Perimenstrual Hormone Withdrawal, Executive Functioning, and Proximal Suicide Risk: An Experimental Approach

• Applicant: Dr. Katja Schmalenberger
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology ; Biological Psychology and Cognitive Neuroscience
• Term: from 2021 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 470147139

Suicide, suicidal thoughts and nonfatal suicidal behaviors are worldwide, major public health problems with potentially devastating effects on individuals, families, and communities. Despite extensive research, our ability to predict or prevent suicide has not sufficiently improved in several decades. There remains an urgent need to further our understanding of the mechanisms underlying suicidality – in particular factors contributing to heightened proximal suicide risk (as opposed to lifetime suicide risk). Since correlational studies suggest that suicide and suicide attempts in women of fertile age occur more frequently in the weeks surrounding the onset of menses (“perimenstrual” phase), fluctuations in the ovarian hormones estradiol (E2) and progesterone (P4) just might be such a predictor. In fact, the pilot study for the proposed research project provides the first experimental support for the premise that E2 and P4 withdrawal (which characterizes the perimenstrual phase) increases proximal suicide risk. However, the mechanisms underlying this effect remain unclear. Given that the perimenstrual phase is also associated with an impairment of executive functions (a set of cognitive processes enabling us to engage in goal- and future-oriented behavior) and, in turn, this cognitive impairment is linked to heightened suicide risk, the perimenstrual hormone withdrawal effect on proximal suicide risk might be mediated by impairment of executive functioning. The proposed study will be the first to empirically test this hypothesis. To do so, in a placebo-controlled experiment, 90 female outpatients with past-month suicidal ideation will complete two counterbalanced perimenstrual conditions: (1) natural perimenstrual hormone withdrawal with placebo patches and pills (placebo condition), and (2) prevention of perimenstrual hormone withdrawal via administration of exogenous hormones (E2 patches, P4 pills; experimental condition). Each of the ten laboratory visits will assess participant’s (a) levels of ovarian hormones via blood samples, (b) the core executive functions (working memory, inhibition, and shifting) via objective tasks, (c) and proximal suicide risk (ideation, planning, intent, non-suicidal self-injury, attempts) via self-report. Whether it is the impairment of executive functions that underlies the perimenstrual increase in suicide risk will be tested by means of multilevel models and mediational analyses. In any case, the study will clarify which processes play a role in perimenstrually heightened suicide risk (and, possibly, which do not) and, thus, support the highly important search for malleable targets in the treatment of imminently increased suicide risk.

• DFG Programme: WBP Fellowship
• International Connection: USA
• Host: Professorin Dr. Tory Eisenlohr-Moul