Early Menarche Linked to Increased Risk for Teen Depression

Megan Brooks

January 06, 2011

January 6, 2011 — Girls who begin menstruating early — before 11.5 years of age — are more likely to exhibit depressive symptoms in midadolescence than their peers who begin menstruating after the age of 13.5 years, new research suggests.

The study lends support to the hypothesis that girls who mature earlier than their peers are more vulnerable to psychological distress, say the researchers, led by Carol Joinson, PhD, of the School of Social and Community Medicine, University of Bristol, in the United Kingdom.

The study is published in the January issue of the British Journal of Psychiatry.

"There is something about the changes in the brain with menarche that puts young women at higher risk for depression," Adelaide S. Robb, MD, a member of the American Academy of Child & Adolescent Psychiatry, who was not involved in the study, noted in an interview with Medscape Medical News.

"We see other developmentally linked risks for mental disorders, such as postpartum depression, which again occurs around a rapid and dramatic alteration in hormones," said Dr. Robb, an associate professor of psychiatry and pediatrics, George Washington University Children's National Medical Center, in Washington, DC.

"A growing body of research suggests a link between timing of menarche and risk of depressive symptoms in adolescence, but few have prospectively examined the emergence of depressive symptoms from late childhood into adolescence," the investigators write.

Independent Association

They examined associations between timing of menarche and depressive symptoms in 2184 girls enrolled in the Avon Longitudinal Study of Parents and Children. This ongoing population-based study is investigating a range of environmental and other influences on the health and development of children.

Girls in the sample completed the Short Mood and Feelings Questionnaire at the age of 10.5 years and again at the ages of 13 and 14 years.

The mean age at onset of menarche was 12.6 years, which corresponds closely to that reported in other contemporary samples from the United States and Western European countries, the researchers say.

They defined early menarche as before the age of 11.6 years (1 SD below the mean age of 12.5 years; 16.7% of the sample). They defined late menarche as occurring at or after 13.6 years (17.7% of the cohort). The remaining group (65.6%) was defined as having a normal age at onset and made up the reference group.

They found that girls with early menarche had the highest level of depressive symptoms at the ages of 13 years (P = .007) and 14 years (P < .001), compared with those with normative and late timing of menarche. Girls who started menstruating after the age of 13.5 years had the lowest level of depressive symptoms.

Even after taking into account well-established shared risk factors for depressive symptoms and earlier menarche, including being overweight, there remained evidence of an independent association between early menarche and depressive symptoms.

"It is notable," the researchers write, "that girls with early menarche initially experienced the earliest rise in level of depressive symptoms from late childhood (10.5 years) to early adolescence (13 years) compared with the other groups, but between 13 and 14 years there was no further divergence in level of symptoms between the normative and early-onset groups.

"By age 14, there was separation between all 3 groups, with the early menarche group having the highest level of depressive symptoms, followed by normative, then late onset — an apparent dose-response relationship," they add.

Critical Period

The investigators note that the transition into puberty is a critical developmental period, associated with many biological, cognitive, and social changes. These include increased conflict with parents, the development of romantic relationships, changes in body image, and fluctuating hormone levels.

These changes may have a more negative impact on girls who mature at an earlier age than their peers. "Early maturing girls may feel isolated and faced with demands that are inconsistent with their level of cognitive and emotional development," the study authors write.

Dr. Robb made the point that "after the onset of puberty, the gender ratio for depression goes from 1:1 to 2:1 for females to males. What this study shows is that once menarche happens that childhood rate rises toward the adult rate fairly rapidly. Those young ladies with earlier onset of menarche experience the earlier onset of adult depression rates."

What's not clear from the study is whether early menstruation is associated with persistent psychological problems.

"It would have been nice to follow all the young ladies out to age 18 to see if the slopes for the normal and late menarche individuals eventually matched the early menarche individuals," Dr. Robb said.

"If girls who reach puberty early are at greater risk for psychological problems in adolescence, it may be possible to help them with school- and family-based programs aimed at early intervention and prevention," Dr. Joinson said in written statement.

According to Dr. Robb, healthcare professionals should ask their female pediatric patients about menarche and if they are postmenarche ask about depressive symptoms.

The study was funded by the Economic and Social Research Council. The study authors and Dr. Robb have disclosed no relevant financial relationships.

Br J Psychiatry. 2011;198:17-23.

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