Is trait rumination associated with affective reactivity to the menstrual cycle? A prospective analysis.

BACKGROUND: A minority of naturally cycling individuals experience clinically significant affective changes across the menstrual cycle. However, few studies have examined cognitive and behavioral constructs that may maintain or worsen these changes. Several small studies link rumination with premenstrual negative affect, with authors concluding that a tendency to ruminate amplifies and perpetuates hormone-sensitive affective symptoms. Replication in larger samples is needed to confirm the validity of rumination as a treatment target. METHOD: 190 cycling individuals (M = 30.82 years; 61.1% Caucasian) were recruited for moderate perceived stress, a risk factor for cyclical symptoms. They completed the Rumination Response Scale at baseline, then reported daily affective and physical symptoms across 1-6 cycles. Multilevel growth models tested trait rumination as a predictor of baseline levels, luteal increases, and follicular decreases in symptoms. RESULTS: The degree of affective cyclicity was normally distributed across a substantial range, supporting feasibility of hypothesis tests and validating the concept of dimensional hormone sensitivity. Contrary to prediction, higher brooding did not predict levels or cyclical changes of any symptom. In a subsample selected for luteal increases in negative affect, brooding predicted higher baseline negative affect but still did not predict affective cyclicity. CONCLUSIONS: An individual's trait-like propensity to engage in rumination may not be a valid treatment target in premenstrual mood disorders. State-like changes in rumination should still be further explored, and well-powered prospective studies should explore other cognitive and behavioral factors to inform development of targeted psychological treatments for patients with cyclical affective symptoms.

Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality.

OBJECTIVE: Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle-suicidality relationship, and how these associations vary across individuals. METHODS: Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models. RESULTS: Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality. CONCLUSIONS: Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.

What's Stopping Us? Using GnRH Analogs With Stable Hormone Addback in Treatment-Resistant Premenstrual Dysphoric Disorder: Practical Guidelines and Risk-Benefit Analysis for Long-term Therapy.

Objective: Despite the documented success of gonadotropin-releasing hormone analogs (GnRHa) for the treatment of treatment-resistant premenstrual dysphoric disorder (PMDD), many patients struggle to find providers who have sufficient knowledge of PMDD and its evidence-based treatments and/or who are comfortable treating PMDD after first-line treatment options have failed. Here, we discuss the barriers to initiating GnRHa for treatment-resistant premenstrual dysphoric disorder (PMDD) and offer practical solutions to address these barriers for providers who encounter patients with treatment-resistant PMDD but may not have the necessary expertise or comfort with providing evidence-based treatments (ie, gynecologists, general psychiatrists). We have included supplementary materials including patient and provider handouts, screening tools, and treatment algorithms with the hope that this review may serve as a primer on PMDD and the use of GnRHa with hormonal addback as a treatment, as well as a guideline for clinicians delivering this treatment to patients in need.Options: In addition to offering practical treatment guidelines for first and second lines of treatment for PMDD, this review offers an in-depth discussion of GnRHa for treatment-resistant PMDD.Outcomes: The burden of illness in PMDD is estimated to be similar to that of other mood disorders, and those suffering from PMDD are at a high risk for suicide.Evidence: We present a selective review of relevant clinical trials evidence supporting the use of GnRHa with addback hormones in treatment-resistant PMDD (the most recent evidence cited was published in 2021), highlighting the rationale for addback hormones and presenting the different possible hormonal addback approaches.Values: The PMDD community has and continues to suffer from debilitating symptoms despite the known interventions. This article provides guidance for implementing GnRHa into practice among a broader scope of clinicians including general psychiatrists.Benefits, Harms, and Costs: The primary benefit of implementing this guideline is that a broad range of clinicians beyond reproductive psychiatrists who encounter patients with PMDD will have a template for assessing and treating PMDD and implementing GnRHa treatment when first-line treatments fail. Harms are expected to be minimal; however, some patients may have side effects or adverse reactions to the treatment or may not respond as they had hoped. Costs of GnRHa can be high depending on insurance coverage. We provide information within the guideline to help navigate this barrier.Recommendations: (1) Prospective symptom rating in evaluating for PMDD is necessary for diagnosis and evaluating treatment response. (2) SSRIs and oral contraceptives should be trialed as the first- and second-line treatments for PMDD. (3) When first- and second-line treatments have failed to yield symptom relief, the use of GnRHa with hormone addback should be considered. Risks and benefits of GnRHa should be weighed among clinicians and patients, and potential barriers to access should be discussed.Validation: This article adds to the available systematic reviews on the effectiveness of GnRHa in the treatment of PMDD and Royal College of Obstetrics and Gynecology's guidelines on the treatment of PMDD.

