3 - (SYM 6) Characterizing Daily Symptom Correlates of Suicidal Ideation and Planning in a Transdiagnostic Sample of Female Outpatients: Covariation and Mediation of Menstrual Cycle Effects

Although several trait predictors of suicide have been identified, predictors of imminent risk for suicide remain scarce. Cross-sectional studies have demonstrated that the weeks surrounding menses onset lead to heightened suicide risk in female patients. The current work investigated (1) which daily symptoms covary with suicidal ideation (SI) and planning (SP) among females, (2) the role of the menstrual cycle in this daily symptom variation, and (3) how daily fluctuations in symptoms mediate the cycle-suicidality relationship.

A sample of naturally-cycling female psychiatric outpatients with past-month SI provided daily ratings of symptoms (i.e., depression, hopelessness, overwhelm, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, interpersonal conflict), along with SI and SP across at least one cycle. Five menstrual cycle phases were identified using menses and urine luteinizing hormone (LH)-surge ovulation testing.

Our first set of multilevel structural equation models (MSEM) testing daily covariation of symptoms with SI and SP revealed that all symptoms (except anxiety) uniquely covaried with severity of SI (estimates ranged from .12 to .63; all p’s < 0.05). Meanwhile, daily fluctuations in depressed mood, hopelessness, rejection sensitivity, and perceived burdensomeness were each independently associated with increased likelihood of SP (estimates ranged from .17 to .27; all p’s < 0.05).

Our next set of MSEMs tested pairwise menstrual cycle phase contrasts as predictors of daily changes in psychiatric symptoms along with SI and SP. All psychiatric symptoms (except agitation) along with SI and SP were most severe during the perimenstrual phase of the menstrual cycle relative to other cycle phases (estimates ranged from .08 to .66; p’s < 0.05).

Our final set of MSEMs tested the mediating role of daily symptoms in the relationship between menstrual cycle phase contrasts and SI and SP. Daily changes in depression, perceived burdensomeness, hopelessness, and anhedonia each served a unique mediating role in the perimenstrual worsening of SI (estimates of indirect effects ranged from .04 to .16; p’s < 0.05), while only depression mediated the perimenstrual worsening of SP (estimates of indirect effects ranged from .06 to .08 across cycle phase contrasts; p’s < 0.05).

These findings explain the pathways by which the menstrual cycle influences daily changes in suicide risk, and highlight a need for more intensive longitudinal and experimental research on suicidality across the cycle.