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Arch Womens Ment Health
DOI 10.1007/s00737-013-0375-6
ORIGINAL ARTICLE
The Iranian version of the Premenstrual Symptoms Screening
Tool (PSST): a validation study
Fatemeh Zahra Hariri & Lida Moghaddam-Banaem &
Shiva Siah Bazi & Amal Saki Malehi & Ali Montazeri
Received: 9 October 2012 / Accepted: 5 August 2013
# Springer-Verlag Wien 2013
Abstract The objective of the current study was to translate
and test psychometric properties of the Premenstrual Symp-
toms Screening Tool (PSST) in Iran. Using a standard “for-
ward–backward” procedure, the English version of PSST was
translated into Persian. A random sample of university stu-
dents aged 18 years and over completed the questionnaire in
Tehran, Iran. Psychometric properties of the Iranian version of
PSST were assessed by performing reliability (internal con-
sistency) and validity analyses [Content Validity Ratio (CVR)
and Content Validity Index (CVI)]. In all, 925 female students
took part in the study. Of these, 284 (30.7 %) had premenstrual
syndrome (PMS) and 119 (12.9 %) had premenstrual dys-
phoric disorder (PMDD). Reliability of the PSST as measured
by internal consistency was found to be satisfactory
(Cronbach’s alpha coefficient, 0.93). The content validity as
assessed by CVR and CVI were desirable (0.7 and 0.8, re-
spectively). The Iranian version of PSST seems to be a reliable
F. Z. Hariri : L. Moghaddam-Banaem : S. Siah Bazi
Department of Midwifery and Reproductive Health, Faculty of
Medical Sciences, Tarbiat Modares University, Tehran, Iran
F. Z. Hariri
e-mail: Fatemehzahra_hariri@yahoo.com
L. Moghaddam-Banaem
e-mail: moghaddamb@modares.ac.ir
S. Siah Bazi
e-mail: shiva_siahbazi@yahoo.com
A. Saki Malehi
Department of Biostatistics, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran
e-mail: a.saki@modares.ac.ir
A. Montazeri (*)
Mental Health Research Group, Health Metrics Research Center,
Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
e-mail: montazeri@acecr.ac.ir
and valid measure of detecting PMS and PMDD in Iranian
young female populations.
Keywords Premenstrual Symptoms Screening Tool .
Validation study . Iran
Introduction
The cyclic nature of the female reproductive function is a
natural part of a woman’s life and this cyclic hormonal func-
tioning is accompanied by changes in several physical and
psychological aspects (Gonda et al. 2008). These changes
vary extremely in severity and between individuals and can
cause deterioration of interpersonal relations or interfere with
normal activities. These physiological and psychological
changes are described as premenstrual syndrome (He et al.
2009; Gonda et al. 2008; Reed et al. 2008). The typical
definition of premenstrual syndrome (PMS) is a collection of
recurrent physical, psychological, and emotional symptoms
related to menstrual cycles. These symptoms occur during
luteal phase and disappear at or within a few days of the onset
of menstruation (Reed et al. 2008; Berek 2007; Braverman
2007; Speroff and Fritz 2005). More than 80 % of women
experience one of the premenstrual symptoms as defined by
International Classification of Diseases-10 (He et al. 2009). It
is estimated that clinically significant PMS (moderate to se-
vere) occurs in 20–50 % of women (Pearlstein and Steiner
2008). The more severe form of PMS is known as premen-
strual disphoric disorder (PMDD) and 3–8 % of women may
experience it. PMDD includes severe symptoms that may
have serious impacts on individuals, their families, and their
relationships (Halbreich et al. 2003). Diagnostic criteria for
PMS and PMDD are shown in Boxes 1 and 2 (American
College of Obstetricians and Gynecologists 2000; American
Psychiatric Association 2000).

Box 1. American College of Obstetricians and Gynecolo-
gist diagnostic criteria for PMS
A. Patient reports one or more of the following affective and somatic
symptoms during 5 days before menses in each of three prior
menstrual cycles
Affective
Depression
Angry outbursts
Anxiety
Irritability
Confusion
Social withdrawal
Somatic
Breast tenderness
Abdominal bloating
Headache
Swelling of extremities
B. Symptoms relived within 4 days of menses onset without recurrence
until at least cycle day 13
C. Symptoms present in absence of any pharmacologic therapy, hormone
ingestion or drug or alcohol abuse
D. Symptoms occur reproducibly during 2 cycles of prospective recording
E. Patient suffers from identifiable dysfunction in social or economic
performance
Box 2. Diagnostic and Statistical Manual of Mental Disor-
ders criteria (DSM-IV) diagnostic criteria for PMDD
A. In most menstrual cycles, five (or more) of the following symptoms are
present, with at least one of the symptoms being either 1, 2, 3 or 4:
1. Markedly depressed mood, feelings of hopelessness or self-
depreciatory thoughts
2. Marked anxiety, tension, feeling of being “keyed up” or “on edge”
3. Marked affective lability (e.g., feeling suddenly sad or tearful or with
increased sensitivity to rejection)
4. Persistent and marked anger or irritability or increased interpersonal
conflicts
5. Subjective sense of difficulty in concentrating
6. Decreased interest in usual activities (e.g., work, school, friends,
hobbies)
7. Lethargy, easy fatigability or marked lack of energy
8. Marked change in appetite, overeating or specific food cravings
9. Hypersomnia or insomnia
10. A sense of being overwhelmed or out of control
11. Other physical symptoms, such as breast tenderness or swelling,
headaches, joint or muscle pain, a sensation of “bloating”, weight gain
B. Symptoms markedly Interference with work, school or social
relationships
C. Symptoms of PMDD must be present for most of the time during the
last week of the luteal phase (premenses) and absent during the week
after menses
D. The disturbance cannot be merely an exacerbation of the symptoms of
another disorder
E. The first three criteria must be Confirmation by prospective daily
ratings for two consecutive menstrual cycles
F.Z. Hariri et al.
The traditional way to diagnose PMS or PMDD is to fill in a
number of charts about the occurrence of different physical and
psychological symptoms by women at least for two consecutive
menstrual cycles. Studies have shown that women usually refuse
daily charting or few women agree to complete daily charting
(Takeda et al. 2006; Johnson 2004). Among different measures to
identify who suffer from PMS/PMDD, the Premenstrual Symp-
toms Screening Tool (PSST) is a well-known instrument and
includes a list of premenstrual symptoms as well as a measure of
impairment in accordance with the DSM-IV for PMDD. In fact,
it reflects and translates categorical DSM-IV criteria into a rating
scale of severity. It is believed that the PSST detects severity
and impact of premenstrual symptoms, establishes quickly if
women qualify for PMS or PMDD, and is less time consuming
and more practical than two cycles of prospective charting. The
aim of devising the questionnaire was to make a simple user-
friendly screening tool to identify women who suffer from
severe PMS/PMDD and who are likely to benefit from treat-
ment. Steiner et al. developed this instrument and McMaster
University holds the copyright (Steiner et al. 2003).
The PSST has been used in different countries. Validated
translations of this questionnaire are available in Hindu for
India, Polish, Italian, Spanish for Venezuela, Korean, Chinese
(mainland), Swedish, and Thai. Nonvalidated translations are
available in Chinese for Taiwan, French, German, Japanese,
Portuguese, Romanian, and Spanish (Flintbox 2012; Tschudin
et al. 2010; Chayachinda et al. 2008; Kayatekin et al. 2008;
Tschudin et al. 2007; Takeda et al. 2006). Potential
applications for the PSST include diagnostic purposes,
clinical and academic research, and clinical trials (eval-
uating prevalence of PMS/PMDD and effect of different
treatments, etc.). Considering its different applications,
this study was conducted to provide the Persian version
of PSST and validate it in Iran.
