Weak associations between pubertal development and psychiatric and behavioral problems

Assessing causal links between age at menarche and adolescent mental health: a Mendelian randomisation study

BACKGROUND

The timing of puberty may have an important impact on adolescent mental health. In particular, earlier age at menarche has been associated with elevated rates of depression in adolescents. Previous research suggests that this relationship may be causal, but replication and an investigation of whether this effect extends to other mental health domains is warranted.

METHODS

In this Registered Report, we triangulated evidence from different causal inference methods using a new wave of data (N = 13,398) from the Norwegian Mother, Father, and Child Cohort Study. We combined multiple regression, one- and two-sample Mendelian randomisation (MR), and negative control analyses (using pre-pubertal symptoms as outcomes) to assess the causal links between age at menarche and different domains of adolescent mental health.

RESULTS

Our results supported the hypothesis that earlier age at menarche is associated with elevated depressive symptoms in early adolescence based on multiple regression (β =  - 0.11, 95% CI [- 0.12, - 0.09], pone-tailed < 0.01). One-sample MR analyses suggested that this relationship may be causal (β =  - 0.07, 95% CI [- 0.13, 0.00], pone-tailed = 0.03), but the effect was small, corresponding to just a 0.06 standard deviation increase in depressive symptoms with each earlier year of menarche. There was also some evidence of a causal relationship with depression diagnoses during adolescence based on one-sample MR (OR = 0.74, 95% CI [0.54, 1.01], pone-tailed = 0.03), corresponding to a 29% increase in the odds of receiving a depression diagnosis with each earlier year of menarche. Negative control and two-sample MR sensitivity analyses were broadly consistent with this pattern of results. Multivariable MR analyses accounting for the genetic overlap between age at menarche and childhood body size provided some evidence of confounding. Meanwhile, we found little consistent evidence of effects on other domains of mental health after accounting for co-occurring depression and other confounding.

CONCLUSIONS

We found evidence that age at menarche affected diagnoses of adolescent depression, but not other domains of mental health. Our findings suggest that earlier age at menarche is linked to problems in specific domains rather than adolescent mental health in general.

Distinct Constellations of Common Risk Factors Differentially Relate to Executive-Function Ability in Children

Executive functioning (EF) has been shown to relate to academic achievement and well-being. Independent bodies of work have aimed to understand what environmental or personal attributes influence EF ability. However, most research has not considered how constellations of risk factors create distinct patterns of influence on EF ability. The current study tested a sample of children aged 9 to 10 years from the United States (N = 10,323, 48.06% female, Mage = 9.9 years, age range = 8.9-11.08 years) using a latent profile analysis (LPA) to detect subgroups that varied in their combinations of various risk factors. Six distinct groups of risk factors for children emerged, which in turn related to different average EF abilities. We found that family socioeconomic measures related to a subgroup having above- or below-average EF ability, but we also found an effect on EF across different risk factors. These results inform our understanding of individual variations in EF ability and highlight the idea that EF interventions should consider risk holistically.

Concurrent and long-term effects of early pubertal timing on alcohol, cigarette, and cannabis use from adolescence to adulthood

OBJECTIVE

Early pubertal timing is a risk factor for substance use during adolescence. Fewer studies investigated whether early pubertal timing continues to predict substance use in late adolescence and adulthood, suggesting that long-term effects of pubertal timing vary across substances and by biological sex. Finally, existing studies on pubertal timing and substance use in adulthood involved predominantly White samples. Thus, this longitudinal study examined the concurrent and long-term effects of pubertal timing on alcohol, cigarette, and cannabis use together with sex differences in predominantly Black youth from the United States.

METHOD

The sample included 603 youth (52% male, 80% Black) who were interviewed in early adolescence (mean age: 13.2), late adolescence (mean age: 17.6), and young adulthood (mean age: 27.7). During early adolescence, youth self-reported their physical maturation based on Tanner scores, which were adjusted for age and used as indicators of pubertal timing. Youth self-reported their substance use at each time point.

