The relationship between menstrual cycle phases and suicide attempts

Objective: The validity of prior studies on the menstrual cycle and suicide attempts assumes that suicidal women accurately describe their cycles. The three objectives of this study were 1) to explore whether prior inconsiste ncies are due to the effects of sample selection and method of assessment o f the menstrual cycle, 2) to assess the relationship between the menstrual cycle phase and suicide attempts, and 3) to establish the role of sexual ho rmones in suicide attempts. Methods: The original sample included 134 women who came to the emergency room of a general hospital after a suicide attem pt. One hundred eight female blood donors were recruited as control subject s. The menstrual cycle was divided into follicular, midcycle, and luteal ph ases using two clinical methods and serum hormonal assessment. Dividing the follicular phase into menstrual and nonmenstrual phases was also considere d. Results: Two of 11 previously used sampling methods produced a sample si ze similar to that of the hormonal assessment. kappa values between the two clinical and the endocrinological methods were low (0.40-0.50). The number of suicide attempts during the follicular phase (particularly during the m enstrual phase) was significantly higher than expected. Conclusions: Despit e the inability to control far other variables and limitations, the results of this study suggest that sample selection could introduce biases and tha t studies relating psychiatric symptomatology and menstrual cycle phases ne ed to use hormonal determinations. New studies are needed to verify that su icide attempts are more frequent during the follicular phase (particularly during the menstrual phase).