Cycles of risk: Associations between menstrual cycle and suicidal ideation among women April Smith a,⇑ , Saul Miller b , Lindsay Bodell c , Jessica Ribeiro c , Thomas Joiner Jr. c , Jon Maner d a Department of Psychology, Miami University, 90 N. Patterson Drive, Oxford, OH 45056, USA b Department of Psychology, University of Kentucky, 106-B Kastle Hall, Lexington, KY 40506, USA c Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA d Kellogg School of Management, Northwestern University, 2001 Sheridan Rd, Evanston, IL 60208, USA article info Article history: Received 6 May 2014 Received in revised form 23 September 2014 Accepted 28 September 2014 Available online 21 October 2014 Keywords: Interpersonal theory of suicide Suicidal ideation Menstrual cycle Progesterone Prolactin abstract The current study examined associations between cyclic variation in hormone levels and perceived bur- densomeness and thwarted belongingness – two determinants of suicidal ideation. Nineteen participants who experienced suicidal ideation and had normal menstrual cycles were selected out of 1482 college students and completed a series of on-line questionnaires every other day for 1 month. Menstrual cycle status, depressive symptoms, and feelings of perceived burdensomeness and thwarted belongingness were assessed. Hormone levels were estimated based on standardized actuarial data. Lower levels of pro- gesterone were associated with greater feelings of burdensomeness. Perceived burdensomeness was also greater during the follicular phase than the luteal phase. Additionally, lower levels of prolactin were asso- ciated with both increased feelings of burdensomeness and thwarted belongingness; however, these associations were not significant after controlling for depression. Results suggest that hormonal variation is associated with the determinants of suicidal ideation and provide further explanation for associations found between the menstrual cycle and suicide risk. Ó 2014 Elsevier Ltd. All rights reserved. 1. Introduction Research investigating the hormonal underpinnings of suicidal- ity is still nascent; however, there have been some noteworthy results regarding the relationship between the menstrual cycle, hormone levels, and suicidality. In their review of 44 published studies on suicidal behavior and the menstrual cycle, Saunders and Hawton (2006) found that, among studies that included sui- cide attempts as a dependent variable, the majority (15 out of 23) observed a greater prevalence of suicide attempts during the late luteal and follicular phases of the menstrual cycle. Further, all three studies examining suicidal ideation across the menstrual cycle found higher levels of ideation during menstruation. The menstrual cycle is characterized by dramatic fluctuations in sev- eral hormones, so such findings provide support for an association between hormonal factors and suicidal ideation and behavior. Baca-Garcia, Diaz-Sastre, de Leon, and Saiz-Ruiz (2000) and Baca-Garcia et al. (2010) have conducted several studies more spe- cifically investigating changes in suicidal behavior across the men- strual cycle. In one of their earlier studies they found that suicide attempts occurred more frequently during the follicular phase of the menstrual cycle as compared to other phases of the cycle (Baca-Garcia et al., 2000). In a more recent study of a large sample of women who had been hospitalized following a suicide attempt, Baca-Garcia et al. (2010) found that suicide attempts were more likely to occur early in the follicular phase, during menses, which is typically when gonadal hormones, such as progesterone, are low. Further, Pompili et al. (2012) found prolactin levels were lower in female attempters compared to female non-attempters in an inpatient sample. This is notable given that prolactin levels are low during the follicular phase, and in particular during menses (Franchimont et al., 1976). Thus, it appears that the follicular phase, when both progesterone and prolactin levels are low, may be associated with increased suicide risk among normally cycling women. Research on progesterone and anxiety provides some insights into a potential mechanism for the relationship between proges- terone and suicidal behavior and ideation. For instance, studies have found that levels of progesterone and progesterone derived hormones (e.g., allopregnanolone) have anxiolytic effects (Soderpalm, Lindsey, Purdy, Hauger, & Witde, 2004; Timby et al., 2006; Wieland, Lan, Mirasedeghi, & Gee, 1991). As such, it is possi- ble that when progesterone levels are low (i.e., during the follicular http://dx.doi.org/10.1016/j.paid.2014.09.043 0191-8869/Ó 2014 Elsevier Ltd. All rights reserved. ⇑ Corresponding author. Tel.: +1 513 529 3751; fax: +1 513 529 2420. E-mail address: aprilsmith@miamioh.edu (A. Smith). Personality and Individual Differences 74 (2015) 35–40 Contents lists available at ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid