Earlier puberty associated with increased risk of depression in girls

1. In girls, earlier onset of breast development was associated with a higher risk of depression.

2. In boys, earlier onset of genitalia development was not found to be significantly associated with the presence of depression.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The age of onset of puberty has been on a rapid decline globally. While adolescence is known to be a period of psychiatric turmoil, earlier onset is thought to place younger children at increased risk for adjustment difficulties. This prospective cohort study sought to address whether there were any associations between the age of the onset of puberty and self-reported presence of depression in males and females from a non-Western population. Results showed that the onset of breast/genitalia development associated with depression differed between males and females. Earlier onset of breast development was associated with a higher risk of depression in females, whereas, an earlier onset of genitalia development was unrelated to the presence of depression in males. In both genders, an earlier onset of pubic hair development was not found to be significantly associated with the presence of depression. This study was limited by an incomplete data set for the onset of puberty, the possibility to misclassify breast development, and variance in interrater reliability given that different physicians assessed pubertal development. Given that this study was performed in a Chinese population, one could also call to question the generalizability of this study. Additional studies will be needed to further characterize this earlier onset depression in order to aid in prevention.

Click to read the study, published today in Pediatrics

Relevant Reading: The emerging sex difference in adolescent depression: interacting contributions of puberty and peer stress

In-Depth [prospective cohort]: In this study, 8327 children were followed as part of Hong Kong’s Children of 1997 birth cohort. This cohort was originally established to investigate the association of secondhand smoke exposure with infant health. Recruitment occurred at birth in 49 of the maternal and child health centers in Hong Kong. Several years later, the same members of the cohort were recruited to participate in a follow up assessment of depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) for patients between 12 and 15 years of age. Pubertal status was visually assessed by physicians at the Student Health Services according to Marshall and Tanner stages. PHQ-9 scores ranged from 0 to 27; the mean PHQ-9 score was 3.1 ± 3.5 and was higher in girls (3.4 ± 3.5) than in boys (2.9 ± 3.4). Results of this study demonstrated that earlier age of onset of breast development in girls was associated with a higher risk of depression (OR 0.83, 95% CI [0.79-1.14]). In boys, the age of onset of genitalia development was not significantly associated with to depression. In addition, the association of the age of onset of pubic hair development did not differ from gender to gender, and was not related to the presence of depression.

Image: PD

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