Elsevier

Journal of Affective Disorders

Volume 155, February 2014, Pages 13-19
Journal of Affective Disorders

Review
Pubertal timing in girls and depression: A systematic review

https://doi.org/10.1016/j.jad.2013.10.034Get rights and content

Abstract

Background

Because the incidence of depression increases after puberty, it is possible that pubertal timing in girls influences the onset of depression. Our objective was to assess the effect of early and late puberty in girls on the incidence of depression.

Methods

We systematically searched relevant databases for controlled studies that assessed the impact of pubertal timing in girls on the incidence of depression or depressive symptoms. The last search was completed in August 2013. Two authors selected the studies, extracted the data, and assessed the quality of the evidence. Meta-analyses of the adjusted and unadjusted results were calculated using random effects.

Results

Four cohort studies were included (n=8055 participants). Early puberty significantly increased the risk of new cases of depression in the unadjusted meta-analysis (RR=1.33; CI 95%: 1.02, 1.73) but not in the adjusted estimate of two of the included studies (RR=1.48; CI 95%: 0.69, 2.28). For late puberty, no significant associations were found (unadjusted RR=1.28; CI 95%: 0.87, 1.88). Two studies assessed the effect of early puberty on depressive symptoms and found positive associations. The quality of the available evidence was rated as very low.

Limitations

The polled results had wide confidence intervals, and the available evidence was of very low quality.

Conclusions

The available evidence supports little confidence regarding the impact of pubertal timing on the onset of depression in girls but suggests that early puberty in girls may increase the risk of depression. Further higher quality studies are needed to clarify the association between pubertal timing and the incidence of depression in girls and women.

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)

  • S. Laitinen-Krispijn et al.

    The role of pubertal progress in the development of depression in early adolescence

    J. Affect Disord.

    (1999)
  • P.M. Lewinsohn et al.

    Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications

    Clin. Psychol. Rev.

    (1998)
  • S. Moussavi et al.

    Depression, chronic diseases, and decrements in health: results from the World Health Surveys

    Lancet

    (2007)
  • G.C. Patton et al.

    Predicting female depression across puberty: a two-nation longitudinal study

    J. Am. Acad. Child Adolesc. Psychiatry

    (2008)
  • M.B. Pierce et al.

    Role of lifetime body mass index in the association between age at puberty and adult lipids: findings from men and women in a British birth cohort

    Ann. Epidemiol.

    (2010)
  • H.Z. Reinherz et al.

    Psychosocial risks for major depression in late adolescence: a longitudinal community study

    J. Am. Acad. Child Adolesc. Psychiatry

    (1993)
  • R.M.B. White et al.

    Contextual amplification or attenuation of pubertal timing effects on depressive symptoms among Mexican American girls

    Journal of Adolescent Health

    (2012)
  • I. Andersen et al.

    Increasing prevalence of depression from 2000 to 2006

    Scand. J. Public Health

    (2011)
  • A. Angold et al.

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

    Psychol. Med.

    (1998)
  • Bai, A., Shukla, V.K., Bak, G., Wells, G., 2012. Quality Assessment Tools Project Report. Canadian Agency for Drugs and...
  • A. Benoit et al.

    Pubertal timing and depressive symptoms in late adolescence: the moderating role of individual, peer, and parental factors

    Dev. Psychopathol.

    (2013)
  • J.M. Boden et al.

    Age of menarche and psychosocial outcomes in a New Zealand birth cohort

    J. Am. Acad. Child Adolesc. Psychiatry

    (2011)
  • L. Born et al.

    The relationship between menarche and depression in adolescence

    CNS Spectrums

    (2001)
  • V.K. Burt et al.

    Epidemiology of depression throughout the female life cycle

    J. Clin. Psychiatry

    (2002)
  • B.J. Cairns et al.

    Lifetime body size and reproductive factors: comparisons of data recorded prospectively with self reports in middle age

    BMC Med. Res. Methodol.

    (2011)
  • J. Canals et al.

    Predictors of depression at eighteen. A 7-year follow-up study in a Spanish nonclinical population

    Eur. Child Adolesc. Psychiatry

    (2002)
  • J. Canals Sans et al.

    Symptoms of depression during puberty: initial results of a longitudinal epidemiological study

    Actas Luso. Esp. Neurol. Psiquiatr. Cienc. Afines

    (1991)
  • R. Carter et al.

    Ethnicity, perceived pubertal timing, externalizing behaviors, and depressive symptoms among black adolescent girls

    J. Youth Adolesc.

    (2011)
  • G.J. Cho et al.

    Age at menarche in a Korean population: secular trends and influencing factors

    Eur. J. Pediatr.

    (2010)
  • W.M. Compton et al.

    Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991–1992 and 2001–2002

    Am. J. Psychiatry

    (2006)
  • C.S. Conley et al.

    The emerging sex difference in adolescent depression: interacting contributions of puberty and peer stress

    Dev. Psychopathol.

    (2009)
  • C.S. Conley et al.

    Explaining the longitudinal association between puberty and depression: sex differences in the mediating effects of peer stress

    Dev. Psychopathol.

    (2012)
  • R. Cooper et al.

    Validity of age at menarche self-reported in adulthood

    J. Epidemiol. Community Health

    (2006)
  • J.J. Deeks et al.

    Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis

  • Cited by (0)

    View full text