Title: The influence of primary dysmenorrhea on chronotypes, social jetlag, and night eating
habits: A cross-sectional study of anxiety and depression
Version: 0 Date: 28 Apr 2025
Reviewer:  Pradeep Balakrishnan
Reviewer's report:
Overview:
This study examines how the severity of primary dysmenorrhea (PD) affects various factors,
including chronotype, social jetlag, night eating syndrome, and mood disorders such as
depression and anxiety. The authors aimed to identify patterns in these areas across different
severities of PD—mild, moderate, and severe—using a cross-sectional approach with a sample
of medical students. The research sheds light on how PD severity influences these aspects,
providing a broader understanding of its effects beyond just the physical symptoms.
Strengths:
Relevant Research Topic:
The study delves into an important and underexplored area by investigating how primary
dysmenorrhea (PD) interacts with psychological factors, such as mood disorders, eating habits,
and social jetlag. This research enhances our understanding of the broader consequences of PD,
especially its links to conditions like anxiety, depression, and night eating syndrome. These
connections merit further exploration in both clinical practice and academic research.
Well-Defined Methodology:
The study is grounded in a well-structured methodology, using validated instruments like the
“Morning-Evening Test” for chronotype, the “Social Jetlag Test,” and the Beck Depression
and Anxiety Inventories. This approach ensures the collection of reliable data and facilitates
consistent comparisons across participants, making the findings both meaningful and robust.
Insightful Results:
The study uncovers significant findings, such as the higher prevalence of night eating syndrome
and social jetlag among participants with severe PD, as well as the strong link between
PD severity and increased anxiety and depression. These results are crucial for advancing
our understanding of PD's far-reaching effects and highlight the psychological and lifestyle
challenges that may be overlooked in the management of the condition.
Areas for Improvement:
Sample Diversity and Generalizability:
The study’s sample is limited to medical students aged 18–25, which restricts the generalizability
of the findings. PD may manifest differently in other age groups, professions, or socioeconomic
backgrounds. Future research should aim to include a more diverse sample to ensure that the
findings are relevant to a broader population, particularly women at different stages of life.
Limitations of Cross-Sectional Design:
Although the cross-sectional design offers valuable insights into the relationships between PD
severity and psychological/eating behaviors, it does not establish causality. A longitudinal study
would provide clarity on whether PD leads to these mood and lifestyle changes, or if these factors
exacerbate PD symptoms. Including control groups (such as women without PD) could help
isolate the effects of PD itself and provide a clearer comparison.
Potential Confounding Variables:
While the study addresses mood disorders and eating behaviors, it does not consider other
potential factors that could influence these outcomes, such as stress, general health, lifestyle
habits, or comorbid conditions. Controlling for these variables would improve the accuracy of
the findings and offer a more precise understanding of the relationship between PD and these
factors.
Unexplained Findings on Chronotype:
The study found no significant effect of PD severity on chronotype, which is surprising given the
well-documented relationship between menstrual health and sleep/circadian rhythms in other
research. A more detailed explanation for why chronotype remained unchanged across PD
severity groups could provide valuable insights into how PD affects daily functioning. This point
warrants further exploration.
Transparency in Statistical Analysis:
While the study presents significant results, it would benefit from greater transparency in the
statistical methods used. Providing more details on the statistical tests employed to assess group
differences would help strengthen the study’s reliability and replicability. Clearer statistical
explanations would also bolster the study’s credibility.
Writing and Presentation:
The writing is generally clear and well-organized, making the article accessible to a broad
audience. The abstract offers a concise and effective summary of the study’s objectives,
methods, results, and conclusions. However, the methods section could be enhanced with
additional details on how participants were recruited and how the questionnaires were
administered. Additionally, while the results are presented clearly, a more thorough discussion
of the clinical implications of the findings would add depth to the conclusion.
Conclusion:
This study offers valuable insights into how primary dysmenorrhea can affect mood, eating
habits, and social jetlag, underscoring the importance of addressing these factors in the
management of PD. However, the study’s limitations, such as the narrow sample and cross-
sectional design, suggest that further research with more diverse populations and longitudinal
designs is needed. These findings represent an important step toward understanding the broader
impact of dysmenorrhea, and they suggest that healthcare providers should consider both the
physical and emotional aspects of PD when treating affected individuals.