Study: Idiopathic central precocious puberty patients at increased risk for psychiatric disorders

Study: Idiopathic central precocious puberty patients at increased risk for psychiatric disorders | Image Credit: © Dzmitry - © Dzmitry - stock.adobe.com.

There was evidence of an elevated risk for psychiatric disorders among patients with central precocious puberty (CPP), according to a recent German study published in JAMA Network Open.¹

It is known that early pubertal timing is associated with an increased risk of mental health issues, though previous studies, according to the investigators, that have examined these associations with CPP have yielded inconclusive results.

The study authors noted CPP is characterized by accelerated onset of pubertal development, defined by physical changes before 8 years of age in females or prior to 9 years of age in males. It is estimated that CPP is 9-times more frequent in girls than boys, and has demonstrated an increase in incidence rates in recent decades, according to a Denmark study previously published in JAMA Network Open.²

In a retrospective, population-based cohort design, patients with CPP identified from German health insurance data were included (approximately 6.5 million individuals) and followed from January 2010 to June 2023. The main outcomes and measures of the study were anxiety disorders, depression, oppositional defiant and conduct disorders (ODD/CD) and and attention deficit/hyperactivity disorder (ADHD).¹

The investigators compared incidence rates for psychiatric disorders between patients and controls matched exactly for sex, birth year interval, insurance period, and obesity, before and after the diagnosis of CPP.

In all, and after validation criteria was met, there were 1094 patients with idiopathic CPP identified, of which 91.3% were female. These participants were identified and compared with 5448 controls, of which 91.3% were also female.

Compared to the control individuals, those with CPP were more likely to receive a diagnosis of:

• Any mental disorder: 270 CPP (24.7%) vs 920 controls (16.9%) (adjusted risk ratio [aRR], 1.48; 95% CI, 1.31-1.67)
• Depression: 82 CPP 7.5%) vs 252 controls (4.6%) (aRR, 1.73; 95% CI, 1.37-2.20)
• Anxiety disorders: 88 CPP (8%) vs 312 controls (5.7%) (aRR, 1.45; 95% CI, 1.16-1.82)
• ODD/CD: 87 CPP (8%) vs 243 controls (4.5%) aRR, 1.76; 95% CI, 1.39-2.23)
• ADHD: 123 CPP (11.2%) vs 397 controls (7.3%) (aRR, 1.53; 95% CI, 1.27-1.86)

"Temporal trends showed increased incidence rates for ODD/CD even before the diagnosis of CPP," the study investigators wrote. "For depression and ADHD, incidence rates remained increased for at least 8 years after the initial CPP diagnosis."

Overall, CPP was linked to an increased risk of psychiatric disorders with data supporting long-term mental health outcomes, which according to the authors, suggests "that caretakers of children with CPP should be vigilant for the emergence of psychiatric symptoms to initiate psychiatric care at an early stage."

References:

1. Dinkelbach L, Grasemann C, Kiewert C, Leikeim L, Schmidt B, Hirtz R. Central Precocious Puberty and Psychiatric Disorders. JAMA Netw Open. 2025;8(6):e2516679. doi:10.1001/jamanetworkopen.2025.16679
2. Bräuner EV, Busch AS, Eckert-Lind C, Koch T, Hickey M, Juul A. Trends in the incidence of central precocious puberty and normal variant puberty among children in Denmark, 1998 to 2017. JAMA Netw Open. 2020;3(10):e2015665. doi:10.1001/jamanetworkopen.2020.15665