Early pubertal onset may not only predispose girls to depressive and antisocial symptoms during adolescence; it may be a harbinger of continued psychiatric pathology into early- and mid-adulthood, according to findings published in Pediatrics.
Although early onset of puberty in girls is a known antecedent of various psychopathologies of adolescence, there has been little effort to follow these girls beyond late adolescence, resulting in a lack of published information regarding the duration of psychiatric effects into adulthood. These US researchers therefore attempted to clarify the nature of such chronic associations, which they believe could have great public health implications.
The investigators used data from the National Longitudinal Study of Adolescent Health (Add Health), a prospective observational trial executed in 4 waves from 1994 through 2008. The study tracked girls (N=7802) starting in adolescence and followed them for approximately 14 years to observe trajectories and clinical outcomes of psychopathologies first noticed around the onset of puberty (particularly if pubertal development and menarche occurred earlier than in peers).
The 2 primary outcomes were depressive and antisocial dispositions self-reported by the patients. To assess depressive symptoms, participants completed the Center for Epidemiologic Studies Depression Scale regarding the past week at waves I and IV. For antisocial behaviors, participants used a 0 to 3 scale to rate their frequency over the past year. Results were presented in the form of 3 separate models of influence, based on timing/wave of measurement: proximal, lingering, and increasing.
In terms of depressive symptoms, the proximal model indicated that earlier menarche predicted — linearly and significantly — increased impairment during adolescence, with later maturation linked with lower symptom levels (b =-0.87; P <.05). Similarly, the lingering model showed a significant linear association between menarche and continued symptoms at wave IV, when subjects were nearly 30 years old (b =-0.84; P <.05). However, the increasing model, which accounts for wave I baseline levels, no longer reflected a significant connection between pubertal timing and symptoms at wave IV (b =-0.61; P <.05). This data pattern suggests that affected girls experience a heightened vulnerability to depression during adolescence that persists into adulthood.
Looking at antisocial behavior, the proximal model again demonstrated a significant linear relationship between menarche and antisocial tendencies during adolescence, whereby girls who matured earlier reported more frequent antisocial behaviors (b =-0.09; P <.05). As with depressive symptoms above, the lingering model again reflected a persistent association between early maturation and antisocial behaviors at wave IV (b =-0.02; P <.05). Unlike the results for depressive symptoms, the increasing model for antisocial behaviors did show some significance, albeit marginal (b =-0.02; P =.08). These findings support a clear link between early menarche and increased antisocial behavior that begins in adolescence and continues into adult life.
Study limitations include imprecise comprehension of the mechanisms behind longitudinal effects; use of menarche as pubertal timing indicator, which may miss processes that take place earlier in puberty; lack of parental reports that could offer more context and a fuller picture of youth pathologies; inability to extrapolate findings to other disorders in addition to depression and antisocial behaviors; and a disproportionate skewing toward girls within the collective body of early puberty research.
Rather than early menarche merely presenting girls with temporary psychological and emotional growing pains, it appears that precocious development does indeed predispose these girls to continued difficulties with depression and antisocial behaviors during their adult lives. Recognizing this predisposition is especially important for pediatricians, who should remain aware of these associations in patients who mature early and who should pay special attention to the potential for persistent mental health issues into adulthood.
Mendle J, Ryan RM, McKone KMP. Age at menarche, depression, and antisocial behavior in adulthood [published online December 26, 2017]. Pediatrics. doi:10.1542/peds.2017-1703