RESULTS

Early pubertal timing was associated with higher odds of alcohol use during early adolescence but did not predict alcohol use during late adolescence or adulthood. While early pubertal timing did not predict cigarette use at any time point, early pubertal timing predicted greater odds for cannabis use during early adolescence and higher rates of cannabis use in adulthood. Moreover, early pubertal timing predicted greater risk for couse of alcohol, cigarettes, and cannabis in adulthood. No effects differed by sex.

CONCLUSIONS

These findings suggest that links between pubertal timing and substance use vary across substances and developmental periods. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Relative Pubertal Maturation and Perceived Popularity on Symptoms of Depression and Social Anxiety in Adolescent Boys and Girls

Research has shown that adolescents - particularly girls - who mature relatively early often experience more internalizing problems. This effect is thought to be partially driven by psychosocial mechanisms, but previous research based relative pubertal maturation on complete samples or population standards, instead of considering the adolescents' direct peer environment. In the current study the level of adolescents' pubertal development was assessed relative to their classmates in order to examine relative pubertal maturation. The effects of adolescents' relative pubertal status, and their perceived popularity, on symptoms of social anxiety and depression in adolescents were studied. All analyses were also performed for absolute pubertal maturation. Participants were 397 young adolescents (Mage = 13.06, SD = 0.36, 49.9% girls) at timepoint 1, and 307 (Mage = 14.08, SD = 0.36, 50.5% girls) at timepoint 2. A significant positive relationship was found between relative pubertal timing and symptoms of depression for girls but not boys. Social anxiety symptoms were not significantly related to relative pubertal timing in either sex. Relative pubertal maturation had no effect on change in or persistence of depressive and social anxiety symptoms one year later. The effects of the comparison with the immediate peer environment, did not seem to explain more variance in internalizing symptoms than the effects of early maturation.

Pubertal timing and adolescent outcomes: investigating explanations for associations with a genetically informed design

BACKGROUND

Psychopathology and risky behaviors increase during adolescence, and understanding which adolescents are most at risk informs prevention and intervention efforts. Pubertal timing relative to same-sex, same-age peers is a known correlate of adolescent outcomes among both boys and girls. However, it remains unclear whether this relation is better explained by a plausible causal process or unobserved familial liability.

METHODS

We extended previous research by examining associations between pubertal timing in early adolescence (age 14) and outcomes in later adolescence (age 17) in a community sample of 2,510 twins (49% boys, 51% girls).

RESULTS

Earlier pubertal timing was associated with more substance use, risk behavior, internalizing and externalizing problems, and peer problems in later adolescence; these effects were small, consistent with previous literature. Follow-up co-twin control analyses indicated that within-twin-pair differences in pubertal timing were not associated with within-twin-pair differences in most adolescent outcomes after accounting for shared familial liability, suggesting that earlier pubertal timing and adolescent outcomes both reflect familial risk factors. Biometric models indicated that associations between earlier pubertal timing and negative adolescent outcomes were largely attributable to shared genetic liability.

CONCLUSIONS

Although earlier pubertal timing was associated with negative adolescent outcomes, our results suggests that these associations did not appear to be caused by earlier pubertal timing but were likely caused by shared genetic influences.

Age at menarche relates to depression in adolescent girls: Comparing a clinical sample to the general pediatric population

CONTEXT

The timing of puberty, physical features of pubertal development, and hormones are closely intertwined but may also individually contribute to the risk for depression and depression severity. Additionally, their effects on mood may depend on depression severity, but previously this has only been studied in mostly subclinical depression.

METHODS

In 184 girls from a single psychiatric hospital with significant depressive symptoms (Beck Depression Inventory-II score > 13), the relationship between depression severity and age at menarche (AAM), pubertal status, and gonadal/adrenal hormones (estradiol, progesterone, DHEA-S, androstenedione, testosterone, dihydrotestosterone) was investigated. Moreover, AAM in depressed girls was compared to that from a representative sample of German adolescents without a psychiatric disorder (N = 1674). Androgen levels were compared to those of age- and sex-matched controls (N = 59).

