Reviewer’s report
Title: 
Prevalence and correlates of current suicidal ideation in women with
premenstrual dysphoric disorder
Version: 
1 
Date: 
05 Aug 2021
Reviewer's report:
The manuscript reported a high prevalence of suicidal ideation (nearly 40%)
among women with PMDD, assessed with prospective daily symptom ratings.
The study also reported a positive association between previous psychological
treatment for PMDD and higher depressive symptoms in the late luteal phase
and suicidal behavior, and a negative association between higher ratings of self-
rated health and suicidal ideation among women with PMDD. 
Those findings lend support to previous reports on high prevalence of suicidal
ideation among PMDD with retrospective assessment of PMDD. The authors
interpreted the observed association for previous psychological treatment and
depressive symptoms in the late luteal phase cautiously in the "discussion" by
noting that those women with PMDD probably had severe symptomology. 
The manuscript was well-written, clear and brief. The findings are natural, and
the conclusions are logical. I have three general comments:
Firstly, the suicidal behavior was assessed in the late luteal phase, which is also
the time window when women with PMDD have symptom manifestation. It
would add more highlights to the paper with the prevalence of suicidal ideation
during the symptom-free days, if the data allows. The potentially varying
prevalence of suicidal ideation across the menstrual cycle among women with
PMDD could be of great interest to both the readers and future research given
the cyclicity of premenstrual symptoms.
Secondly, one of the main findings was the crude association between depressive
symptom score during late luteal phase, measured with MADRS-S, and suicidal
ideation among women with PMDD. Meanwhile, depression is also one of the
core affective symptoms of PMDD. It would be very interesting to see how
different symptoms of PMDD, measured by DRSP, both physical ones and
affective ones, correlates with suicidal ideation among women with PMDD. 
Lastly, the study utilized many scales and questionnaires. It's generally important
to offer information on the validity of the questionnaires (e.g., sensitivity,
specificity).
Some minor comments are as follows:
"Introduction"
1. P3, line 57-63: The first paragraph gives a short introduction of PMDD. It
should be re-organized in a better way. Perhaps considering moving up the last
sentence on psychological symptoms of PMDD to the second sentence so that it
starts with the symptoms, then functional impairment, then comorbidities and
lastly prevalence of the studied disease.
2. One prospective register-based cohort study in Sweden published on BMC
Med recently (DOI https://doi.org/10.1186/s12916-021-01989-4) suggested an
association between premenstrual disorders and suicidal behavior, which is one
milestone in this topic should be acknowledged in the background. 
"Materials and methods"
3. P4, line 102: some characteristics included in the study, such as age,
education etc., are rather demographic characteristics or psychosocial and health
characteristics. Please update it throughout the manuscript.
"Results"
4. P6, line 142: what kind of "other reasons?", one example would be helpful for
readers to grasp the idea.
5. P6, line 146: change eighty-three to numbers 
6. P6, line 154-155: This sentence is a bit misleading. The study population is
clearly defined as women with PMDD or PMDD patients. 
7. P6, line 156: It's wrong to say "associated with lower odds ratios" when
interpretating results from logistic regression. I suggest changing to "were
negatively associated with suicidal ideation".
8. P6, line 157-159: please specify "among women with PMDD".
"Discussion"
9. P7, line 177-178: previous hospitalization of psychiatric disorders was
excluded at the enrollment stage, which means the "self-reported history of
depression" (or anxiety) was mild to moderate depression. It would be helpful to
brief the readers the reasons that previous hospitalization of psychiatric
disorders, including depression and anxiety was one of the exclusion criteria, but
not a previous diagnosis of psychiatric disorders.
10. P7, line 182-183: the biggest concern on retrospective diagnosis of PMDD is
the validity. 
11. P7, line 183-184: this sentence can be misleading. Firstly, suicidality is not
one of the diagnostic criteria of PMDD as defined in DSM-V. Moreover,
"confound" has its epidemiological definition and doesn't suit here.
I look forward to reading the authors' response. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes