Premenstrual disorders: the key to addressing sex disparities in mental health among adolescents and young adults

Research problem and specific questionsSex/gender differences in mental health among adolescents and young adults (AYAs) are well documented. Yet, the driving forces are poorly understood.

Premenstrual disorders (PMDs) are common yet under-investigated mental/behavioral conditions emerging during adolescence, with a significant psychosocial impact on young women.

Our recent work based on cross-sectional data revealed that the higher prevalence rates of depression and anxiety in adolescent girls than boys did not emerge until menarche and were almost fully attributable to PMDs.

However, prospective data are urgently needed to demonstrate the causal relations between PMDs and mental ill-health in young women, and subsequently the contribution to the sex disparities in AYAs mental health.Data and methodsLeveraging the nationwide Swedish register data and two large prospective cohorts (the LifeGene and CATSS), this proposal aims to develop a strategy roadmap for future interventions reducing mental health sex/gender disparities among AYAs through novel prevention programs for PMDs.

Specifically, we aim to: 1) assess the association of PMDs and subsequent risks of depression and anxiety using population and sibling analyses; 2) quantify the mediating role of PMDs in the sex differences in mental health and suicidal behavior using mediation analysis; and 3) determine modifiable childhood causal risk factors for PMDs using Mendelian randomization (MR) analysis.Plan for project realizationThe research team consists of multidisciplinary experts from epidemiology, OB/GYN, psychology/psychiatry, and genetics from Iceland, Sweden, and the US.

The applicant has extensive experience in conducting cutting-edge studies on women´s mental health, particularly among AYAs, using registers and large population-based cohorts with advanced methods integrating omics data.

One full-time PhD student and 70% of a postdoc will be financed to implement the projects over 3-years under the applicant´s supervision.

RelevanceMental ill-health is the leading cause of disease burden among AYAs in Sweden and the sex/gender disparity is alarmingly concerning. However, very limited progress has been implemented so far.

Through this program, we will fill an important knowledge gap in the contribution of PMDs to the sex/gender disparities in AYAs mental health, and provide innovative guidelines for future interventions targeted to reduce such disparities.