Anxiety, Self-esteem and Body Image in Girls with Precocious Puberty

A Clinical Study of Girls With Idiopathic Central Precocious Puberty and Psychological Behavior Problems

To understand the psychological effects on behavior of girls with idiopathic central precocious puberty (ICPP) and to explore the role of gonadotropin-releasing hormone analog (GnRHa) in the reversal or blocking of the negative psychological effects on behaviors of girls with ICPP. A total of 100 girls with ICPP diagnosed at the Department of Endocrinology of Jiangxi Children's Hospital were divided into the treatment group and observation group with 50 cases in each group. The control group consisted of 50 healthy girls examined at our hospital during the same period. The Achenbach Child Behavior Check List ([CBCL] for parents) was used to evaluate the psychological effects on behavior of the girls diagnosed with ICPP and the girls in the control group, and the scores of related behavioral factors were calculated. At the same time, the psychological effects on behaviors of the girls with ICPP treated with GnRHa were followed up. (1) There were 100 girls with ICPP and 30 with behavioral problems. There were 50 normal healthy girls (control group) with 3 cases of behavior problems. Of the 50 girls with ICPP, after treatment, 8 had behavioral issues. The rate of abnormal psychological effects on behavior in the group of girls with ICPP before treatment was significantly higher than in the control group (P < .01), and after treatment, the rate was lower than before treatment (P < .05). (2) The scores of depression, social withdrawal, poor communication, and school discipline violation in the ICPP group were higher than those in the control group, with a statistical significance (P < .01). (3) After 24 months of GnRHa treatment for girls in the ICPP group, the scores of 4 factors, including depression, social withdrawal, poor communication, and violation of discipline in the Achenbach CBCL, were significantly different before and after treatment (P < .05). (1) Girls with ICPP have low self-esteem, low self-confidence, high incidences of psychological effects on behavior problems, manifested in depression, withdrawal, poor communication, discipline violations, and other aspects; (2) GnRHa treatment can reverse the low self-esteem and low self-confidence of girls with ICPP to varying degrees.

Early puberty paradox: an investigation of anxiety levels of mothers and children, children's quality of life, and psychiatric diagnoses

Early puberty signs lead to an increase in anxiety levels of parents and children. The aim of this study was to investigate the quality of life and anxiety levels of girls and their mothers who were admitted to a pediatric endocrinology clinic with concerns about early puberty. Girls and their mothers who were admitted to endocrinology outpatient clinic with concerns about early puberty were compared to healthy control group. Screen for Child Anxiety Related Emotional Disorders (SCARED) parent form, Quality of Life for Children Scale (PedsQL) parent form, and Beck Anxiety Inventory (BAI) were administered to the mothers. Children were evaluated with the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS Lifetime Version) (K-SADS-PL). The study sample consisted of 92 girls and 62 of them were administered to clinic with concerns about early puberty. There were 30 girls in early puberty group (group 1), 32 girls were in the normal development group (group 2), and 30 were in the healthy control group (group 3). The anxiety level of group 1 and group 2 was significantly higher, and their quality of life was significantly lower when compared to group 3 (p < 0.001). Mother's anxiety level was found significantly higher in group 2 (p < 0.001). It has shown that anxiety level and quality of life of children were associated with anxiety level of mothers and the current Tanner stage (r = 0.302, p < 0.005).    Conclusion: Mothers and children who have concerns about early puberty are negatively affected when early puberty is a possibility. For this reason, educating parents will prevent negative impacts of this situation on children. At the same time, it will decrease health burden. What is Known? • Early adolescence is one of the most common reasons for admission to pediatric endocrinology outpatient clinics. It is known that increasing early adolescence anxiety in the society causes cost and time losses in the field of health. However, studies investigating the reasons for this result are limited in the literature. What's New? • The level of anxiety increased significantly in girls with suspected precocious puberty and their mothers, and their quality of life was affected. • For this reason, we would like to emphasize the importance of multidisciplinary approaches before psychiatric disorders occur in children with suspected precocious puberty and their parents.

Guilt, Uncertainty, Education Needs, and Knowledge of Mothers With Children Experiencing Precocious Puberty

Introduction. Childhood illnesses not only affect the child, but also the family members. Objective. The purpose of this study was to investigate the guilt, uncertainty, education needs, and knowledge of mothers with children experiencing precocious puberty. Methods. Data were collected in August, 2017. The participants of the study were the mothers of children experiencing precocious puberty. A total of 111 copies of questionnaires were collected. Descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient were used for the analysis, using the SPSS 24.0 program. Results. Mothers of children experiencing precocious puberty require psychological interventions that can alleviate their guilt and uncertainty, as well as enhance their knowledge of the emotional support needed by their children. Conclusion. Mothers with children experiencing precocious puberty had a high level of education needs to know, but the knowledge they knew was insufficient. Future studies need to focus on developing education programs for mothers dealing with their child’s precocious puberty.

Psychological aspects of pre-adolescents or adolescents with precocious puberty: A systematic review

PROBLEM

Precocious puberty (PP) is an illness that appears when puberty, begins some years earlier than usual, provoking inferences in preadolescents and adolescents and their families. Therefore, the aim is to analyze if psychological consequences can be observed in groups of preadolescents or adolescents with PP.

METHOD

A bibliographic search of the scientific literature was made following the PRISMA guide in the following databases: ProQuest, Psychinfo, Web Of Science, and Scopus. 592 studies were found, were uploaded to Covidence to make a screening, of which finally 6 were included for the revision according to the inclusion and exclusion criteria. Two independent evaluators made the search, selection, data extraction and quality evaluation of studies independently. The agreement degree between both was excellent in all of the cases.

RESULTS

211 preadolescents participated in total in all studies, of which 99 were preadolescents with PP, with a mean age of 8,94 years old. Studies evaluated so heterogeneous variables, such as psychopathology, self-image, neuropsychological and cognitive variables, and reasons to delay or stop PP. The quality of studies was moderated especially due to the low quality of the studies design, which were mostly transversal, and the representativity of the sample, being selected by convenience.

CONCLUSIONS AND IMPLICATIONS

More research is needed to evaluate the psychological consequences of the PP diagnosis in pediatrics, and its protection factors, because none of the studies approached this question. We consider that it is necessary to increment the quality of these studies, and that these take a biopsychosocial perspective.

Psychosocial adaptation to precocious puberty: A nursing support program

PROBLEM

This study aimed to determine the effects of a nursing support program (NSP) based on the Roy Adaptation Model on the psychosocial adaptation of girls with precocious puberty and their mothers.

METHODS

This study adopted a pre-post design. It included 26 girls diagnosed with precocious puberty and their mothers. Data were collected using a Demographic Information Form; the Child Behavior Checklist for Ages 6-18; and the Depression, Anxiety, and Stress Scale. Participants were then enrolled in a NSP based on the Roy Adaptation Model. The same measures were administered at the end of the support program to the participants.

FINDINGS

It was determined that at the beginning of the program, approximately one-third of the mothers had depression, 15% anxiety, and approximately 20% experienced stress. Mothers' anxiety and stress levels and girls' anxiety/depression and total problem scores significantly decreased after the NSP.

CONCLUSIONS

The NSP designed for this study positively affected the psychosocial problems of girls with precocious puberty and their mothers.

