Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women

Qian Yang; Edda Björk Þórðardóttir; Arna Hauksdóttir; Thor Aspelund; Jóhanna Jakobsdóttir; Thorhildur Halldorsdottir; Gunnar Tómasson; Harpa Rúnarsdóttir; Hilda Björk Daníelsdóttir; Elizabeth R Bertone-Johnson; Arvid Sjölander; Fang Fang; Donghao Lu; Unnur Anna Valdimarsdóttir

doi:10.1186/s12916-022-02275-7

Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women

Qian Yang, Edda Björk Þórðardóttir, Arna Hauksdóttir, Thor Aspelund, Jóhanna Jakobsdóttir, Thorhildur Halldorsdottir, Gunnar Tómasson, Harpa Rúnarsdóttir, Hilda Björk Daníelsdóttir, Elizabeth R Bertone-Johnson, Arvid Sjölander, Fang Fang, Donghao Lu, Unnur Anna Valdimarsdóttir

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Abstract

Background: Childhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored. Methods: To evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression. Results: At a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11–1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21–2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs. Conclusions: Our findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.

Original language	English
Article number	60
Pages (from-to)	60
Journal	BMC Medicine
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12916-022-02275-7
Publication status	Published - 21 Feb 2022

Bibliographical note

Funding Information:
Open access funding provided by Karolinska Institute. The work is supported by the Erik and Edith Fernström Foundation (No. 2019-00415 to Dr. Yang), the Chinese Scholarship Council (No. 201700260289 to Dr. Yang), the Icelandic Research Fund (No. 185287-051 to Dr. Þórðardóttir), the Swedish Research Council for Health, Working Life and Welfare (FORTE) (No. 2020-00971 to Dr. Lu), the Swedish Research Council (Vetenskapsrådet) (No. 2020-01003 to Dr. Lu), and the Grant of Excellence from the Icelandic Research Fund (No. 163362-051 and 218274-051 to Dr. Valdimarsdóttir) and European Research Council (No. 726413 to Dr. Valdimarsdóttir). Researchers are independent of the funders. The funding has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Publisher Copyright:
© 2022, The Author(s).

Other keywords

Adult
Adverse Childhood Experiences
Anxiety Disorders
Child
Child Abuse/psychology
Cross-Sectional Studies
Female
Humans
Prospective Studies
Childhood maltreatment
Violence
PMS
PMDD
Premenstrual disorders
Household dysfunction
Adverse childhood experiences

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10.1186/s12916-022-02275-7

s12916-022-02275-7Final published version, 734 KBLicence: CC BY

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Yang, Q., Þórðardóttir, E. B., Hauksdóttir, A., Aspelund, T., Jakobsdóttir, J., Halldorsdottir, T., Tómasson, G., Rúnarsdóttir, H., Daníelsdóttir, H. B., Bertone-Johnson, E. R., Sjölander, A., Fang, F., Lu, D., & Valdimarsdóttir, U. A. (2022). Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women. BMC Medicine, 20(1), 60. Article 60. https://doi.org/10.1186/s12916-022-02275-7

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title = "Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women",

abstract = "Background: Childhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored. Methods: To evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression. Results: At a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11–1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21–2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs. Conclusions: Our findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.",

keywords = "Adult, Adverse Childhood Experiences, Anxiety Disorders, Child, Child Abuse/psychology, Cross-Sectional Studies, Female, Humans, Prospective Studies, Childhood maltreatment, Violence, PMS, PMDD, Premenstrual disorders, Household dysfunction, Adverse childhood experiences",

author = "Qian Yang and {\TH}{\'o}r{\dh}ard{\'o}ttir, {Edda Bj{\"o}rk} and Arna Hauksd{\'o}ttir and Thor Aspelund and J{\'o}hanna Jakobsd{\'o}ttir and Thorhildur Halldorsdottir and Gunnar T{\'o}masson and Harpa R{\'u}narsd{\'o}ttir and Dan{\'i}elsd{\'o}ttir, {Hilda Bj{\"o}rk} and Bertone-Johnson, {Elizabeth R} and Arvid Sj{\"o}lander and Fang Fang and Donghao Lu and Valdimarsd{\'o}ttir, {Unnur Anna}",

