Early puberty tied to risk of poor mental wellbeing and alcohol, cigarettes and drugs consumption: Study

The body changes, hormones surge, and the transition from child to teenager is well underway. But when puberty begins earlier than among peers, it may have consequences for young people – even when it falls within what medical science considers the normal range. That is one of the key findings of three new studies from the research group of Professor Cecilia Ramlau-Hansen from the Department of Public Health at Aarhus University:

“Early puberty is associated with an increased risk of general psychological distress, in terms of lower self-rated health, psychiatric diagnoses and the use of psychiatric medication among young people. The trend is strongest for girls, but it also applies to boys. Our studies suggest that girls who enter puberty early may have twice the risk of receiving psychiatric medication for mental health conditions in general, compared with girls who begin puberty at the same time as their classmates. Among boys, we found only a slight increase in risk,” says Postdoc Anne Gaml-Sørensen, who is first author behind the study.

The studies are based on cohort investigations in which a total of 15,818 Danish adolescents completed questionnaires on puberty. We have investigated risk factors for earlier puberty in these Danish adolescents, and now – as they grow older – we investigate the consequences of earlier puberty, tells Professor Cecilia Ramlau-Hansen.

Primarily affects girls

Moreover, around 4% of the girls received an anxiety diagnosis, while approximately 12% reported social anxiety symptoms, says PhD student Anne Marie Ladehoff Thomsen, who specifically has investigated anxiety in adolescents with earlier puberty. The earlier the girls entered puberty, the higher their risk of receiving a register-based anxiety diagnosis. The risk was around 26% higher for each year earlier they began puberty.

And it is not only the risk of mental health difficulties such as anxiety that increases when hormonal changes begin early. According to Postdoc Pernille Jul Clemmensen, who has investigated risk-taking behaviours, it is also reflected in young people’s relationship with alcohol, tobacco and recreational drugs.

“What we can also see is that earlier and more rapid pubertal development is associated with increased risk-taking behaviour during adolescence. This may manifest itself in earlier and more frequent use of alcohol, tobacco and drugs,” she explains.

The findings add nuance to and expand existing knowledge by incorporating both the timing and tempo of puberty, as well as a broad spectrum of mental health outcomes. Cecilia Ramlau-Hansen and the other researchers behind the studies hope the results may encourage healthcare professionals and other caregivers to pay closer attention to the wellbeing of young people who enter puberty early. At the same time, she emphasises that further research is needed.

“These studies show that there is an association. However, further research is now needed to explore the mechanisms underlying these links – including biological, psychological and social processes,” she explains.

Reference:

Gaml-Sørensen A, Thomsen AML, Clemmensen PJ, Benson TE, Brix N, Ernst A, Strandberg-Larsen K, Ramlau-Hansen CH. Pubertal development and mental health: A population-based cohort study on self-rated health, psychotropic medication, and psychiatric diagnoses. J Affect Disord. 2026 Apr 1;398:121014. doi: 10.1016/j.jad.2025.121014.