Methods
Questionnaire
The PSST is a 19-item instrument consisting of two domains:
the first domain includes 14 items related to psychological,
physical, and behavioral symptoms and the second domain (five
items) evaluates the impact of symptoms on women’s function-
ing. Each item is rated on a four-point scale (not at all=0, mild=
1, moderate=2, severe=3). According to the instruction of the
PSST devised by Steiner et al. (2003) for diagnosis of PMS,
from the following 14 symptoms [(1) tension/anxiety, (2)
irritability/anger, (3) depressed mood/hopelessness, (4) tearful/
increased sensitivity to rejection, (5) decreased interest in work
activities, (6) decreased interest in home activities, (7) decreased
interest in social activities, (8) difficulty concentrating, (9)
fatigue/lack of energy, (10) overeating/food cravings, (11)
The Iranian version of the Premenstrual Symptoms Screening Tool
insomnia, (12) hypersomnia, (13) feeling overwhelmed, and
(14) physical symptoms], women must report at least five
symptoms as moderate or severe where at least one should be
from symptoms numbers 1–4 (namely core symptoms). Also,
they must report if their symptoms interfere moderately or
severely with their ability to function in at least one of five
items in the second domain [(a) work efficiency, (b) relation-
ships with coworker (c) relationships with family, (d) social life
activities, and (e) home responsibilities]. For diagnosis of
PMDD, the following criteria must be present: (1) at least one
of the symptoms (1 to 4) as severe; (2) in addition, at least four
of the symptoms (1 to 14) as moderate to severe; and (3) at least
one of a, b, c, d, and e as severe (Steiner et al. 2003).
Translation
The standard “forward–backward” procedure was applied to
translate the PSST from English into Persian. Two health
professionals translated the questionnaire into Persian and
consequently a provisional forward version was provided.
Two other professional translators then did backward transla-
tion. Finally, the provisional version of the Iranian question-
naire was developed and pilot tested to assess the feasibility
and clarity of the items and response categories. Thirty female
students residing in Tehran University dormitories participat-
ed in the pilot study. They were asked to respond to a short
questionnaire to indicate the items that were difficult to un-
derstand, confusing, or offensive. Subsequently, the PSST was
reviewed by a panel of experts and the final version of the
Persian questionnaire was provided.
Study population and data collection
The PSST was distributed between a random sample of 1,300
female students aged 18 and over residing in dormitories of
universities in Tehran. In all, 925 individuals completed the
questionnaire.
Statistical analysis
Reliability To test reliability, the internal consistency was
measured using Cronbach’s alpha coefficient. Cronbach’s
alpha ≥0.7 was considered satisfactory (Nunnally and
Bernstein 1994). In addition, the correlation between the
two domains of the questionnaire was assessed by Pearson
correlation coefficient (r).
Validity Validity of the instrument was evaluated by face
validity and content validity. Content validity was determined
using both qualitative and quantitative methods. To determine
qualitative content validity, a panel of 10 experts was asked to
make comments on items in relation to Persian grammar, word-
ing, item allocation, and scaling and also the accuracy, clarity,
style, and cultural relevance of the translation. Content Validity
Ratio (CVR) and Content Validity Index (CVI) were used to
establish quantitative content validity. For measuring, CVR
members of the expert panel were asked to rate each item as
“essential,” “useful, but not essential,” or “not necessary”. Then,
CVR was calculated to indicate whether the item was pertinent.
The minimum acceptable value of CVR for each item in this
study was set at 0.62. Members of the expert panel also were
asked to rate each item in terms of relevancy, clarity, and sim-
plicity. These item ratings were on a Likert scale from 1 to 4.
Then, for each item, CVI was computed as the number of experts
giving a rating of either 3 or 4 divided by the total number of
experts. The CVI value of ≥0.78 was considered acceptable
(Polit et al. 2007; Grant and Davis 1997; Lawshe 1975).
Ethics
The ethics committee of the Faculty of Medical Sciences of
Tarbiat Modares University approved the study. All partici-
pants gave their verbal consent.
Results
Pilot testing
We conducted a pilot study on 30 female students residing in
Tehran University dormitories to check the face validity of the
translated version of the PSST. There were no problems
regarding either the items or response categories. However, a
few changes were made on the basis of the pretest results.
Ninety percent of the students indicated that there were no
problems in completing the questionnaire. Ninety-six percent
stated that there were no offensive words or phrases in the
questionnaire. According to 83 % of the participants,
there were no confusing or difficult words to under-
stand. The mean time required for completion of the
PSST was 4.5 min (SD=1.5) indicating that the PSST is
an easy-to-use questionnaire.
The study sample
In all, 925 individuals were included in the main study. The
mean (SD) age of participants was 22.58 (±3.16)years and it
was 21.58 (±2.7)kg/m2 for Body Mass Index (BMI). The
mean menstrual cycle length was 28.6 (±3.0)days with 6.3
(±1.39) bleeding days. Menstrual cycle was regular in 85.2 %
of the students and 74.2 % of the students had dysmenorrhea.
Three groups of students were identified. The first group
consisted of 522 (56.4 %) students who experienced no or
mild symptoms of PMS (no/mild PMS group). The second
group included 284 (30.7 %) individuals with PMS whose
symptoms had moderate or severe effects on their daily
 F.Z. Hariri et al.

functions (moderate to severe PMS group). In the third group,
119 (12.9 %) of the students met the DSM-IV criteria for
diagnosis of PMDD (PMDD group). Of all factors studied,
only age, duration of menstrual cycle, and marital status of the
subjects were significantly different between the three groups.
For instance, in subjects who were 26–30 years old, 10.5 %
had no or mild PMS, 16.5 % had moderate to severe PMS, and
22.7 % had PMDD; 7.4 % of the single students had PMDD
whereas 15.1 % of the married ones had PMS (Table 1).
Then, we evaluated the effects of different potential risk
factors of PMS and PMDD including age; BMI; marital status;
duration of menstrual periods and bleedings; dysmenorrhea;
systemic diseases; athletic sports; and consumption of oral
contraceptives, systemic drugs, multivitamins, and minerals
by multinomial regression analysis. Performing multiple lo-
gistic regression analysis, it was found that PMS and PMDD
were significantly associated with age (OR, 1.09; 95 % CI,
1.03–1.14 for PMS; OR, 1.09; 95 % CI, 1.01–1.16 for
PMDD). There was also a significant relationship between
dysmenorrhea and PMS (OR, 2.33; 95 % CI, 1.55–3.5). In
addition, the relationship between PMDD and systemic
diseases (OR, 1.88; 95 % CI, 1.17–3.02) and marital
status (OR, 1.99; 95 % CI, 1.03–3.93 for married women)
were significant (Table 2).

