Reviewer’s report
Title: 
Prevalence and correlates of current suicidal ideation in women with
premenstrual dysphoric disorder
Version: 
1 
Date: 
02 Sep 2021
Reviewer's report:
The authors present a timely and robust investigation of the point prevalence of
suicidal ideation among individuals with prospectively-confirmed PMDD. The
authors are correct in noting that a major limitation (and perhaps even fatal
flaw!) of prior research on this topic is that patients have never been
prospectively diagnosed with PMDD in studies investigating these questions.
Therefore, this is a critical finding and a huge contribution to the field. I have a
number of suggestions below that I hope will further strengthen the manuscript:
The authors may wish to consider adding "current suicidal ideation" or "point
prevalence of suicidal ideation" in the title and throughout-- it wasn't until i
looked very carefully at the methods that I realized this was a study about
current/point prevalence of ideation in PMDD rather than lifetime prevalence of
ideation in PMDD.
The authors should more clearly state in the abstract and throughout the paper
that use of retrospective/provisional diagnosis (as in prior work on this topic) is
known to be fundamentally invalid (due to repeated demonstrations that
retrospective PMDD reports have abysmal specificity when compared to
prospective PMDD as a criterion)-- that is, I think the authors don't make it clear
enough how problematic this lack of prospective data has been. It was not simply
a moderate limitation of prior work-- it was a fatal flaw.
Similarly, the authors use the term "probable PMDD" in the introduction to refer
to provisional PMDD using the SCID-5 and other retrospective instruments. My
read of the literature is that these instruments are no better than chance at
identifying cases of PMDD (e.g., Joyce et al., 2021, in the journal Addiction for
a notable recent example, although there are many). Therefore, I would not
describe provisional/retrospective PMDD as "probable PMDD" but rather
"individuals retrospectively reporting symptoms of PMDD", and I would
carefully note that this methodological approach is seen as a fatal flaw among a
majority of expert researchers in this area.
While it is reasonable that the authors excluded those with psychiatric
comorbidities for the purposes of these trial data, they should also note that
psychiatric comorbidities are not incompatible with the diagnosis of PMDD so
long as the symptoms are unique in each disorder (see DSM-5, and Hartlage et
al., 2004, Methods Dilemma paper)-- indeed, most clinicians with experience
treating PMDD will note that comorbidity is the rule rather than the exception
among those with prospectively-confirmed PMDD (even after setting aside those
with a purely PME phenotype).
Related to this, the authors should note that this feature of the dataset would
likely lead to an UNDER-estimate of the real prevalence of suicidality in
PMDD, since comorbidities are likely to increase risk further in real-world
samples.
What is "snuff"?
Please mathematically define precisely how "50% change" was calculated
(numerator, denominator, etc)) and note the page number on which the DSM-5
refers to a 50% criterion-- I was unable to find it but I may have missed it. 
In
general, this prospective approach appears defensible but I believe more detail is
needed to ensure comparability with other samples in the future.
The authors should consider replacing "women" with "people who menstruate"
or "participants" or "patients" throughout - a surprising number of individuals
who menstruate do not identify as women, and unless gender identity has been
explicitly assessed, "women" should probably be replaced.
On line 170, the authors should note that differing criteria for defining PMDD
and psychiatric ruleouts also affect prevalence.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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