RESULTS

AAM but not pubertal stage or biochemical parameters related to depression. Girls with AAM at the lower normative range of pubertal development were 61 % more likely to develop depression and scored 4.9 points higher on the depression scale than girls experiencing menarche at the population average. Androstenedione levels were increased in the psychiatric sample, but neither androgen nor gonadal hormone levels were associated with depression severity.

LIMITATIONS

The study is cross-sectional.

CONCLUSIONS

These observations confirm previous studies in mostly subclinical depression and highlight the importance of AAM for adolescent depression. Thus, AAM could be considered a prognostic factor for a clinical risk score assessing the probability of adolescent depression. Moreover, these findings suggest fostering efforts that address risk factors that contribute to an earlier AAM.

The Distinct Roles of Biological and Perceived Pubertal Timing in Delinquency and Depressive Symptoms from Adolescence to Adulthood

Pubertal timing is a robust predictor of externalizing and internalizing problems in adolescence, but controversies remain whether only early or off-time (both early and late) pubertal timing is associated with negative developmental outcomes and whether effects differ across perceptions of pubertal timing and actual biological pubertal timing. Additionally, less is known about the longevity of pubertal timing effects and mediators of effects that persist through adolescence and into adulthood. This longitudinal study investigated the effects of early and off-time pubertal timing, in form of perceived pubertal timing relative to peers and reported biological pubertal timing relative to age, on delinquency and depressive symptoms in adolescence and young adulthood between 2003 and 2022. Peer deviance and school connectedness were examined as mediators of any persisting effects. The sample included 704 youth (52% male, 76% African American, 22% Non-Hispanic White) who were assessed at four time points from early adolescence (Mean ages: 11.8, 13.2) to late adolescence (Mean age: 17.6) and young adulthood (Mean age: 27.7). Perceived off-time pubertal timing in males and early biological pubertal timing in both males and females were risk factors for persistent delinquency into young adulthood, but neither form of pubertal timing was associated with depressive symptoms. None of the effects were mediated by peer deviance or school connectedness. These findings advance the understanding of more nuanced effects of pubertal timing on adjustment problems in diverse youth as they develop from early adolescence to adulthood.

Causal Effect of Age at Menarche on the Risk for Depression: Results From a Two-Sample Multivariable Mendelian Randomization Study

A fair number of epidemiological studies suggest that age at menarche (AAM) is associated with depression, but the reported effect sizes are small, and there is evidence of residual confounding. Moreover, previous Mendelian randomization (MR) studies to avoid inferential problems inherent to epidemiological studies have provided mixed findings. To clarify the causal relationship between age at menarche and broadly defined depression risk, we used 360 genome-wide significantly AAM-related single-nucleotide polymorphisms (SNPs) as instrumental variable and data from the latest GWAS for the broadly defined depression risk on 807,553 individuals (246,363 cases and 561,190 controls). Multiple methods to account for heterogeneity of the instrumental variable (penalized weighted median, MR Lasso, and contamination mixture method), systematic and idiosyncratic pleiotropy (MR RAPS), and horizontal pleiotropy (MR PRESSO and multivariable MR using three methods) were used. Body mass index, education attainment, and total white blood count were considered pleiotropic phenotypes in the multivariable MR analysis. In the univariable [inverse-variance weighted (IVW): OR = 0.96, 95% confidence interval = 0.94–0.98, p = 0.0003] and multivariable MR analysis (IVW: OR = 0.96, 95% confidence interval = 0.94–0.99, p = 0.007), there was a significant causal effect of AAM on depression risk. Thus, the present study supports conclusions from previous epidemiological studies implicating AAM in depression without the pitfalls of residual confounding and reverse causation. Considering the adverse consequences of an earlier AAM on mental health, this finding should foster efforts to address risk factors that promote an earlier AAM.