note = "Funding Information: Open access funding provided by Karolinska Institute. The work is supported by the Erik and Edith Fernstr{\"o}m Foundation (No. 2019-00415 to Dr. Yang), the Chinese Scholarship Council (No. 201700260289 to Dr. Yang), the Icelandic Research Fund (No. 185287-051 to Dr. {\TH}{\'o}r{\dh}ard{\'o}ttir), the Swedish Research Council for Health, Working Life and Welfare (FORTE) (No. 2020-00971 to Dr. Lu), the Swedish Research Council (Vetenskapsr{\aa}det) (No. 2020-01003 to Dr. Lu), and the Grant of Excellence from the Icelandic Research Fund (No. 163362-051 and 218274-051 to Dr. Valdimarsd{\'o}ttir) and European Research Council (No. 726413 to Dr. Valdimarsd{\'o}ttir). Researchers are independent of the funders. The funding has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = feb,

day = "21",

doi = "10.1186/s12916-022-02275-7",

language = "English",

volume = "20",

pages = "60",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

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Yang, Q, Þórðardóttir, EB , Hauksdóttir, A , Aspelund, T , Jakobsdóttir, J, Halldorsdottir, T, Tómasson, G, Rúnarsdóttir, H, Daníelsdóttir, HB, Bertone-Johnson, ER, Sjölander, A, Fang, F, Lu, D & Valdimarsdóttir, UA 2022, 'Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women', BMC Medicine, vol. 20, no. 1, 60, pp. 60. https://doi.org/10.1186/s12916-022-02275-7

TY - JOUR

T1 - Association between adverse childhood experiences and premenstrual disorders

T2 - a cross-sectional analysis of 11,973 women

AU - Yang, Qian

AU - Þórðardóttir, Edda Björk

AU - Hauksdóttir, Arna

AU - Aspelund, Thor

AU - Jakobsdóttir, Jóhanna

AU - Halldorsdottir, Thorhildur

AU - Tómasson, Gunnar

AU - Rúnarsdóttir, Harpa

AU - Daníelsdóttir, Hilda Björk

AU - Bertone-Johnson, Elizabeth R

AU - Sjölander, Arvid

AU - Fang, Fang

AU - Lu, Donghao

AU - Valdimarsdóttir, Unnur Anna

N1 - Funding Information: Open access funding provided by Karolinska Institute. The work is supported by the Erik and Edith Fernström Foundation (No. 2019-00415 to Dr. Yang), the Chinese Scholarship Council (No. 201700260289 to Dr. Yang), the Icelandic Research Fund (No. 185287-051 to Dr. Þórðardóttir), the Swedish Research Council for Health, Working Life and Welfare (FORTE) (No. 2020-00971 to Dr. Lu), the Swedish Research Council (Vetenskapsrådet) (No. 2020-01003 to Dr. Lu), and the Grant of Excellence from the Icelandic Research Fund (No. 163362-051 and 218274-051 to Dr. Valdimarsdóttir) and European Research Council (No. 726413 to Dr. Valdimarsdóttir). Researchers are independent of the funders. The funding has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: © 2022, The Author(s).

PY - 2022/2/21

Y1 - 2022/2/21

N2 - Background: Childhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored. Methods: To evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression. Results: At a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11–1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21–2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs. Conclusions: Our findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.

AB - Background: Childhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored. Methods: To evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression. Results: At a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11–1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21–2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs. Conclusions: Our findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.

KW - Adult

KW - Adverse Childhood Experiences

KW - Anxiety Disorders

KW - Child

KW - Child Abuse/psychology

KW - Cross-Sectional Studies

KW - Female

KW - Humans

KW - Prospective Studies

KW - Childhood maltreatment

KW - Violence

KW - PMS

KW - PMDD

KW - Premenstrual disorders

KW - Household dysfunction

KW - Adverse childhood experiences

UR - http://www.scopus.com/inward/record.url?scp=85125002741&partnerID=8YFLogxK

U2 - 10.1186/s12916-022-02275-7

DO - 10.1186/s12916-022-02275-7

M3 - Article

C2 - 35184745

SN - 1741-7015

VL - 20

SP - 60

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 60

ER -

Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women

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Bibliographical note

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