Early puberty is linked to higher anxiety risk in girls

An analysis of the Danish National Birth Cohort (DNBC) data found that an earlier start and a faster tempo of puberty in girls were associated with a higher risk of an anxiety disorder diagnosis and social anxiety disorder symptoms. On the other hand, a later start to puberty and a slower tempo were associated with a lower risk of social anxiety symptoms compared with girls who developed at an average rate. The paper was published in the Journal of Affective Disorders.

Puberty is a major developmental transition in which young people undergo rapid physical, hormonal, emotional, and social changes. The age at which puberty begins, known as pubertal timing, varies considerably between individuals. In recent decades, it has been gradually decreasing in many Western populations. Puberty also differs in tempo, meaning the speed at which these developmental changes progress once they have begun.

Both timing and tempo may influence how adolescents adapt psychologically to this period of change. Earlier pubertal development has been repeatedly linked to a greater risk of anxiety in girls, although the evidence is less clear for boys. Social anxiety disorder has been linked to puberty particularly often because it first emerges during adolescence in many cases. This disorder involves an intense fear of being judged, embarrassed, or negatively evaluated by others.

Also, entering puberty earlier may expose young people to heightened social expectations and self-consciousness before their emotional coping abilities have fully developed. Likewise, a faster pubertal tempo may leave less time to adjust to the biological and social changes that accompany adolescence.

Study author Anne Marie Ladehoff Thomsen and her colleagues note that previous research on the potential influence of pubertal tempo on anxiety has mostly been conducted on small samples, assessed only one aspect of puberty, or combined boys and girls, in spite of their differences in hormonal and other developmental aspects. They conducted a study in which they investigated the associations between pubertal timing and tempo with anxiety disorders, and social anxiety disorder in particular. These authors hypothesized that earlier and faster pubertal development would be associated with a higher risk of anxiety, but more so in girls than in boys.

Free daily newsletter

To overcome the shortcomings of previous studies, they analyzed data from a large population-based study: the Puberty Cohort of the Danish National Birth Cohort. From 1996 to 2002, Danish-speaking pregnant women were invited to participate in the study at their first antenatal visit with a general practitioner. Approximately 50% of general practitioners in Denmark participated, enrolling around 92,000 women with their unborn children. This represented a 60% participation rate among eligible women and corresponded to 30% of all children born in Denmark during this period.

The participating women were interviewed about their health and health-related behaviors in four consecutive telephone interviews around gestational weeks 17 and 32, as well as 6 and 18 months after they gave birth. Questionnaires were also mailed to them when their children were 7 and 11 years old. When their children were 18 years old, the young adults received a digital invitation to complete another questionnaire, asking for information on their mental health, family relations, social relations, and health behaviors. In total, 49,963 young adults participated in this data collection.

The Puberty Cohort consisted of single-birth children (excluding twins and multiples) born between 2000 and 2003 to mothers who participated in the first telephone interview during pregnancy. Ultimately, this involved 15,818 children who completed at least one web-based questionnaire on their current pubertal development, starting from 11.5 years of age and then every six months throughout puberty. Of these children, 8,123 were girls.

Of the group, 13,208 completed at least two pubertal development questionnaires, allowing researchers to calculate their pubertal development tempo and explore the relationship between their physical development and mental health diagnoses registered in the Danish National Patient Register. Additionally, a smaller subset of participants completed mental health questionnaires when they were 18 years old, allowing the study authors to calculate associations between pubertal development and self-reported mental health characteristics.

The results showed that children with earlier pubertal development, particularly girls, tended to have parents with lower socioeconomic status who were less likely to live together when the children were 7 years of age. Their mothers tended to have their menarche (their first menstrual period) at an earlier age compared with their peers and were more likely to have experienced a psychiatric disorder during the first trimester of pregnancy. These children were also more often bullied at 7 years of age compared with children with average pubertal timing. Adolescents with later puberty tended to show the opposite pattern.

By 19 years of age, 4% of girls had an anxiety disorder diagnosis. Eight percent had contact with a private practice psychologist or psychiatrist, and 4% had redeemed prescribed psychotropic medications (drugs that affect the mind, emotions, and behavior, such as antidepressants and anti-anxiety medications). In boys, 1.5% had an anxiety disorder diagnosis by this age, 3.5% had contact with private practice psychologists or psychiatrists, and 1.4% had redeemed psychotropic medications.

In girls, an earlier start and faster tempo of pubertal development were associated with a higher risk of any anxiety disorder diagnosis and self-reported social anxiety disorder symptoms, as well as a higher likelihood of seeking psychological or psychiatric treatment and being prescribed psychotropic medications. More specifically, for each year earlier that breast development began, the odds of an anxiety disorder diagnosis were 26% higher. Each year of earlier pubic hair development was associated with 49% higher odds of self-reported social anxiety disorder symptoms compared with the average. On the other hand, later pubertal development was associated with a lower risk of anxiety and social anxiety symptoms.

Findings in boys were inconsistent, and no firm links between pubertal timing and anxiety disorder risk could be established.

“If earlier and faster puberty increases the risks of an anxiety disorder diagnosis and SAD [social anxiety disorder] symptoms, targeted interventions are warranted for girls with early/fast puberty and sub-clinical anxiety. Findings for boys need further exploration,” the study authors concluded.

The study contributes to the scientific understanding of the links between pubertal development and mental health. However, it should be noted that the design of this study does not allow any definitive causal inferences to be derived from the results.

The paper, “Pubertal timing and tempo and anxiety symptoms, disorders and treatments in Danish adolescents: A population-based follow-up study,” was authored by Anne Marie Ladehoff Thomsen, Andreas Ernst, Katrine Strandberg-Larsen, Charlotte Ulrikka Rask, Anne Gaml-Sørensen, Pernille Jul Clemmensen, Thea Emily Benson, Nis Brix, Onyebuchi A. Arah, and Cecilia Høst Ramlau-Hansen.