Early Puberty Linked to Long-Term Risk of Psychiatric Disorders, Study Finds
Germany: A new cohort study published in JAMA Network Open reveals that children diagnosed with idiopathic central precocious puberty (CPP) may be significantly more vulnerable to developing a range of psychiatric disorders, with mental health challenges potentially persisting for several years following the initial diagnosis.
Led by Dr. Lars Dinkelbach from the Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Germany, the study evaluated data from more than 6.5 million individuals insured under the German statutory health system between 2010 and 2023. The research aimed to investigate the long-term psychiatric implications of CPP, a condition where puberty begins unusually early without an identifiable cause.
Using a population-based, retrospective cohort design, the researchers analyzed the health records of 1,094 patients with idiopathic CPP and compared them to 5,448 matched controls. Participants were matched based on sex, birth year interval, obesity status, and insurance period to ensure accurate comparisons. Nearly all CPP cases (91.3%) were female, and around 23% had obesity.
The study revealed the following findings:
- 24.7% of children with CPP were diagnosed with at least one psychiatric disorder, compared to 16.9% of controls.
- The risk of depression was higher in CPP patients (7.5%) than in controls (4.6%), with an adjusted risk ratio (aRR) of 1.73.
- Anxiety disorders were more common in CPP patients, with an aRR of 1.45.
- Oppositional defiant and conduct disorders (ODD/CD) showed an elevated risk in CPP patients, with an aRR of 1.76.
- The risk of attention-deficit/hyperactivity disorder (ADHD) was also increased, with an aRR of 1.53.
- ODD/CD symptoms were observed to begin even before the diagnosis of CPP.
- Higher rates of depression and ADHD persisted for at least eight years after the initial CPP diagnosis, indicating long-term mental health impacts.
According to the authors, the study is the first to provide robust, large-scale evidence linking CPP with an increased risk of psychiatric disorders. It also sheds light on the timing of symptom onset, emphasizing the importance of early and sustained mental health monitoring in these children.
Notably, the study identified an increased risk of psychiatric issues not only in girls who predominantly present with CPP but also in boys. This group is often underrepresented in research on puberty.
The authors recommend that healthcare providers, parents, and caregivers remain vigilant for signs of emotional or behavioral challenges in children with CPP, even long after the initial endocrine diagnosis. Early psychiatric evaluation and intervention could play a crucial role in improving long-term outcomes.
The authors concluded, "Further research is warranted to explore the biological and psychosocial mechanisms that may underlie this association, to inform targeted interventions to support the mental well-being of affected children."
Reference:
Dinkelbach L, Grasemann C, Kiewert C, Leikeim L, Schmidt B, Hirtz R. Central Precocious Puberty and Psychiatric Disorders. JAMA Netw Open. 2025;8(6):e2516679. doi:10.1001/jamanetworkopen.2025.16679
