Pediatricians need a better understanding of the effects of early puberty for girls beyond adolescence into adulthood.
Jane Mendle, PhD
Onset of menarche
It is well known that early puberty in girls is associated with a myriad of psychosocial effects that make them vulnerable to depression and antisocial behavior during adolescence. Less known is how these effects play out over time and into adulthood.
Into this gap comes research from a new study that tracked the psychosocial effects of early puberty beyond adolescence and into adulthood to look at how long the psychosocial effects of early puberty may last.1
“Our study tracks girls through adolescence into their late 20s, far longer than other studies, and we see that girls who went through earlier puberty are still showing higher rates of depressive symptoms and antisocial behavior than their peers,” says Jane Mendle, PhD, associate professor, Department of Human Development, College of Human Ecology, Cornell University, Ithaca, New York, and lead author of the study.
To examine the associations of age at menarche with development and duration of depressive symptoms and antisocial behaviors, Mendle and colleagues collected and analyzed data on 7802 female participants taken from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Conducted between 1994 and 2008, Add Health is a national survey study that assessed adolescent health and risk behavior in a large socioeconomically, ethnically, and racially diverse cohort.2Data was collected by interviewing participants over 14 years (in 4 different time periods or waves) to determine the age at menarche (used as a proxy for pubertal development) and development and duration of depressive symptoms and antisocial behaviors. To assess depressive symptoms, participants completed the Center for Epidemiologic Studies Depression Scale (CES-D) during the first and last time periods of the study. The CES-D is a self-report evaluation that measures cognitive, affective, and physiologic symptoms of depression experienced by the participant over the past week. Antisocial behaviors (ie, doing damage to property, stealing, breaking into building, selling drugs) were also assessed twice (during the first and last time periods).
The study found that the onset of menarche was about 12 years for most of the girls (31%) followed by age 13 (24%) and age 11 (19%), but ranged from 7 to 24 years. About 10% of girls reported age of menarche at age 10 or younger.
Using various regression models to assess associations of age at menarche to depressive symptoms and antisocial behaviors, the investigators found a significant association between later ages of menarche and lower levels of depressive symptoms during adolescence and over time. For example, compared with a girl with an onset of menarche at age 12 years (the average age), a girl who has an onset of menarche at age 10 years is 8% more likely to have depressive symptoms in adolescence and 6% more likely to still have depressive symptoms in her 20s. When looking at a girl who begins menarche at age 8 years, the percentages of depressive symptoms increase to 25% in adolescence and 20% into her 20s.
Similar findings were seen for antisocial behavior, with younger age at onset of menarche associated significantly and linearly with a higher frequency of antisocial behavior. For example, the study found that compared with a girl with an onset of menarche at age 12 years, girls with early menarche at age 10 years had a 5% greater chance of displaying antisocial behavior in adolescence that persisted into their 20s (although only marginally significant).
Highlighting that these findings show that the magnitude of the association between puberty and depressive symptoms and antisocial behavior remain stable over time, Mendle underscored that psychological vulnerability of earlier puberty lingers longer than previously expected.
“It’s not simply a question of adolescent ‘growing pains,’” she says.
Given that more girls are entering puberty at a younger age, Mendle and colleagues highlight that a better understanding of the long-term psychosocial effects of early puberty are needed. Their study provides a needed step in that direction by showing that the psychosocial vulnerabilities associated with early puberty can extend into adulthood. This finding shines a light on the importance of pediatricians and other healthcare providers who care for children and adolescents to recognize the potential adverse psychosocial effects of early puberty on the psychosocial well-being of children long after they’ve shed their adolescence.
Emphasizing that puberty is a complicated psychological experience, as well as a biological transition, Mendle underscores the need to recognize the effect of puberty on all domains of life both during adolescence and in what it portends for adulthood.
“The best thing that pediatricians can do is to be sensitive to the psychological importance of puberty for early maturing girls, and recognize the duration of its effects,” she says.
1. Mendle J, Ryan RM, McKone KMP. Age at menarche, depression, and antisocial behavior in adulthood. Pediatrics. 2018;141(1):e20171703.
2. Harris KM. The National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I & II, 1994-1996; Wave III, 2001-2002; Wave IV, 2007-2009 (machine-readable data file and documentation). Chapel Hill, NC: Carolina Population Center, University of North Carolina at Chapel Hill; 2009. DOI: 10.3886/ICPSR27021.v9.