Published online Apr 19, 2022. doi: 10.5498/wjp.v12.i4.603
Peer-review started: March 28, 2021
First decision: October 4, 2021
Revised: October 23, 2021
Accepted: April 1, 2022
Article in press: April 1, 2022
Published online: April 19, 2022
Processing time: 380 Days and 9.3 Hours
Premenstrual symptoms (PMS) are very common in child-bearing women and include several physical and emotional symptoms lasting for one week before menstruation. The premenstrual dysphoric disorder consists of the symptoms of PMS and, more significant depressive symptoms that affect the functioning of women. Some instruments measure the severity of these symptoms (Premenstrual Symptoms screening tool, PSST). Others assess the presence or absence of these symptoms and are usually used to diagnose if the premenstrual symptoms recur over two consecutive cycles (Mini international neuropsychiatric interview, module U).
As required by the Diagnostic and Statistical Manual of Mental Disorders, the daily recording of symptoms over two months is challenging to comply with regularly. Further, women might not receive the proper treatment if no adequate assessment or diagnosis is made. We believe that using appropriate scales like PSST that measures the severity of symptoms can be validated as tools for diagnosis.
To compare the scores of both PSST and MINI module U. We also calculated the cut-off scores on the dimensional PSST items by using the categorical MINI-U as a gold standard.
We recruited eligible women from primary care centers. Two blinded raters independently administered the dichotomous Arabic MINI module U and the Arabic PSST to women. We compared the scores on the PSST items by MINI-U responses (Yes vs No) using the median and interquartile range. To determine the cut-off scores on the PSST (including sensitivity and specificity measures), we used the receiver operating characteristics analyses using the MINI-U answers as the gold standard.
According to the MINI-U, the most common symptoms were physical symptoms (86.7%), fatigue or lack of energy (74.4%), and anger or irritability (73.3%). Out of the 14 symptoms assessed, nine had a median score of 3 (moderate), four symptoms had a median rating of 2 (mild), and one symptom had a median rating of 1.5 (not at all to mild). Among the MINI-U dichotomous answers, all PSST ratings were significantly higher among participants who answered Yes (P < 0.01). The cut-off scores for the items on anger or irritability, anxiety or tension, decreased interest in work or home activities, overeating, hypersomnia, and physical symptoms were 2.5 on the corresponding PSST items. The balanced sensitivity and specificity values for all the corresponding cut-off scores were adequate, ranging from 0.50 to 0.83.
Our results suggest that the severity measures of PSST can capture the PMDD cases with significantly severe symptoms who would benefit from treatment initiation. Furthermore, women with moderate/severe PMS symptoms have a higher rate of work absences and increased medical expenses. These women can, therefore, benefit from a prompt referral and timely treatment.
Larger prospective studies are needed to further validate the utility of cut-off scores from PSST to confirm the diagnosis and justify the initiation of treatment.