What psychosocial and behavioral factors are linked to worse PMDD symptoms?

Background Premenstrual Dysphoric Disorder (PMDD) is seen by some as a severe form of PMS, which significantly impacts daily life. While psychosocial and behavioural factors are thought to influence symptom severity, prior research has relied on cross-sectional designs. Aims This systematic review aimed to (1) identify tools and measures used to assess psychosocial and behavioural risk or protective factors in relation to PMDD symptom severity, and (2) to examine relationships between psychosocial or behavioural risk factors and PMDD symptom severity, which have been identified using intensive longitudinal methods. Methods A protocol was pre-registered (PROSPERO ID: CRD42023410126) and MEDLINE, Web of Science, Embase, CINAHL, and PsycINFO were searched. Eligible studies included reproductive-age participants, validated PMDD measures and intensive longitudinal methodologies. Data were extracted independently and quality assessed using the JBI critical appraisal tool. Due to heterogeneity, narrative synthesis with effect direction plots was conducted. Results 13,507 records were screened and 12 studies (N = 2486 participants) were included. Nine PMDD measurements were used, most commonly the Daily Record of Severity of Problems. Substantial heterogeneity in study design, inclusion/exclusion criteria, and calculation of PMDD variables limited comparability. Consistent evidence linked family history of PMS, dysmenorrhea, and earlier menarche to higher PMDD symptom severity. Associations with depression, daily stress, and exercise were mixed, while smoking showed no clear relationship. Conclusions Evidence suggests psychosocial and behavioural factors may influence PMDD severity, but methodological inconsistencies restrict conclusions. Standardised, DSM-aligned measures, broader inclusion criteria, and transparent reporting are essential to advance the field.

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