ReviewPubertal timing in girls and depression: A systematic review
Introduction
Depression is a globally common disease that has a greater negative effect on overall health than diabetes, angina, arthritis or asthma (Moussavi et al., 2007). Moreover, depression is the leading cause of the global burden of neuropsychiatric diseases (Eaton et al., 2008). Following the onset of adolescence, depression affects more women than men, with a prevalence almost two-folder higher (Hosseinpoor et al., 2012a). Genetic predisposition and negative life events play a major role in the onset of depression and are equally distributed between both genders (Johnson et al., 2013, Rice et al., 2003). Socioeconomic inequalities between genders may account for the increased burden of depression in women, as lower socioeconomic status, which is more frequent in women, is a risk factor for depression (Hosseinpoor et al., 2012b, Lorant et al., 2003). The differences in gender distribution of depression may also be associated with biological characteristics, and gonadal hormones have been highlighted as one such characteristic (Nemeth et al., 2013).
The 1-year prevalence of depression in adolescents is estimated to be 4–5% (Costello et al., 2005, Jane Costello et al., 2006). Depression during adolescence is associated with important current and future morbidity. It can lead to lower educational attainment among those who are depressed during this important developmental period and may play a role in social status (Lewinsohn et al., 1998, Fletcher, 2008, Thapar et al., 2012). In addition, depression during adolescence is a major risk factor for suicide in this age group (Windfuhr et al., 2008).
Puberty is a period of biological and social change that also affects self-esteem and psychological equilibrium. Cohort studies have reported that changes in pubertal timing – deviation from normal development – are associated with cardiovascular diseases (Feng et al., 2008, Kivimäki et al., 2008). Pubertal timing has also been suggested to influence the onset of depression (Patton and Viner, 2007). The basis of this hypothesis is the modulatory effect of gonadal hormones on the neuroendocrine system. Higher levels of estrogen during puberty may change the sensitivity of neurotransmitter systems, particularly the production of serotonin receptors at the transcriptional level (Steiner et al., 2003). The altered distribution or function of serotonin receptor subtypes brought on by changes in the hormonal milieu at menarche may amplify vulnerability to mood disorders, especially when changes in normal timing are present (Steiner et al., 2003).
Despite these predictions, conclusive evidence from epidemiological studies in the field could not be identified. This scenario motivated us to perform a systematic review with meta-analysis of the effect of pubertal timing in girls on the incidence of depression.
Section snippets
Protocol and registration
The protocol for the current review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42012003074.
Eligibility criteria
We considered case control and cohort studies that assessed the influence of early or late puberty in girls on the incidence of depressive symptoms or depressive disorders eligible for this review.
Information sources and search strategy
We searched MEDLINE, EMBASE, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library,
Results
The literature search retrieved 984 records (Figs. 1). After assessing the titles and abstracts, we selected 31 records for full text assessment and included five reports from four distinct cohort studies. The reason for exclusion of the other 26 papers are depicited in Fig. 1 (Angold et al., 1998; Benoit et al., 2013; Born and Steiner, 2001; Burt and Stein, 2002; Canals et al., 2002; Canals Sans et al., 1991; Carter et al., 2011; Conley and Rudolph, 2009; Conley et al., 2012; Davison et al.,
Discussion
Evidence from the available unadjusted results of the cohort studies demonstrated that girls who experienced early puberty are at a higher risk of developing depression during adolescence. An adjusted meta-analysis could only be performed for two of the studies, and no significant associations were found. Late puberty was not significantly associated with depression, although fewer individuals were assessed for this exposure. With regard to depressive symptoms, two individual studies identified
Conclusions
Early puberty in girls seems to be a risk factor for the onset of depression, while no increased risk was found for late puberty. Parents and healthcare providers should be aware of mood monitoring in teenagers girls with early puberty. The quality of the evidence could be greatly improved by further well-designed research to better explore how puberty and depression interact. This could be accomplished through ongoing longitudinal studies, particularly birth cohorts for which accurate records
Role of funding source
This research was partially supported by a public research agency (Brazilian National Research Council), which did not interfere on the research conduction or on the writing of the manuscript.
Conflict of interest
The authors have no conflicts of interest in the context of this work.
Acknowledgments
This research was partially supported by a Public research agency (Brazilian National Research Council).
References (69)
- et al.
GRADE guidelines: 3. Rating the quality of evidence
J. Clin. Epidemiol.
(2011) - et al.
10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden
J. Am. Acad. Child Adolesc. Psychiatry
(2005) - et al.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13
Soc. Sci. Med.
(2007) - et al.
Effects of age at menarche, reproductive years, and menopause on metabolic risk factors for cardiovascular diseases
Atherosclerosis
(2008) - et al.
A longitudinal study of depressive symptomatology in young adolescents
J. Am. Acad. Child. Adolesc. Psychiatry
(1990) - et al.
Dietary protein intake throughout childhood is associated with the timing of puberty
J. Nutr.
(2010) - et al.
GRADE guidelines: 2. Framing the question and deciding on important outcomes
J. Clin. Epidemiol.
(2011) - et al.
Ethnic differences in the association between pubertal status and symptoms of depression in adolescent girls
J. Adolesc. Health
(1999) - et al.
Age at menarche and depression at the age of 31 years: findings from the Northern Finland 1966 Birth Cohort Study
J. Psychosom. Res.
(2004) - et al.
The characteristics of asymptomatic female adolescents at high risk for depression: the baseline assessment from a prospective 8-year study
J. Affect. Disord.
(2004)