Pubertal development and mental health: A population-based cohort study on self-rated health, psychotropic medication, and psychiatric diagnoses

Earlier age at menarche may influence mental health but less is known of other measures of pubertal development. We aimed to investigate general mental health consequences of altered timing and tempo of several pubertal milestones in adolescents from the population-based Danish National Birth Cohort (DNBC).

Information on pubertal development (Tanner stages, age at menarche, age at first ejaculation, and voice break), was provided half-yearly throughout puberty in 6941 adolescent females and 6267 adolescent males. Timing (earlier, average, later) and tempo (faster, average, slower) of puberty were derived using non-linear mixed effect growth models and analysed as categorical and continuous variables. Outcomes included self-rated health obtained from the DNBC 18-year follow-up, and redemption of any prescribed psychotropic medication or any psychiatric diagnosis obtained from the Danish registers up to age 19 years. Adjusted odds ratios were estimated using logistic regression.

Earlier pubertal timing and faster pubertal tempo were associated with higher odds, whereas later pubertal timing and slower pubertal tempo were associated with lower odds of the mental health outcomes, ranging from poor self-rated health to redeeming any psychotropic medication and receiving a psychiatric diagnosis. Associations were strongest in female adolescents.

Altered pubertal development was associated with all unfavorable mental health outcomes. Vulnerable adolescents at increased risk of poor mental health due to earlier pubertal timing or faster pubertal tempo should be identified with the potential to introduce earlier interventions and support preventive actions for these adolescents.