Sex differences in the blood-brain barrier: Implications for mental health

Prevalence of mental disorders, including major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SZ) are increasing at alarming rates in our societies. Growing evidence points toward major sex differences in these conditions, and high rates of treatment resistance support the need to consider novel biological mechanisms outside of neuronal function to gain mechanistic insights that could lead to innovative therapies. Blood-brain barrier alterations have been reported in MDD, BD and SZ. Here, we provide an overview of sex-specific immune, endocrine, vascular and transcriptional-mediated changes that could affect neurovascular integrity and possibly contribute to the pathogenesis of mental disorders. We also identify pitfalls in current literature and highlight promising vascular biomarkers. Better understanding of how these adaptations can contribute to mental health status is essential not only in the context of MDD, BD and SZ but also cardiovascular diseases and stroke which are associated with higher prevalence of these conditions.

Is there an association between prenatal testosterone and autistic traits in adolescents?

Prenatal testosterone (pT) is a crucial component in physiological masculinization in humans. In line with the Prenatal Sex Steroid Theory of autism, some studies have found a positive correlation between pT and autistic traits in childhood. However, effects in adolescence have not been explored. Hormonal and environmental changes occurring during puberty may alter the strength or the nature of prenatal effects on autistic traits. The current study examines if pT relates to autistic traits in a non-clinical sample of adolescents and young adults (N = 97, 170 observations; age 13-21 years old). It also explores pT interactions with pubertal stage and timing. PT concentrations were measured from amniotic fluid extracted in the 2nd trimester of gestation via amniocentesis conducted for clinical purposes. Autistic traits were measured by self- and parent-reports on the Autism Spectrum Quotient (AQ) which provides a total score and 5 sub-scores (social skills, communication, imagination, attention switching and attention to detail). Self-reported pubertal stage was regressed on age to provide a measure of relative timing. We found no statistical evidence for a direct association between pT and autistic traits in this adolescent sample (males, females or full sample). Exploratory analyses suggested that pT correlated positively with autistic traits in adolescents with earlier puberty-onset, but statistical robustness of this finding was limited. Further exploratory post-hoc tests suggested the pT-by-pubertal timing interaction was stronger in males relative to females, in self-reported compared to parent-reported AQ and specifically for social traits. These findings require replication in larger samples. Findings have implications for understanding the effects of pT on human behavior, specifically existence of effects in adolescence.

Identifying Predictors of Momentary Negative Affect and Depression Severity in Adolescents with Autism: An Exploratory Ecological Momentary Assessment Study

Depression is a common comorbidity in autism spectrum disorder (ASD). Little is known about risk factors for depression and depressive symptoms in this population. Ecological momentary assessment (EMA) has been used in the typically developing population to identify risk factors for depression, but has been rarely applied in ASD populations. In this exploratory study, 17 autistic adolescents participated in an EMA protocol in which they reported on their current activities and emotions six times per day for seven consecutive days. Results suggested that negative affect is predicted by momentary quality of social interaction and enjoyment of the current activity (p < 0.05). Additionally, affective instability predicted depressive symptoms. These results provide insights into risk factors for depression in this vulnerable population.

Trajectories of Violent and Nonviolent Behaviors From Adolescence to Early Adulthood: Does Early Puberty Matter, and, If So, How Long?

PURPOSE

It is well known that pubertal timing affects adolescents' externalizing behaviors, but it is unknown if this effect lasts into adulthood. This study assessed if and when the early maturation effect wanes, specifically in two domains of externalizing behaviors: nonviolent and violent behaviors.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) that include age-appropriate items of violent and nonviolent behaviors assessed from ages 11-30 over four waves (N = 4,255), we conducted a series of longitudinal growth curve analyses to evaluate the effect of pubertal timing on the trajectories of nonviolent and violent externalizing behaviors for males and females.

RESULTS

Compared to later maturing male peers, early maturing males reported significantly elevated overall externalizing, nonviolent, and violent behaviors throughout adolescence, but became indistinguishable from on-time and late-maturing counterparts in young adulthood. Similarly, early maturing females showed higher levels of overall externalizing and nonviolent behaviors than later maturing counterparts, but no effect of pubertal timing was seen on the trajectories of violent behaviors. However, early maturing females' overall externalizing and nonviolent behaviors also became indistinguishable from on-time and late-maturing females after adolescence.