Table 1 Demographic and med-

ical characteristics of the study Total No/mild Moderate to PMDD
sample (n =925) PMS (n =522) severe PMS (n =119)
(n =284)
No. (%) No. (%) No. (%) No. (%)

Age (years)*
≤18 50 (5.4) 38 (7.3) 11 (3.9) 1 (0.8)
19–25 730 (78.9) 418 (80.1)) 222 (78.1) 90 (75.6)
26–30 129 (13.9) 55 (10.5) 47 (16.5) 27 (22.8)
31–35 12 (1.4) 9 (1.7) 3 (1.1) 0 (0)
>35 4 (0.4) 2 (0.4) 1 (0.4) 1 (0.8)
Marital status*
Single 851 (89.1) 487 (93.3) 263 (92.6) 101 (84.9)
Married 74 (10.9) 35 (6.7) 21 (7.4) 18 (15.1)
Field of study
Nonmedical 698 (75.5) 401 (76.8) 211 (74.3) 86 (72.3)
Medical 227 (24.5) 121 (23.2) 73 (25.7) 33 (27.7)
BMI
<18.5 105 (11.4) 59 (11.3) 32 (11.3) 14 (11.8)
≥18.5<25 716 (77.4) 410 (78.5) 214 (75.3) 92 (77.3)
≥25<30 99 (10.7) 52 (10) 35 (12.3) 12 (10.1)
≥30 5 (0.5) 1 (0.2) 3 (1.1) 1 (0.8)
Menstrual status
Regular 787 (85.1) 439 (84.1) 243 (85.6) 105 (88.2)
Irregular 138 (14.9) 83 (15.9) 41 (14.4) 14 (11.8)
Menstrual cycle length (days, n =787)* Missing (n =138)
<23 24 (3) 12 (2.8) 11 (4.5) 1 (1)
≥23≤35 742 (94.3) 408 (92.7) 231 (95.5) 103 (98)
>35 21 (2.7) 20 (4.5) 0 (0) 1 (1)
Length of bleeding Missing (n =5)
(days, n =920)
3–7 806 (87.1) 465 (89.6) 239 (84.5) 102 (86.4)
>7 114 (12.3) 54 (10.4) 44 (15.5) 16 (13.6)
Smoking
No 914 (98.8) 516 (98.9) 281 (98.9) 117 (98.3)
Yes 11 (1.2) 6 (1.1) 3 (1.1) 2 (1.7)
Oral contraception
*P value<0.05, significant dif- No 883 (95.5) 497 (95.2) 274 (96.5) 112 (94.1)
ference between three groups of Yes 42 (4.5) 25 (4.8) 10 (3.5) 7 (5.9)
students based on chi-square test
The Iranian version of the Premenstrual Symptoms Screening Tool

Table 2 Factors associated with PMS and PMDD obtained from multi- Table 3 Comparison of symptoms in three groups of females
ple logistic regression analyses
No/mild Moderate to PMDD
PMS PMDD PMS severe PMS

OR (95 % CI) P OR (95 % CI) P Moderate to severe symptoms

Anger/irritability 40.8 88.7 99.2
Age 1.086 (1.031–1.144) 0.002 1.09 (1.01–1.16) 0.015
Anxiety/tension 22.6 69 85.7
BMI 1.01 (0.95–1.07) 0.64 0.98 (0.90–1.07) 0.74
Tearful 21.6 61.3 85.7
Duration of 1.06 (0.94–1.02) 0.27 0.95 (0.78–1.07) 0.28
Depressed mood 22.4 76.4 92.4
bleeding
Duration of 0.96 (0.91–1.02) 0.21 0.95 (0.88–1.02) 0.20 Decreased interest in work activities 16.9 59.2 73.9
menstrual Decreased interest in home activities 21.6 60.2 73.1
cycle Decreased interest in social activities 16.7 60.9 74.8
Marital status
Difficulty concentrating 13 55.6 69.7
Single 1.0 (ref.) 1
Fatigue/lack of energy 38.9 78.9 86.6
Married 0.82 (0.44–3.44) 0.55 1.99 (1.01–3.93) 0.04
Overeating/food cravings 14 29.9 35.3
Field of study
Insomnia 5.2 16.9 21
Nonmedical 1 1
Hypersomnia 23.2 53.9 65.5
Medical 1.13 (0.77–1.64) 0.51 1.46 (0.893–2.41) 0.13
Feeling overwhelmed 13 55.6 70.6
Dysmenorrhea
Physical symptoms 48.1 78.2 84.9
No 1 1
Work efficiency or productivity 8.2 59.2 86.6
Yes 2.33 (1.55–3.50) 0.0001 1.62 (0.96–2.74) 0.07
Relationships with coworkers 10.9 70.1 95.8
Smoking status
Relationships with family 10.2 65.8 85.7
No 1 1
Social life activities 6.1 62.7 84.9
Yes 0.38 (0.04–3.44) 0.39 1.79 (0.31–10.1) 0.5
Home responsibilities 7.3 51.4 74.8
Oral contraception
No 1 1 P <0.0001 for all symptoms (moderate to severe PMS or PMDD vs. no/
Yes 0.83 (0.32–2.16) 0.71 1.5 (0.53–4.21) 0.43 mild PMS) derived from chi-square test
Drug consumption
No 1 1 students in no/mild PMS group. The differences in all symp-
Yes 1.22 (0.73–2.03) 0.44 1.35 (0.72–2.50) 0.34 toms were statistically significant (P <0.0001).
