New research
Early Pubertal Timing and Testosterone Associated With Higher Levels of Adolescent Depression in Girls

https://doi.org/10.1016/j.jaac.2019.02.007Get rights and content

Objective

The prevalence of depression increases dramatically during puberty in girls. Earlier work in this sample reported that the sex steroids estradiol and testosterone were associated with increased depression in girls. Using three additional data waves (983 new observations), we retest the relative contributions of pubertal timing, pubertal status, and sex hormones on the increases in female depression.

Method

Eight waves of data from the prospective, representative Great Smoky Mountains Study were used covering female participants in the community who were 9 to 16 years of age (3,005 assessments of 630 girls; 1993−2000). Structured interviews assessed depressive disorders. Youth rated their pubertal status using Tanner stage drawings, and sex steroids were assayed from dried blood spots.

Results

Risk for depression during puberty was associated with both age and Tanner stage in univariate models. In adjusted models accounting for pubertal timing and sex steroids, the apparent effects of age and Tanner stage were attenuated both in terms of statistical significance and effect size. The only significant predictors of change in depression status during puberty were early pubertal timing (odds ratio = 5.8, 95% CI = 1.9−17.9, p = .002 after age 12 years) and higher testosterone levels (odds ratio = 2.0, 95% CI = 1.1−3.8, p = .03 for quartile-split variable).

Conclusion

The added observations have modified the original conclusions, implicating the following: testosterone only, but not estradiol; and early pubertal timing, but not age or pubertal status per se. These findings argue for multiple pubertal determinants of depression risk, including factors that are socially and biologically mediated.

Section snippets

Pubertal Timing

Interindividual variation in the onset of pubertal processes can create a period of contrast during which same-aged girls differ significantly from one another with respect to highly salient physical attributes such as breast size, distribution of subcutaneous fat, hip-to-waist ratio, and body hair. Girls who mature earliest have been shown to be at greater risk for depressive symptoms or disorders by some studies 4, 5, 6 but not by others.7 Proposed mechanisms for early pubertal timing effects

Participants

The Great Smoky Mountains Study is a longitudinal study of the development of psychiatric disorder in rural and urban youth.21 A representative sample of 3 cohorts of children, aged 9, 11, and 13 years at intake, was recruited from 11 counties in western North Carolina. Potential participants were selected from the population of some 20,000 children where each household had an equal probability of selection. The study used a two-stage sampling design. A screening questionnaire was administered

Missing Data

Of the 3,005 available observations on 630 female participants aged 9 to 16 years, 1,089 participants (36%) had data missing on Tanner stage, testosterone, or estradiol. Missingness was not associated with the probability of depression (Tanner stage: odds ratio [OR] = 0.9, 95% CI 0.5−1.9, p = .87; estradiol: OR = 1.1, 95% CI = 0.62.3, p = .73; testosterone: OR = 1.2, 95% CI = 0.6−2.6, p = .64; any pubertal variable: OR = 1.1, 95% CI = 0.5−2.2, p = .89). Furthermore, 566 or 89.8% of the 630

Discussion

In two earlier papers based on the first three waves of the Great Smoky Mountains Study, estradiol and testosterone explained all of the effects of age and Tanner stage on the prevalence of depression in girls.13, 19 Furthermore, there were no effects of the timing of puberty on increases in depression diagnosis. When three additional data waves between ages 12 and 16 years were collected, strengthening data coverage in mid to late puberty, and almost doubling the number of total assessments,

References (35)

  • J. Mendle et al.

    Development's tortoise and hare: pubertal timing, pubertal tempo, and depressive symptoms in boys and girls

    Dev Psychol

    (2010)
  • C. Hayward et al.

    Psychiatric risk associated with early puberty in adolescent girls

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • J.S. Hyde et al.

    The ABCs of depression: integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression

    Psychol Rev

    (2008)
  • C. Hayward

    Methodological concerns in puberty-related research

  • R.C. Kessler et al.

    Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication

    Arch Gen Psychiatry

    (2005)
  • G. Lewis et al.

    The association between pubertal status and depressive symptoms and diagnoses in adolescent females: a population-based cohort study

    PLoS One

    (2018)
  • A. Angold et al.

    Puberty and depression: the roles of age, pubertal status, and pubertal timing

    Psychol Med

    (1998)
  • Cited by (57)

    • Depressive disorders

      2023, Encyclopedia of Mental Health, Third Edition: Volume 1-3
    View all citing articles on Scopus

    The work presented here was supported by the National Institute of Mental Health (NIMH; MH080230, MH63970, MH63671, MH48085, MH075766, MH094605, MH117559, and MH104576), the National Institute on Drug Abuse (NIDA; DA/MH11301, DA011301, DA016977, DA036523, and DA023026), the National Institute for Child Health and Development (NICHD; HD093651), and the William T. Grant Foundation.

    Dr. Copeland had full access to all the data in the study, performed all statistical analyses, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    The authors would like to thank the participants of the Great Smoky Mountains Study and their families for their longstanding involvement in this study.

    Disclosure: Dr. Copeland has received research support from NIMH, NIDA, and NICHD. Dr. Shanahan has received research support from NIMH. Drs. Costello and Angold are currently retired. Dr. Worthman reports no biomedical financial interests or potential conflicts of interest.

    View full text