CONCLUSIONS

These findings clarify the differential effect of early maturation on nonviolent and violent behaviors, especially in females, and highlight the short-lived nature of the effects of early pubertal timing.

Early pubertal timing predicts onset and recurrence of depressive episodes in boys and girls

BACKGROUND

Recurrent depressive episodes during adolescence result in significant impairment and increased risk for subsequent adverse outcomes throughout the life span. Evidence suggests that early pubertal timing predicts the onset of depressive episodes (particularly for girls); however, it is not known if pubertal timing prospectively predicts recurrent depressive episodes in youth.

METHODS

At baseline, 603 youth (56% female, at baseline: M_age  = 12.09, SD = 2.35) reported on their pubertal development. Youth and their parents completed a semistructured diagnostic interview to assess depressive episodes at baseline and then evaluated for onset repeatedly every 6 months for a period of 36 months.

RESULTS

Controlling for past history of depression, Cox proportional hazards models examined whether earlier pubertal timing predicted (a) days to first depressive episode from baseline and (b) days to a second (recurrent) depressive episode from the end of the first episode. Early pubertal timing predicted the onset of the first depressive episode after baseline (b = .19, Wald = 5.36, p = .02, HR = 1.21), as well as a recurrent episode during course of study follow-up episode (b = .32, Wald = 6.16, p = .01, HR = 1.38).

CONCLUSIONS

Findings reinforce the importance of considering the impact of early pubertal timing on depression risk. Investigation on how pubertal timing interacts with other risk factors to predict depression recurrence is needed.

Early pubertal maturation and externalizing behaviors: Examination of peer delinquency as mediator and cognitive flexibility as a moderator

INTRODUCTION

While peer delinquency is a known mediator between early pubertal timing and externalizing behaviors, little is known about factors that could protect against the adverse influence of peer delinquency. This study assesses the possible moderating role of cognitive flexibility, which is one index of executive functioning that facilitates flexible and adaptive responses to challenging situations. We assessed the interactive influence of peer delinquency and cognitive flexibility in the association between pubertal maturation and externalizing behaviors in boys and girls.

METHOD

Participants were 220 adolescents (111 boys) from the United States, between the ages of 11 and 16 years (M = 13.2, SD = 1.53) who participated in the Adolescent Emotion Study (AES).

RESULTS

Findings from the cross-sectional path modeling analyses provided evidence for the mediating role of peer delinquency for boys and girls, indicating that early maturing adolescents tend to affiliate with delinquent peers, which in turn exacerbates externalizing problems. Additionally, the moderating role of cognitive flexibility was also demonstrated for both boys and girls. Region of significance tests revealed that relatively well-developed cognitive flexibility skills could protect against the adverse influences of peer delinquency, whereas lower levels could exacerbate those negative influences.

CONCLUSION

These findings suggest that involvement with deviant peers increases vulnerability for both early maturing boys and girls. Additionally, cognitive flexibility was an important moderating factor for adolescents, such that youths with less developed skills would be at a higher risk for psychopathology, whereas those with better development could be protected.

Early pubertal timing and adult adjustment outcomes: Persistence, attenuation, or accentuation?

Early pubertal timing is associated with internalizing and externalizing problems during adolescence. However, few studies explicitly test whether early puberty is especially problematic for those with pre-existing problems (i.e., accentuation) and little is known about whether the negative correlates of early pubertal timing persist past young adulthood. We address these questions using longitudinal data from up to 451 participants in the Iowa Youth and Families project (e.g., Ge, Conger, & Elder, 1996, 2001). We replicated and extended previous results reported for this sample during adolescence (e.g., early maturing boys and girls reported more substance use) and found some evidence for accentuation in adolescence for psychological distress and substance use. However, correlations between early puberty and adult outcomes assessed up to two decades later were largely indistinguishable from zero including attenuation effects. These results suggest that any negative correlates of early pubertal timing are attenuated by the fourth decade of life.