Vitamins supplementation
No 1 1 Reliability and validity
Yes 1.31 (0.84–2.05) 0.22 1.67 (0.93–3) 0.08
Minerals supplementation Computing Cronbach’s alpha coefficient is a common way to
No 1 1 assess internal consistency. This was found to be 0.89 for the
Yes 0.96 (0.63–1.47) 0.87 0.93 (0.53–1.66) 0.82 first domain, 0.91 for the second domain, and 0.93 overall;
Athletic sports well above the threshold (0.7). Also, correlation coefficient
No 1 1 between two domains was 0.93, which was quite satisfactory.
Yes 0.82 (0.32–2.16) 0.62 1.55 (0.65–3.66) 0.31 According to the expert panel, a few changes were made. In
Systemic diseases the first domain, in question 8 for “Difficulty concentration”,
No 1 1 an example was added for better understanding. In item A of
Yes 1.07 (0.75–1.33) 0.69 1.88 (1.17–3.02) 0.008 the second domain, we omitted the word “productivity” and
added the word “educational” because all participants were
students and none of them had any other jobs. In item B, we
Premenstrual symptoms added the word “friends” instead of coworkers. The CVR and
CVI were found to be 0.7 and 0.8, respectively, well above our
There was significant relationship between PMS/PMDD and selected standards (0.62 for CVR and 0.78 for CVI).
severity of symptoms. Moderate to severe symptoms were
more present in participants of moderate to severe PMS or
PMDD group compared to those with no/mild PMS (Table 3). Discussion
For example, a high proportion of students with moderate to
severe PMS (88.7 %) and PMDD (99.2 %) reported moderate The PSST is an instrument that reflects DSM-IV criteria for
to severe anger/irritability compared to only 40.8 % of diagnosing of PMS/PMDD and this study was conducted to

assess its psychometric properties in Iran. Overall, the findings
showed promising results. The Persian PSST version proved
to be acceptable to females as most of them did not
consider its questions difficult, confusing, or offensive.
Its reliability, as measured by the internal consistency,
was found to be satisfactory (Cronbach’s alpha coefficient,
0.93). Also, content validity of the instrument as measured
by CVR=0.7 and CVI=0.8 were found to be satisfactory.
Interestingly, we realized that a few changes in wording
by our expert panel were very similar to the suggestions
by pioneering authors when they used the PSST for
adolescents (Steiner et al. 2011).
Prevalence of PMS in this study was 30.7 % and it was
almost similar to studies from Iran and elsewhere (Heinemann
et al. 2010; Borenstein et al. 2003; Taghizadeh et al. 2003).
However, higher prevalence for PMS was reported from
Iran and other countries ranging from 40 to 80 %
(Talaei et al. 2009; Alavi et al. 2007; Farhadinasab
and Kashani 2003; Shahpourian et al. 2006; Derman
et al. 2004).
According to DSM-IV, 3–8 % of women meet the criteria
for PMDD but even when using the DSM-IV criteria, the
prevalence of PMDD vary significantly depending upon the
method of measuring symptoms (Pearlstein and Steiner 2008;
Halbreich et al. 2003). Although the prevalence of PMDD was
rather high in this study (12.9 %), it was comparable with
other studies from Iran and elsewhere. Some studies have
reported similar high prevalence of PMDD among Iranian
students (Nourjah 2008). Yankers (1997) determined the prev-
alence of PMDD as 20.4 % in the USA while in a more recent
study, 11.3 % of American participants aged 18–49 had
PMDD (Rabinson and Swindle 2000).