Alcohol use and motives for drinking across the menstrual cycle in a psychiatric outpatient sample.

BACKGROUND: Females who misuse alcohol experience high rates of negative physical and mental health consequences. Existing findings are inconsistent but suggest a relationship between ovarian hormones and alcohol use. We aim to clarify how alcohol use and drinking motives vary across the menstrual cycle in female psychiatric outpatients using the luteinizing hormone (LH)-confirmed cycle phase. METHODS: Daily self-reports (n = 3721) were collected from 94 naturally cycling females, recruited for past-month suicidal ideation, during the baseline phase of three parent clinical trials between February 2017 and May 2022. Multilevel logistic and linear models estimated the relationship between the cycle phase (with LH-surge confirmed ovulation) and daily alcohol use or drinking motives, moderated by the weekend. Models were adjusted for age, legal drinking status, substance use disorder, and the COVID-19 pandemic, and included random effects. RESULTS: Participants were generally more likely to drink in the midluteal (vs. perimenstrual) phase, but more likely to drink heavily on weekends in periovulatory and perimenstrual (vs. midluteal) phases. Social motives for drinking were significantly higher on weekends in the periovulatory, mid-follicular, and midluteal phases (vs. weekdays), but this finding was non-significant in the perimenstrual phase. Participants rated drinking to cope higher in the perimenstrual phase (vs. midluteal phase), regardless of the weekend. CONCLUSION: In a psychiatric sample with LH-surge-confirmed ovulation, we find an increased likelihood to drink heavily in periovulatory and perimenstrual phases on weekends. We also find that the perimenstrual phase is associated with increased drinking to cope, and relatively lower weekend social drinking. Finally, random effects across models suggest individual differences in the extent to which the cycle influences drinking. Our findings stress (1) predictable phases of increased high-risk alcohol use across the menstrual cycle, and (2) the importance of individual assessment of cyclical changes in alcohol use to predict and prevent ovulation- and menses-related surges in heavy drinking.

Three tests of the Vulnerability-Stress-Adaptation Model: Independent prediction, mediation, and generalizability.

Objective: Efforts to understand why some marriages thrive while others falter are (a) not well integrated conceptually and (b) rely heavily on data collected from White middle-class samples. The Vulnerability-Stress-Adaptation Model (VSA; Karney and Bradbury, 1995) is used here to integrate prior efforts and is tested using data collected from couples living with low incomes. Background: The VSA Model assumes (a) that enduring vulnerabilities, stress, and couple communication account for unique variance in relationship satisfaction, (b) that communication mediates the effects of vulnerabilities and stress on satisfaction, and (c) that the predictors of satisfaction generalize across socioeconomic levels. To date, these assumptions remain untested. Materials and methods: With 388 couples from diverse backgrounds (88% Black or Hispanic), we used latent variable structural equation models to examine enduring vulnerabilities, chronic stress, and observed communication as predictors of 4-wave, 27-month satisfaction trajectories, first as main effects and then interacting with a validated 10-item index of sociodemographic risk. Results: (a) The three variable sets independently predict satisfaction trajectories; (b) couple communication does not mediate the effects of enduring vulnerabilities or stress on satisfaction; and (c) in 19% of tests, effects were stronger among couples with higher sociodemographic risk. Conclusion: Effects of established predictor domains on satisfaction replicate in a diverse sample of newlywed couples, and most findings generalize across levels of sociodemographic risk. The failure of couple communication to mediate effects of enduring personal vulnerabilities and stress raises new questions about how these two domains undermine committed partnerships.

Cumulative Risk and Intimate Partner Aggression.

Objective: Intimate Partner Aggression (IPA) is recognized as a serious challenge to public health, and numerous models specify individual, interpersonal, and contextual antecedents of relationally aggressive behavior. The present study aims to synthesize prior work by determining whether the accumulation of selected factors at these three levels of analysis, when considered simultaneously, predicts IPA. Method: We collected self-report, observational, and social network data from 462 newlywed spouses (231 couples) from low-income neighborhoods at three separate time points across the first 18 months of marriage. Results: Latent growth curve analyses showed that individual and relational risk were consistently related to IPA initial status (i.e., intercepts), for husbands and wives. Effects of contextual risk on IPA were less consistent. All risk indices were unrelated to 18-month changes in IPA. Furthermore, individual and dyadic deficits increased risk for IPA independent of partners' contextual risk. Conclusions: Even after adjusting for potential distal influences, individual and dyadic variables emerge as clear risk factors of IPA. Although there were no significant associations between contextual variables and IPA intercepts and slopes in LGCM, we did find evidence for correlations between all three facets of risk. In light of this co-occurrence of risk across various domains, we recommend locating interventions that target individual and relational risk (e.g., therapies addressing neurotic tendencies and couple therapy with a communication skills training component) specifically within higher-risk environments.

