Patient Perspectives of Healthcare for Premenstrual Dysphoric Disorder in Australia: A Mixed-Methods Study.

Background: Premenstrual Dysphoric Disorder (PMDD) is associated with higher suicidality and reduced functioning. Diagnosis and treatment can improve symptoms and quality of life. Poor quality healthcare experiences for people seeking help for PMDD have been documented in other countries, but not in Australia. Objective: To quantitatively and qualitatively describe experiences of healthcare for PMDD in Australia, including variations in experience by healthcare provider (HCP) type. Methods: We employed mixed methods including an online survey and semi-structured interviews in adults who had sought healthcare in Australia for PMDD symptoms. Quantitative data was analysed using descriptive statistics, chi-square analyses, t-tests, and multilevel logistic modelling. Qualitative data was analysed using reflexive thematic analysis. Results: Survey participants (n = 267) had sought help from an average of 5.1 different HCPs in seeking PMDD diagnosis and perceived an average of 51% of HCPs they had seen to have poor PMDD awareness. GPs were the most frequent HCP type seen first (74%) when seeking diagnosis. More than half reported experiencing medical gaslighting (54%) and misdiagnosis (56%). Interview participants (n = 11) reported misdiagnoses such as depression, anxiety, bipolar disorder, and personality disorders. Interview participants reported feeling that their symptoms were minimised by healthcare providers and that their health care concerns were dismissed. Participants were more likely to report poorer experiences with GPs compared to other HCP types. Less than a fifth of the survey sample (19%) had experienced diagnostic methods consistent with DSM-TR recommendations. Diagnosis was described by interview participants as resulting in increased coping, a mindset of self-compassion and reduced self-perceptions of feeling 'crazy' or having fundamental personality flaws. Conclusions: People in Australia face similar PMDD healthcare barriers to those documented elsewhere. GP training in PMDD screening and clearer patient care pathways with specialist referral are needed to improve healthcare provision and reduce the burden of PMDD.