DASS-21 Stress, but Not Anxiety or Depression, Is Associated with Premenstrual Stress

Background/Objectives: Most women experience premenstrual symptoms. We examined how the eleven DSM-5 premenstrual symptoms relate to concurrent indicators of psychological distress. Methods: In this retrospective cross-sectional study, 847 participants completed a premenstrual symptom checklist and the DASS-21 between 2011 and 2021. Associations between each DSM-5 premenstrual symptom and DASS-21 depression, anxiety, and stress scores were estimated using univariable and multivariable models, adjusting for the other two DASS-21 subscales and prespecified confounders. Results: Eight of the eleven premenstrual symptoms, loss of interest, impaired concentration, depressed mood (p < 0.01), loss of control, anxiety, sleep disturbance, emotional lability, and irritability (p < 0.05), were independently associated with higher DASS-21 stress scores. After adjusting for stress, no associations were observed with DASS-21 anxiety or DASS-21 depression. Conclusions: In this sample, stress was the principal psychological correlate of multiple premenstrual symptoms. These findings indicate co-occurrence rather than causation: the cross-sectional design does not establish directionality, and the observed patterns are compatible with several possibilities (such as stress contributing to, resulting from, or sharing common determinants with premenstrual symptoms). The lack of independent associations with DASS-21 anxiety and depression suggests these symptoms are not merely concurrent expressions of acute anxiety or depressive states. Prospective longitudinal studies are needed to test causal pathways.