Psychological and Gender Differences in a Simulated Cheating Coercion Situation at School

This study aimed to analyze gender, anxiety, and psychological inflexibility differences of high school students’ behaviors in a simulated situation of peer coercion into academic cheating. Method: A total of 1147 volunteer adolescents participated, (Men: N = 479; Mage = 16.3; Women: N = 668; Mage = 16.2). The participants saw 15 s animated online video presenting peer coercion into an academic cheating situation, including a questionnaire about their reactions to face the situation. They also answered the State–Trait Anxiety Inventory for children and adolescents and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y). Gender was associated with the behaviors facing the situation. Higher state anxiety and inflexibility were present in those participants that avoided aggressive behaviors facing the situation; on the other hand, trait anxiety was present in those who reacted aggressively. Finally, higher anxiety and inflexibility were associated with the used moral disengagement mechanisms, but also with peers’ perception as sanctioning or being against the participants’ decision. The most aggressive students were more flexible and less stressed than those who tried to solve assertively. Expectations about peers seem to be relevant to the decision-making facing moral dilemmas and peer victimization.

Gender, Anxiety, and Legitimation of Violence in Adolescents Facing Simulated Physical Aggression at School

We analyzed gender and anxiety differences in middle school students facing a physical peer aggression situation. The participants were 1147 adolescents aged between 12 and 18 years (male: n = 479; female: n = 668) who watched a 12 s animation representing the situation and filled out a questionnaire to analyze the legitimation of violent behaviors and anxiety levels. We registered their decisions to solve the situation using a categorical scale that included assertive, avoidant, aggressive, submissive, and supportive behaviors. Gender was not associated with the adolescent's behaviors in facing a simulated peer aggression situation. However, male teenagers tended to perceive adults as sanctioners and neutrals; those who used the diffusion of responsibility and dehumanization to justify their behavior also showed a higher state of anxiety. Female teenagers who expected legitimation from their peers, presented higher anxiety as well. Educational interventions may use these results, helping adolescents to understand that their acts have substantial implications in the lives of others. It is essential to develop group interventions that modify how adolescents manage their conflicts and change gender stereotypes that significantly impact health. We highlight the need for linking families in educational programs facing the challenges of transforming the legitimization of violence in parental practices.

Managing precocious puberty: A necessity for psychiatric evaluation

OBJECTIVE

Precocious puberty (PP) is one of the most common endocrine disorders in school-age girls. It has been reported that there is an increased tendency for psychiatric disorders for early maturing girls. The aim of this study was to determine the prevalence of psychiatric problems and to investigate depression and anxiety levels, and self-concept characteristics in girls with PP.

METHODS

Girls with PP (n = 41) and controls (n = 45) aged 7-11 years participated in this study. Psychiatric evaluations were conducted with semi-structured interviews. Behavioral and emotional problems were assessed using Child Behavior Check List and Teacher Report Form. Children's Depression Inventory, State-Trait Anxiety Inventory for Children and Piers-Harris Children's Self Concept Scale were administered, respectively.

RESULTS

Girls with PP had significantly more psychiatric diagnosis than controls (68.3 % vs 20 %, p < 0.001). PP group had significantly higher anxious-depressed, somatic complaints, social problems, aggresive behaviors and interestingly autistic traits. Increased symptom levels of depression and anxiety, and lower self-concept scores were also obtained from PP subjects.

CONCLUSIONS

PP is an independent predictor of psychiatric disorders. It is also associated with poorer psychiatric status, lower self esteem characteristics, and autistic traits. A multidisciplinary approach combining endocrinologic and psychiatric evaluations seem to be beneficial for the management of girls with PP.

Treatment of Central Precocious Puberty

Long-acting analogs of GnRH (GnRHas) have been the gold-standard treatment of central precocious puberty (CPP) worldwide and have an enviable track record of safety and efficacy. Recent years have witnessed much growth in the availability of longer-acting and sustained-release forms of GnRHas. Although all available agents appear promising, limited long-term follow-up and/or comparative data are available. In this review, important issues pertaining to the treatment of children with CPP are discussed. In addition to an assessment of the newer extended-release GnRHa formulations, a delineation of factors essential in determining which children should be treated is offered. Outstanding uncertainties in clinical management are highlighted and areas in need of future research identified. Literature searches for this review were performed in PubMed and OVID, with a focus on English-language publications using the terms "central precocious puberty" and "treatment."