Psychological Medicine

Original Articles

Health advantage for black women: patterns in pre-menstrual dysphoric disorder

C. E. Pilvera1 c1, S. Kasla2, R. Desaia1a3 and B. R. Levya2

a1 Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA

a2 Yale School of Public Health, New Haven, CT, USA

a3 National Center for PTSD, West Haven, CT, USA


Background Pre-menstrual dysphoric disorder (PMDD) is commonly studied in white women; consequently, it is unclear whether the prevalence of PMDD varies by race. Although a substantial proportion of black women report symptoms of PMDD, the Biocultural Model of Women's Health and research on other psychiatric disorders suggest that black women may be less likely than white women to experience PMDD in their lifetimes.

Method Multivariate multinomial logistic regression modeling was used with a sample of 2590 English-speaking, pre-menopausal American women (aged 18–40 years) who participated in the Collaborative Psychiatric Epidemiology Surveys in 2001–2003. The sample consisted of 1672 black women and 918 white women. The measure of PMDD yields a provisional diagnosis of PMDD consistent with DSM-IV criteria.

Results Black women were significantly less likely than white women to experience PMDD [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.25–0.79] and pre-menstrual symptoms (OR 0.64, 95% CI 0.47–0.88) in their lifetimes, independently of marital status, employment status, educational attainment, smoking status, body mass index, history of oral contraceptive use, current age, income, history of past-month mood disorder, and a measure of social desirability. The prevalence of PMDD was 2.9% among black women and 4.4% among white women.

Conclusions This study showed for the first time that black women were less likely than white women to experience PMDD and pre-menstrual symptoms, independently of relevant biological, social-contextual and psychological risk factors. This suggests that PMDD may be an exception to the usual direction of racial disparities in health. Further research is needed to determine the mechanisms that explain this health advantage.

(Received May 27 2010)

(Revised October 20 2010)

(Accepted October 26 2010)

(Online publication November 26 2010)


c1 Address for correspondence: C. E. Pilver, Ph.D., Department of Psychiatry, Yale University School of Medicine, VA CT Healthcare System: NEPEC/182, 950 Campbell Avenue, West Haven, CT 06516, USA. (Email: