Health advantage for black women: patterns in pre-menstrual dysphoric disorder

Abstract

Background Pre-menstrual dysphoric disorder (PMDD) is commonly studied in white women; consequently, it is unclear whether the prevalence of PMDD varies by race. Although a substantial proportion of black women report symptoms of PMDD, the Biocultural Model of Women’s Health and research on other psychiatric disorders suggest that black women may be less likely than white women to experience PMDD in their lifetimes. Method Multivariate multinomial logistic regression modeling was used with a sample of 2590 English-speaking, pre-menopausal American women (aged 18–40 years) who participated in the Collaborative Psychiatric Epidemiology Surveys in 2001–2003. The sample consisted of 1672 black women and 918 white women. The measure of PMDD yields a provisional diagnosis of PMDD consistent with DSM-IV criteria. Results Black women were significantly less likely than white women to experience PMDD [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.25–0.79] and pre-menstrual symptoms (OR 0.64, 95% CI 0.47–0.88) in their lifetimes, independently of marital status, employment status, educational attainment, smoking status, body mass index, history of oral contraceptive use, current age, income, history of past-month mood disorder, and a measure of social desirability. The prevalence of PMDD was 2.9% among black women and 4.4% among white women. Conclusions This study showed for the first time that black women were less likely than white women to experience PMDD and pre-menstrual symptoms, independently of relevant biological, social-contextual and psychological risk factors. This suggests that PMDD may be an exception to the usual direction of racial disparities in health. Further research is needed to determine the mechanisms that explain this health advantage.

The magnitude, long-term trend and lifestyle risk factors of dysmenorrhea and premenstrual syndrome

“…A significantly lower risk of PMS/PMDD was related with non-white ethnicity in three cross-sectional studies [118,119,122], whereas three other studies did not report any association between ethnicity and PMS/PMDD [110,113,115]. These findings are, once again, largely in agreement with previous literature reporting mixed results for ethnicity [143,144].…”

“…Education was inconsistently related to the risk of PMS/PMDD in the included studies, with contradictory results. Six studies reported no association between education and PMS/PMDD [25,111,115,118,125,142], four reported a positive associations [113,120,122,150] and three reported a negative associations) [110,123,126]. The findings are supported by previous population-based studies [143,144] and reviews [145] showing mixed results.…”

“…Mixed results were produced from 13 studies investigating the association between age and PMS/PMDD. Four studies [22,115,122,142] suggested that younger age was related to a higher risk of PMS with an odds ratio of up to two, whilst eight studies failed to detect a significant association [25,110,113,118,120,123,125,126]. The other two multi-country studies among women from Europe and Latin America [111] and Asia [141], revealed a inverse U-shaped effect of age on the intensity of PMS (using a total duration and severity index), with the peak prevalence around age 35 years.…”

“…Five longitudinal [22,25,26,108,109] and 17 community-based cross-sectional studies [110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126] reported on the prevalence and/or incidence rates of PMS/PMDD. The results from the studies are summarised in Table 3-9.…”

“…An increased risk of PMS/PMDD was shown for current and former smokers in eight studies [26,110,111,115,118,125,133,142]; however, the other six studies failed to detect a significant association [22,120,122,123,126,150]. In the case-control study nested within the prospective NHS2 [133], researchers performed a series of analyses using different smoking-related variables.…”