Abstract
A large portion of reproductive-aged women report experiencing distressing premenstrual symptoms. These symptoms can be exacerbated by concurrent mood problems and contribute to long-term depressive risk. However, difficulty sleeping and regulating emotional responses are also associated with the premenstrual phase and represent additional, well-established risk factors for depression. The aim of this study was to investigate whether habitual sleep problems and emotion regulation strategies serve to mediate the relationship between mood and premenstrual symptoms in non-treatment–seeking young women. Participants included 265 adult women between the ages of 18 and 25 who provided retrospective self-reports of depressive symptoms, habitual sleep quality, and premenstrual symptoms for the past month. Trait-based difficulties in regulating emotions were also assessed. Greater depressive symptoms significantly predicted greater premenstrual symptoms and both poor sleep and ineffective emotion regulation were shown to mediate this relationship. Poor sleep may enhance experience of premenstrual symptoms via its well-established impact on physical, cognitive, and/or affective functioning. Similarly, an inability to effectively regulate emotional responses in general may exacerbate experience or perception of somatic and mood symptoms during the premenstrual period, contributing to mood disturbances and risk. Findings require replication in future studies using prospective designs and more diverse samples of women.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Total CESD was computed with and without the item addressing sleep.
Total MDQ was computed with and without 2 items which addressed depression and naps
Analyses including only participants with no missing data, and reduced scales (with overlapping items removed) are available in supplemental file.
References
Acikgoz A, Dayi A, Binbay T (2017) Prevalence of premenstrual syndrome and its relationship to depressive symptoms in first-year university students. Saudi Med J 38:1125–1131. https://doi.org/10.15537/smj.2017.11.20526
Aldao A, Nolen-Hoeksema S, Schweizer S (2010) Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev 30:217–237. https://doi.org/10.1016/j.cpr.2009.11.004
Baker FC, Driver HS (2007) Circadian rhythms, sleep, and the menstrual cycle. Sleep Med 8:613–622. https://doi.org/10.1016/j.sleep.2006.09.011
Baker FC, Sassoon SA, Kahan T, Palaniappan L, Nicholas CL, Trinder J, Colrain IM (2012) Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome. J Sleep Res 21:535–545. https://doi.org/10.1111/j.1365-2869.2012.01007.x
Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182
Biggs WS, Demuth RH (2011) Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician 84:918–924
Bowen R, Bowen A, Baetz M, Wagner J, Pierson R (2011) Mood instability in women with premenstrual syndrome. J Obstet Gynaecol Can : JOGC = J d'obstetrique et gynecologie du Canada : JOGC 33:927–934
Chue AE, Gunthert KC, Kim RW, Alfano CA, Ruggiero AR (2018) The role of sleep in adolescents’ daily stress recovery: negative affect spillover and positive affect bounce-back effects. J Adolesc 66:101–111. https://doi.org/10.1016/j.adolescence.2018.05.006
Cohen LH, Gunthert KC, Butler AC, O'Neill SC, Tolpin LH (2005) Daily affective reactivity as a prospective predictor of depressive symptoms. J Pers 73:1687–1713. https://doi.org/10.1111/j.0022-3506.2005.00363.x
de Wild-Hartmann JA, Wichers M, van Bemmel AL, Derom C, Thiery E, Jacobs N, van Os J, Simons CJP (2013) Day-to-day associations between subjective sleep and affect in regard to future depression in a female population-based sample. Br J Psychiatry J Ment Sci 202:407–412. https://doi.org/10.1192/bjp.bp.112.123794
Faul F, Erdfelder D, Lang A, Buchner A (2009) G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191
Ford DE, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention. Jama 262:1479–1484
Forquer LM, Camden AE, Gabriau KM, Johnson CM (2008) Sleep patterns of college students at a public university. J Am Coll Health : J ACH 56:563–565. https://doi.org/10.3200/jach.56.5.563-565
Forrester-Knauss C, Zemp Stutz E, Weiss C, Tschudin S (2011) The interrelation between premenstrual syndrome and major depression: results from a population-based sample. BMC Public Health 11:795. https://doi.org/10.1186/1471-2458-11-795
Gratz KL, Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26:41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gujar N, Yoo SS, Hu P, Walker MP (2011) Sleep deprivation amplifies reactivity of brain reward networks, biasing the appraisal of positive emotional experiences. J Neurosci 31:4466–4474. https://doi.org/10.1523/jneurosci.3220-10.2011
Halbreich U, Borenstein J, Pearlstein T, Kahn LS (2003) The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 28(Suppl 3):1–23
Haley CL, Sung SC, Rush AJ, Trivedi MH, Wisniewski SR, Luther JF, Kornstein SG (2013) The clinical relevance of self-reported premenstrual worsening of depressive symptoms in the management of depressed outpatients: a STAR*D report. J Women's Health 22:219–229. https://doi.org/10.1089/jwh.2011.3186
Harvey A, Alfano CA, Clarke G (2013) Mood Disorders. In: Wolfson A, Montgomery-Downs H (eds) The Oxford Handbook of Infant, Child, and Adolescent Sleep: Development and Problems. Oxford University Press, New York, NY
Hayes AF (2017) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford Press
Kalmbach DA, Pillai V, Roth T, Drake CL (2014) The interplay between daily affect and sleep: a 2-week study of young women. J Sleep Res 23:636–645. https://doi.org/10.1111/jsr.12190
Killgore WD (2010) Effects of sleep deprivation on cognition. Prog Brain Res 185:105–129. https://doi.org/10.1016/b978-0-444-53702-7.00007-5
Kornstein SG et al (2005) Self-reported premenstrual exacerbation of depressive symptoms in patients seeking treatment for major depression. Psychol Med 35:683–692
Larson RA, Carter JR (2016) Total sleep deprivation and pain perception during cold noxious stimuli in humans. Scand J Pain 13:12–16. https://doi.org/10.1016/j.sjpain.2016.05.037
Liu Q, Wang Y, van Heck CH, Qiao W (2017) Stress reactivity and emotion in premenstrual syndrome. Neuropsychiatr Dis Treat 13:1597–1602. https://doi.org/10.2147/ndt.s132001
Lusk BR, Carr AR, Ranson VA, Felmingham KL (2017) Women in the midluteal phase of the menstrual cycle have difficulty suppressing the processing of negative emotional stimuli: an event-related potential study. Cogn Affect Behav Neurosci 17:886–903. https://doi.org/10.3758/s13415-017-0520-1
Mishell DR Jr (2005) Premenstrual disorders: epidemiology and disease burden. Am J Manag Care 11:S473–S479
Moos RH (1968) The development of a menstrual distress questionnaire. Psychosom Med 30:853–867
National Sleep Foundation (2007) Stressed-out American women have no time for sleep: findings from Sleep in America Poll 2007 [Press Release]
Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, Dauvilliers Y, Ferri R, Fung C, Gozal D, Hazen N, Krystal A, Lichstein K, Mallampalli M, Plazzi G, Rawding R, Scheer FA, Somers V, Vitiello MV (2017) National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health 3:6–19. https://doi.org/10.1016/j.sleh.2016.11.006
Ossewaarde L, van Wingen GA, Rijpkema M, Bäckström T, Hermans EJ, Fernández G (2013) Menstrual cycle-related changes in amygdala morphology are associated with changes in stress sensitivity. Hum Brain Mapp 34:1187–1193
Owens H, Christian B, Polivka B (2017) Sleep behaviors in traditional-age college students: a state of the science review with implications for practice. J Am Assoc Nurse Pract 29:695–703. https://doi.org/10.1002/2327-6924.12520
Palmer CA, Alfano CA (2017) Sleep and emotion regulation: an organizing, integrative review. Sleep Med Rev 31:6–16. https://doi.org/10.1016/j.smrv.2015.12.006
Patel V, Tanksale V, Sahasrabhojanee M, Gupte S, Nevrekar P (2006) The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, India. BJOG :Int J Obstet Gynaecol 113:453–463. https://doi.org/10.1111/j.1471-0528.2006.00874.x
Petersen N, London ED, Liang L, Ghahremani DG, Gerards R, Goldman L, Rapkin AJ (2016) Emotion regulation in women with premenstrual dysphoric disorder. Arch Women's Mental Health 19:891–898. https://doi.org/10.1007/s00737-016-0634-4
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401 http://purl.umn.edu/98561
Radloff LS (1991) The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. J Youth Adolesc 20:149–166. https://doi.org/10.1007/bf01537606
Sharkey KM, Crawford SL, Kim S, Joffe H (2014) Objective sleep interruption and reproductive hormone dynamics in the menstrual cycle. Sleep Med 15:688–693. https://doi.org/10.1016/j.sleep.2014.02.003
Sigmon S, Schartal J, Hermann B, Cassel A, Thrope G (2009) The relationship between premenstrual distress and anxiety sensitivity: the mediating role of rumination |Springer Link. J Ration Emot Cogn Behav Ther 27:188–200. https://doi.org/10.1007/s10942-009-0100-6
Sundstrom-Poromaa I (2018) The menstrual cycle influences emotion but has limited effect on cognitive function. Vitam Horm 107:349–376. https://doi.org/10.1016/bs.vh.2018.01.016
Watling J, Pawlik B, Scott K, Booth S, Short MA (2017) Sleep loss and affective functioning: more than just mood. Behav Sleep Med 15:394–409. https://doi.org/10.1080/15402002.2016.1141770
Welz A, Huffziger S, Reinhard I, Alpers GW, Ebner-Priemer U, Kuehner C (2016) Anxiety and rumination moderate menstrual cycle effects on mood in daily life. Women Health 56:540–560. https://doi.org/10.1080/03630242.2015.1101739
Wilson DR, Widmer RB, Cadoret RJ, Judiesch K (1983) Somatic symptoms. A major feature of depression in a family practice. J Affect Disord 5:199–207
Woosley J, Lichstein K (2014) Dysmenorrhea, the menstrual cycle, and sleep. Behav Med 40:14–21. https://doi.org/10.1080/08964289.2013.829020
Wu M, Zhou R, Huang Y (2014) Effects of menstrual cycle and neuroticism on females’ emotion regulation. Int J Psychophysiol: Off J Int Org Psychophysiol 94:351–357. https://doi.org/10.1016/j.ijpsycho.2014.10.003
Wu M, Liang Y, Wang Q, Zhao Y, Zhou R (2016) Emotion dysregulation of women with premenstrual syndrome. Sci Rep 6. https://doi.org/10.1038/srep38501
Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP (2007) The human emotional brain without sleep—a prefrontal amygdala disconnect. In: Curr Biol, Vol 17. Vol 20. England, pp R877-878. https://doi.org/10.1016/j.cub.2007.08.007
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Meers, J.M., Bower, J.L. & Alfano, C.A. Poor sleep and emotion dysregulation mediate the association between depressive and premenstrual symptoms in young adult women. Arch Womens Ment Health 23, 351–359 (2020). https://doi.org/10.1007/s00737-019-00984-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-019-00984-2