Journal Article

Premenstrual syndrome and its association with exposure to political violence, human insecurity, and well-being: a cross-sectional study among Palestinian adolescent refugees

Sarhan, Mohammed B. A., Sugiyama, Daisuke, Wakabayashi, Nao, Fuse, Rie, Hammoudeh, Weeam, Fujiya, Rika, Ghandour, Rula

2025

Overview

Background Premenstrual syndrome (PMS) is a common menstruation-related condition among adolescent girls. Vulnerability to environmental and social factors such as living under war, exposure to political violence (EPV), and human insecurity significantly influence the health and well-being of adolescents more generally. However, research on the association between PMS and social determinants in conflict settings remains limited. This study aimed to identify the severity of PMS and its association with EPV, human insecurity, and well-being among adolescent girls in Palestine refugee camps in the West Bank. Methods This cross-sectional study included 1,399 girls aged 15–18 years residing in 19 Palestinian refugee camps in the West Bank, occupied Palestinian territory. PMS severity was measured using a scale developed based on the literature, expert input, and the girls’ experiences, comprising two categories: “none to mild” and “moderate to severe.” EPV was assessed based on past experiences at individual, familial, collective, and cumulative levels. Multivariate analyses were conducted using five regression models with a primary focus on the relationship between PMS severity and EPV. Results The prevalence of PMS with at least one symptom was 92.1%. PMS severity was positively associated with collective EPV (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1–2.1), whereas individual and familial EPV were only significant when included separately in the model. Girls who experienced two or three types of cumulative EPV (AOR, 2.5; 95% CI, 1.6–3.7) were more likely to experience severe PMS. High levels of human insecurity (AOR, 1.3; 95% CI, 1.0–1.6) and depression-like symptoms (AOR, 1.9; 95% CI, 1.3–2.7) were significantly associated with PMS severity. Conclusions The results demonstrate a significant association between PMS severity and EPV, human insecurity, and low levels of well-being. These findings suggest that prolonged occupation and unresolved conflict may adversely impact adolescent health and exacerbate PMS symptoms, highlighting the need to recognize PMS as a public health concern. In protracted conflict settings, integrating psychosocial support and menstrual health education into schools and community-based programs such as primary healthcare facilities may help adolescent girls manage PMS, menstruation-related symptoms, and associated stressors more effectively. Plain English summary Premenstrual syndrome (PMS) is a common symptom among adolescent girls occurring before menstruation, causing physical and mental symptoms such as headaches and low mood. PMS is not only related to lifestyle but also to trauma and the surrounding environmental and social conditions. People in Palestine have been exposed to political violence caused by long-term occupation and war for several decades, including restrictions on movement, economic instability, and daily insecurity. Political violence includes violence against individuals, such as home invasions and humiliation by soldiers; against families, such as imprisonment, injury, and the loss of family members; and against collectives, such as witnessing or hearing about political violence. Herein, we investigated the relationship between PMS severity and exposure to political violence (EPV), sense of insecurity, and well-being. We conducted home visits with adolescent girls aged 15–18 years living in refugee camps in the West Bank of Palestine. The results showed that 92.1% of girls experienced PMS symptoms, with PMS severity associated with EPV, high levels of insecurity, and low level of well-being. Furthermore, the presence of more types of EPV was strongly associated with PMS severity. These findings demonstrate the potential impact of long-term occupation and conflict on adolescent health, highlighting the need to address PMS as an important adolescent health issue, beyond simply causing discomfort. Integrated psychosocial support and menstrual health education in community- and school-based settings may enable adolescent girls to enhance their coping skills and manage menstruation-related symptoms, including PMS.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adolescent / Adolescents’ sexual reproductive health / Arabs / Cross-Sectional Studies / Exposure to political violence / Exposure to Violence - psychology / Female / Health aspects / Human insecurity / Humans / Maternal and Child Health / Medicine / Medicine & Public Health / Menstruation / Middle East - epidemiology / Palestinian refugees / Pediatric research / Political violence / Politics / Premenstrual syndrome / Premenstrual Syndrome - epidemiology / Premenstrual Syndrome - psychology / Prevalence / Psychological aspects / Public Health / Refugee camps / Refugees - psychology / Refugees - statistics & numerical data / Reproductive Medicine / Security (Psychology) / Social aspects / Teenage girls