Communication that is maladaptive for middle-class couples is adaptive for socioeconomically disadvantaged couples.

Demands for change in a relationship, particularly when met by behavioral withdrawal, foreshadow declines in relationship satisfaction. Yet demands can give partners opportunities to voice concerns, and withdrawal can serve to de-escalate conflict, stabilizing satisfaction instead (e.g., Overall, Fletcher, Simpson, & Sibley, 2009). We aim to reconcile these competing possibilities by arguing that withdrawal in response to requests for change will be detrimental among couples who possess the social, educational, and economic capital needed to address these requests, whereas withdrawal in response to partner demands will be constructive among couples with fewer resources for making the requested changes. Study 1 (N = 515 couples; 18-month follow-up) replicates the harmful effects of observed demand/withdraw communication on changes in wives' satisfaction among relatively affluent couples, while documenting benefits of demand/withdraw communication among relatively disadvantaged couples. Using 4 waves of observational data, Study 2 (N = 431 couples; 9-, 18- and 27-month follow-ups) shows that socioeconomic risk moderates the covariation between the demand/withdraw pattern and wives' relationship satisfaction, with higher levels of withdrawal again proving to be beneficial when socioeconomic risk is high. In both studies, behavioral withdrawal by men appears to be maladaptive when couples have resources and capacities to enact desired changes, but may be adaptive when those resources and capacities are lacking. Efforts to change couple communication without appreciating the larger social and economic contexts of those behaviors may be counterproductive. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Premarital education and later relationship help-seeking.

Despite evidence that empirically supported couple therapies improve marital relationships, relatively few couples seek help when they need it. Low-income couples are particularly unlikely to engage in relationship interventions despite being at greater risk for distress and dissolution than their higher-income counterparts. The present study aimed to clarify how premarital education influences couples' progression through different stages of later help-seeking, as identified in prior research. Using 5 waves of self-report data from a sample of 431 ethnically diverse newlywed couples living in low-income neighborhoods, analyses revealed that wives who received premarital education later considered seeking therapy at a higher level of relationship satisfaction and lower level of problem severity than those who did not receive premarital education, though this was not true for husbands. Wives who received premarital education were also more likely as newlyweds to say that they would seek therapy if their relationship was in trouble, though husbands were not. Spouses who considered seeking therapy were more likely to follow through with participation if they had received premarital education, whereas if they had not received premarital education they were more likely to consider seeking therapy without following through. Similarly, among couples who received therapy, those who also received premarital education sought therapy earlier than those who did not receive premarital education, though not at a higher level of relationship satisfaction. Taken together, these results suggest that participation in premarital education is linked with later help-seeking by empowering couples to take steps throughout their marriage to maintain their relationship. (PsycINFO Database Record

Momentary patterns of covariation between specific affects and interpersonal behavior: Linking relationship science and personality assessment.

Relationships are among the most salient factors affecting happiness and wellbeing for individuals and families. Relationship science has identified the study of dyadic behavioral patterns between couple members during conflict as an important window in to relational functioning with both short-term and long-term consequences. Several methods have been developed for the momentary assessment of behavior during interpersonal transactions. Among these, the most popular is the Specific Affect Coding System (SPAFF), which organizes social behavior into a set of discrete behavioral constructs. This study examines the interpersonal meaning of the SPAFF codes through the lens of interpersonal theory, which uses the fundamental dimensions of Dominance and Affiliation to organize interpersonal behavior. A sample of 67 couples completed a conflict task, which was video recorded and coded using SPAFF and a method for rating momentary interpersonal behavior, the Continuous Assessment of Interpersonal Dynamics (CAID). Actor partner interdependence models in a multilevel structural equation modeling framework were used to study the covariation of SPAFF codes and CAID ratings. Results showed that a number of SPAFF codes had clear interpersonal signatures, but many did not. Additionally, actor and partner effects for the same codes were strongly consistent with interpersonal theory's principle of complementarity. Thus, findings reveal points of convergence and divergence in the 2 systems and provide support for central tenets of interpersonal theory. Future directions based on these initial findings are discussed. (PsycINFO Database Record