Limitations
There were some limitations in this study. As the PSST
is a retrospective questionnaire, it can affect the
reporting of symptoms and thus a higher proportion of
women might be identified as having PMS or PMDD.
Another limitation in this study was the fact that clini-
cians did not examine patients. Consequently, we could
not rule out the possibility of the other medical condi-
tions. Also, as there was one group with no/mild PMS,
we could not differentiate between women with no PMS
symptoms with those who had mild symptoms. In this
study, there was also no gold standard—another well-
approved instrument to detect PMS or PMDD—to com-
pare the findings. Thus, future investigations might be
necessary and indeed using a gold standard such as a
prospective daily charting is needed in future studies to
evaluate the sensitivity and specificity of the PSST as a
screening tool.
F.Z. Hariri et al.
Conclusion
The findings of this validation study indicate that the Iranian
version of PSST is reliable and can be used as a valid measure
for detecting PMS and PMDD in Iran.
References
Alavi A, Salahi Moghaddam A, Alimalayeri N, Ramezanpour A (2007)
Prevalence of clinical manifestation of premenstrual syndrome and
premenstrual dysphoric disorder among Bandar Abbas medical stu-
dents [Persian]. Med J of Hormozgan Univ of Med Sci 10:335–341
American College of Obstetricians and Gynecologists (2000) Clinical
management guidelines for obstetrician-gynecologists: premenstru-
al syndrome. ACOG Practice Bulletin 15:1–9
American Psychiatric Association (2000) Diagnostic and statistical man-
ual of mental disorders fourth edition-text revision (DSM-IV-TR).
American Psychiatric Press, Washington, DC
Berek JS (2007) Berek & Novak’s gynecology. Lippincott, New York
Borenstein JE, Dean BB, Endicott J, Wong J, Brown C, Dickerson V et al
(2003) Health and economic impact of the premenstrual syndrome. J
Reprod Med 48:515–524
Braverman PK (2007) Premenstrual syndrome and premenstrual dys-
phoric disorder. J Pediatr Adolesc Gynecol 20:3–12
Chayachinda C, Rattanachaiyanont M, Phattharayuttawat S, Kooptiwoot
S (2008) Premenstrual syndrome in Thai nurses. J Psychosom
Obstet Gynecol 29:203–209
Derman O, Kanbur N, Tokur TE, Kotluk T (2004) Premenstrual syn-
drome and associated symptoms in adolescent girls. Eur J Obstet
Gynecol Reprod Biol 116:201–206
Farhadinasab A, Kashani K (2003) Study the prevalence of pre-menstrual
dysphoric disorder in Hamedan high school girls in 2003 [Persian]. J
Hamedan Univ of Med Sci 39:25–28
Flintbox (2012) The Premenstrual Symptoms Screening Tool (PSST).
[http://www.flintbox.com/public/project/575]
Gonda X, Telek T, Juhasz G, Lazery J, Vargha A, Bagdy G (2008)
Patterns of mood changes throughout the reproductive cycle in
healthy women without premenstrual dysphoric disorder. Prog
Neuropsychopharmacol Biol Psychiatry 32:1782–1788
Grant JS, Davis LL (1997) Focus on quantitative methods: selection and
use of content experts for instrument development. Res Nurs Health
20:269–274
Halbreich U, Borenstein J, Pearlstein T, Kahn L (2003) The prevalence,
impairment, impact and burden of premenstrual dysphoric disorder
(PMS/PMDD). Psychoneuroendocrinology 28(Suppl 3):1–23
He Z, Chen R, Zhou Y, Geng L, Zhang Z, Chen S et al (2009) Treatment
for premenstrual syndrome with vitex agnus castus: a prospective,
randomized, multi-center placebo controlled study in China.
