Elsevier

Social Science & Medicine

Volume 57, Issue 6, September 2003, Pages 1055-1064
Social Science & Medicine

Early puberty is associated with mental health problems in middle adolescence

https://doi.org/10.1016/S0277-9536(02)00480-XGet rights and content

Abstract

This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14–16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents.

Introduction

Many mental disorders such as major depression (Angold, Costello, & Worthman, 1998), certain anxiety disorders (Feehan, McGee, Raja, & Williams, 1994; Hayward et al., 1992), eating disorders (Steinhausen, 1994) and substance use disorders (Perkonigg, Lieb, & Wittchen, 1998) increase in prevalence during adolescence. A total of 15–25% of adolescents meet the diagnostic criteria of some specific mental disorder (Newman et al., 1996). Stage of pubertal development rather than chronological age has been reported as a risk factor for eating disorders (Koff & Rierdan, 1993), depression (Angold et al., 1998) and anxiety (Hayward et al., 1992).

Puberty includes major hormonal changes that are likely to contribute for example to both to depressive affect and aggression (Brooks-Gunn & Warren, 1989). Biological changes of puberty also have a social value. Therefore, the challenge of adapting to one's own changing body and to role expectations might contribute to negative affect and mental disorders during adolescent development. Thus, from both social and psychological perspectives, maturing off time, either earlier or later than peers, may cause excessive stress and be a risk factor for symptoms and disorders.

For girls, early pubertal timing has been associated with psychosomatic symptoms, eating disorders, depression, anxiety and disturbed self-image (Aro & Taipale, 1987; Graber, Lewinsohn, Seeley, & Brooks-Gunn, 1997; Hayward et al., 1997; Wichstrom, 1995), suicide attempts (Wichstrom, 2000), substance use and delinquent behaviour (Graber et al., 1997; Laitinen-Krispijn, van der Erde, Hazebroek-Kampschreur, & Verhulst, 1999; Lintonen, Rimpelä, Vikat, & Rimpelä, 2000).

Among boys, early maturation has been reported to promote psychosocial adjustment (Stattin & Magnusson, 1990) and late maturation considered a risk for poor adjustment and negative self-perception (Graber et al., 1997; Laitinen-Krispijn et al., 1999; Nottelman et al., 1987). Thus, mental disorders might also be associated with late maturation among boys. However, substance use and delinquency (Graber et al., 1997; Lintonen et al., 2000; Williams & Dunlop, 1999) correlate with early maturation among boys as do suicide attempts (Wichstrom, 2000). We have also found that both bulimia and depression are associated with early maturation among boys (Kaltiala-Heino, Rissanen, Rimpelä, & Rantanen, 2001b; Kaltiala-Heino, Kosunen, & Rimpelä, 2001a).

Most of the previous research on pubertal timing and mental health has focused on girls or on single outcomes. More information is needed on boys and on the specificity of type of disorders (internalising, externalising) associated with pubertal timing among boys and girls.

This study aimed to answer the following questions using a large, non-selected middle adolescent population:

How does pubertal timing correlate with different internalising and externalising problems?

What are the correlates for boys and girls separately?

Section snippets

Material and methods

The School Health Promotion Study is an anonymous classroom survey among 8th and 9th grade secondary school students about health, health behaviour and school experiences. Approved by the Ethical Committee of Tampere University Hospital, the study has been carried out annually since 1995. The data for the present study comprises responses to the 1998 Study. Secondary schools in four regions and 13 towns of Finland participated. The study was carried out in April, at the end of the spring term.

Pubertal timing

Pubertal timing was assessed by the age at onset of menstruation/ejaculations by asking “How old were you when you had your first menstruation (ejaculation)?: (10 years or younger/11 years/12 years/13 years/14 years/15 years or older/I have not yet experienced menstruation (ejaculation)).” A majority of the respondents had experienced menarche/oigarche at age 12 or 13 (Table 1). In this study we use the phrase early onset of menstruation and ejaculations for menarche/oigarche that has occurred

Conclusion

Early pubertal timing associates with mental health problems in middle adolescence. The association between early pubertal timing and externalising problems is similar among girls and boys. Among girls, internalising problems also associate with early puberty, among boys, externalising problems partially explain the association between early puberty and internalising problems. Professionals working with adolescents in health and social services and schools should pay attention to mental health

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