disord 13:277–288. CrossRefPubMedGoogle Scholar
  16. Fourestié V, Lignières BD, Roudot-Thoraval F, Fulli-Lemaire I, Nahoul K, Cremniter D, Fournier S, Lejonc JL (1986) Suicide attempts in hypo-oestrogenic phases of the menstrual cycle. Lancet 328:1357–1360CrossRefGoogle Scholar
  17. Glass GS, Heninger GR, Lansky M, Talan K (1971) Psychiatric emergency related to the menstrual cycle. Am J Psychiatry 128:705–711. CrossRefPubMedGoogle Scholar
  18. Hofmeister S, Bodden S (2016) Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician 94:236–240PubMedGoogle Scholar
  19. Janowsky DS, Gorney R, Mandell AJ (1967) The menstrual cycle: psychiatric and ovarian-adrenocortical hormone correlates: case study and literature review. Arch Gen Psychiatry 17:459–469CrossRefGoogle Scholar
  20. Mann JJ (1998) The neurobiology of suicide. Nat Med 4:25–30CrossRefGoogle Scholar
  21. Mann JJ (2003a) Neurobiology of suicidal behaviour. Nat Rev Neurosci 4:819–828CrossRefGoogle Scholar
  22. Mann JJ (2003b) Neurobiology of suicidal behaviour. Nat Rev Neurosci 4:819–828. CrossRefPubMedGoogle Scholar
  23. Messinis IE, Messini CI, Dafopoulos K (2014) Novel aspects of the endocrinology of the menstrual cycle. Reprod BioMed Online 28:714–722. CrossRefPubMedGoogle Scholar
  24. Pallis DJ, Holding TA (1976) The menstrual cycle and suicidal intent. J Biosoc Sci 8:27–33CrossRefGoogle Scholar
  25. Pilver CE, Libby DJ, Hoff RA (2013) Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 48:437–446. CrossRefPubMedGoogle Scholar
  26. Rosenthal RJ, Rinzler C, Wallsh R, Klausner E (1972) Wrist-cutting syndrome: the meaning of a gesture. Am J Psychiatry 128:1363–1368. CrossRefPubMedGoogle Scholar
  27. Sadeh N, Javdani S, Finy MS, Verona E (2011) Gender differences in emotional risk for self- and other-directed violence among externalizing adults. J Consult Clin Psychol 79:106–117. CrossRefPubMedPubMedCentralGoogle Scholar
  28. Saunders KE, Hawton K (2006) Suicidal behaviour and the menstrual cycle. Psychol Med 36:901–912. CrossRefPubMedGoogle Scholar
  29. Sinclair JM, Gray A, Rivero-Arias O, Saunders KE, Hawton K (2011) Healthcare and social services resource use and costs of self-harm patients. Soc Psychiatry Psychiatr Epidemiol 46:263–271. CrossRefPubMedGoogle Scholar
  30. Tonks CM, Rack PH, Rose MJ (1968) Attempted suicide and the menstrual cycle. J Psychosom Res 11:319–323CrossRefGoogle Scholar
  31. Traskman L, Asberg M, Bertilsson L, Sjostrand L (1981) Monoamine metabolites in CSF and suicidal behavior. Arch Gen Psychiatry 38:631–636CrossRefGoogle Scholar
  32. Wasserman D (2016) Suicide: an unnecessary death. Oxford University PressGoogle Scholar
  33. Zengin Y et al (2015) The relationship between suicide attempts and menstrual cycles in the emergency department and the sociodemographic and clinical characteristics of these patients. J Acad Emerg Med 14:118Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Athanasia Papadopoulou
    • 1
    Email author
  • Vasiliki Efstathiou
    • 1
  • Christos Christodoulou
    • 1
  • Rossetos Gournellis
    • 1
  • Charalabos Papageorgiou
    • 2
  • Athanassios Douzenis
    • 1
  • Manolis Markianos
    • 2
  1. 1.2nd Department of Psychiatry, “Attikon” General HospitalNational and Kapodistrian University of AthensAthensGreece
  2. 2.1st Department of Psychiatry, “Eginition” HospitalNational and Kapodistrian University of AthensAthensGreece

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