Maturitas 63:99–103
Heinemann LA, Minh T, Filonenko A, Uhl-Hochgraber K (2010)
Explorative evaluation of the impact of severe premenstrual
disorders on work absenteeism and productivity. Womens
Health Issues 20:58–65
Johnson SR (2004) Premenstrual syndrome, premenstrual dysphoric
disorder, and beyond: a clinical primer for practitioners. Obstet
Gynecol 104:845–859
Kayatekin ZE, Alex N, Sabo A, Halbreich U (2008) Levetriacetam for
treatment of premenstrual dysphoric disorder: a pilot, open label
study. Arch Womens Ment Health 11:207–211
Lawshe CH (1975) A quantitative approach to content validity. Pers
Psychol 28:563–575
The Iranian version of the Premenstrual Symptoms Screening Tool
Nourjah P (2008) Premenstrual syndrome among teacher training university
students in Iran. J Obstet Gynaecol India 58:49–52
Nunnally JC, Bernstein IH (1994) Psychometric theory. McGraw-Hill,
New York
Pearlstein T, Steiner M (2008) Premenstrual dysphoric disorder: burden
of illness and treatment update. J Psychiatry Neurosci 33:291–301
Polit DF, Beck CT, Owen SV (2007) Is the CVI an acceptable indicator of
content validity? Appraisal and recommendations. Res Nurs Health
30:459–467
Rabinson RL, Swindle RW (2000) Premenstrual symptoms severity:
impact on social function and treatment seeking behaviors. J
Womens Health Gend-Based Med 9:757–768
Reed SC, Levin FR, Evans SM (2008) Changes in mood, cognitive
performance and appetite in the luteal and follicular phase of the
menstrual cycle in women with and without PMDD (premenstrual
dysphoric disorders). Horm Behav 54:185–193
Shahpourian F, Mahmoudi Z, Bastani F, Parsai S, Hoseini F (2006)
Premenstrual syndrome (PMS) and the related symptoms among
students of Iran University of Medical Sciences (IUMS) [Persian]. J
of Nursing of Iran Univ of Med Sci 18:57–66
Speroff L, Fritz MA (2005) Clinical gynecology endocrinology and
infertility. Lippincott, New York
Steiner M, Macdougal M, Brown E (2003) The Premenstrual Symptoms
Screening Tool (PSST) for clinicians. Arch Womens Ment Health
6:203–209
View publication stats
Steiner M, Peer M, Palova E, Freeman EW, Macdougall M, Soares CN
(2011) The Premenstrual Symptoms Screening Tool revised for
adolescents (PSST-A): prevalence of severe PMS and premenstrual
dysphoric disorder in adolescents. Arch Womens Ment Health
14:77–81
Taghizadeh M, Ghofranipour F, Nikpour B, Faghizadeh S (2003) Study
of the frequency of signs, symptoms and self-medication method for
premenstrual syndrome (PMS) [Persian]. Daneshvar Medicine
10:19–26
Takeda T, Tasaka K, Sakata M, Murata Y (2006) Prevalence of premen-
strual syndrome and premenstrual dysphoric disorder in Japanese
women. Arch Womens Ment Health 9:209–212
Talaei A, Fayazi Bordbar MR, Nasiraei M, Dadgar S, Samari AA (2009)
Epidemiology of premenstrual syndrome (PMS) in students of
Mashhad University of Medical Sciences [Persian]. Iranian J Obste,
Gynecol Ferti 12:15–22
Tschudin S, Bertea PC, Zemp E (2010) Prevalence and predictors
of premenstrual syndrome and premenstrual dysphoric disor-
der in a population-based sample. Arch Womens Ment Health
13:485–494
Tschudin S, Bitzer J, Zemp E (2007) Premenstrual syndrome in Switzer-
land assessed by Premenstrual Symptoms Screening Tool [abstract].
J Psychosom Obstet Gynecol 28:S51
Yankers K (1997) The association between premenstrual dysphoric dis-
order and other mood disorders. J Clin Psychiatry 58:19–25