Transitions in stress, depression, and self-esteem across pubertal onset in children with central precocious puberty

To compare psychological well-being of individuals with and without central precocious puberty (CPP) before and after pubertal onset METHODS: Perceived stress, depressive symptoms, and self-esteem were assessed in girls aged 6-14 years (n = 1699) and boys aged 9-17 years (n = 892) before and after pubertal onset (defined as the attainment of Tanner stage 2) using data from the Taiwan pubertal longitudinal study. Multivariable regression models were used to evaluate associations between CPP and psychological outcomes before and after pubertal onset, adjusting for sex, bone age, and body mass index (BMI) Z-score. Structural equation modeling (SEM) was applied to explore pathways linking perceived stress, obesity, self-esteem, depressive symptoms, and CPP in the girls RESULTS: Before pubertal onset, children who developed CPP exhibited higher perceived stress and lower self-esteem than peers. After pubertal onset, CPP was associated with lower perceived stress, fewer depressive symptoms, and higher self-esteem in girls, whereas no significant associations were observed in boys. SEM results revealed that higher perceived stress was associated with higher BMI Z-scores, which were positively associated with CPP risk. Perceived stress was also linked to lower self-esteem, which was associated with greater depressive symptoms DISCUSSION: Psychological vulnerability may precede pubertal onset in children who develop CPP, although these differences attenuate after pubertal onset, particularly in girls. Early-life stress may also contribute to CPP risk through obesity-related pathways IMPLICATIONS AND CONTRIBUTION: Children who develop CPP frequently experience psychological vulnerability before the onset of puberty that improves thereafter, particularly in girls. Early exposure to stress may increase the risk of CPP through pathways linked to obesity.