Early Puberty Linked to Increased Risk of Mental Illness

Central precocious puberty (CPP), generally defined as pubertal onset in girls before they are 8 years old and boys before they are 9 years old, may increase the risk of mental illnesses such as depression, anxiety disorders, and attention deficit/hyperactivity disorder (ADHD), according to a study published yesterday in JAMA Network Open.

For some disorders, the risk associated with CPP remained elevated for many years.

Lars Dinkelbach, M.D., of the University of Duisburg-Essen in Germany, and colleagues compared mental health outcomes of 1,094 patients with idiopathic CPP (91.3% female) with those of 5,448 matched controls. They focused on six disorders that commonly emerge during childhood and adolescence: ADHD, anxiety disorders, depression, oppositional defiant disorder/conduct disorder (ODD/CD), self-harm, and substance use disorders. Patients were born between 2000 and 2023 and followed for just under 11 years.

Compared with controls, patients with CPP had a 48% increased risk of receiving a diagnosis of any of the selected mental disorders over follow-up. This included a 45% increased risk of anxiety disorders, a 53% increased risk of ADHD, a 73% increased risk of depression, and a 76% increased risk of ODD/CD. The incidence of depression and ADHD remained higher in youth with CPP for at least eight years after the initial diagnosis.

The researchers noted several possible explanations for the link between CPP and mental illness:

• Physical and social changes resulting from early puberty (e.g., bullying), combined with age-related limitations in coping capacities, may lead to psychological distress.
• Endocrine changes associated with early puberty may lead to disrupted brain maturation or pathologically altered brain activity patterns.
• Substantial preexisting psychological and social burdens may impair coping with early puberty and CPP, thereby exacerbating its negative effects on mental health.

“Early intervention for mental health disorders in children and adolescents can alleviate disease burden and long-term negative psychosocial consequences,” Dinkelbach and colleagues wrote. “Thus, caretakers of patients with CPP should actively explore psychological symptoms and facilitate early intervention to influence lifetime trajectories of this vulnerable patient population positively. Because our findings indicate long-term sequelae of CPP on mental health, caretakers should be vigilant even after normalization of pubertal development.”

For related information, see the Psychiatric News Alert “Childhood Trauma, Early Puberty Associated With Internalizing Symptoms in Girls.”

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