German researchers have suggested that patients diagnosed with central precocious puberty (CPP) – in which physical changes related to pubertal development occur earlier than usual – had a nearly 50% greater risk of developing psychiatric disorders, including depression and anxiety, with both depression and ADHD remaining persistently elevated for years after diagnosis.
Medscape reports that the scientists – led by Lars Dinkelbach, MD, University Hospital Essen, University of Duisburg-Essen – had conducted a population-based, retrospective cohort study using health insurance data (from January 2010 to June 2023) to evaluate the association between idiopathic CPP and the development of psychiatric disorders.
They included 1 094 patients with idiopathic CPP (91.3% girls) and individually matched them with 5 448 control individuals without the condition (matched for sex, birth year interval, insurance period, and obesity); participants had continuous insurance coverage for at least two years during the study period.
The exposure of interest was a diagnosis of CPP, and psychiatric outcomes evaluated included depression, anxiety disorders, oppositional defiant and conduct disorders, ADHD, self-harm behaviours, and substance use disorders.
Their findings, published in JAMA Network Open, showed that patients with CPP had a higher risk for any mental disorder than their matched control individuals (adjusted risk ratio [aRR], 1.48; 95% CI, 1.31-1.67).
They also showed a higher risk for depression (aRR, 1.73; 95% CI, 1.37-2.20), anxiety disorders (aRR, 1.45; 95% CI, 1.16-1.82), oppositional defiant and conduct disorders (aRR, 1.76; 95% CI, 1.39-2.23), and ADHD (aRR, 1.53; 95% CI, 1.27-1.86) than matched control individuals.
Temporal trends showed that incidence rates of oppositional defiant and conduct disorders were elevated even before the diagnosis of CPP, however, rates of depression and ADHD remained persistently high for up to eight years after the initial diagnosis.
“Caretakers of patients with CPP should actively explore psychological symptoms and facilitate early intervention to influence lifetime trajectories of this vulnerable patient population positively. Because our findings indicate long-term sequelae of CPP on mental health, caretakers should be vigilant even after normalisation of pubertal development,” the authors wrote.
Study details
Central Precocious Puberty and Psychiatric Disorders
Lars Dinkelbach, Corinna Grasemann, Cordula Kiewert, et al.
Published in JAMA on 23 June 2025
Abstract
Importance
Within the physiological range, early pubertal timing is associated with an increased risk of mental health issues. Previous studies examining the associations of central precocious puberty (CPP) with mental health have yielded inconclusive results.
Objective
To describe the risk for development of psychiatric disorders in patients with CPP and to identify periods during which patients with CPP are at heightened risk of developing psychopathological conditions.
Design, Setting, and Participants
In this population-based, retrospective cohort study, patients with CPP and matched controls were identified from German health insurance data (approximately 6.5m individuals) and followed from January 2010 to June 2023. Individuals were included if they had continuous insurance coverage for at least 2 years during the study period. Data were analysed from July 2024 to March 2025.
Exposure
Diagnosis of CPP.
Main Outcomes and Measures
Diagnosis of depression, anxiety disorders, oppositional defiant and conduct disorders (ODD/CD), and attention deficit/hyperactivity disorder (ADHD). Incidence rates for psychiatric disorders before and after the diagnosis of CPP were compared between patients and controls exactly matched for sex, birth year interval, insurance period, and obesity.
Results
After the application of validation criteria, 1094 patients with idiopathic CPP (438 born from 2010-2014 [40.0%]; 999 female [91.3%]; 249 [22.8%] with obesity) were identified and compared with 5448 controls (2184 born between 2010-2014 [40.1%]; 4975 female [91.3%]; 1242 with obesity [22.8%]). Compared with controls, patients with CPP were more likely to receive a diagnosis of any mental disorder (270 patients [24.7%] vs 920 controls [16.9%]; adjusted risk ratio [aRR], 1.48; 95% CI, 1.31-1.67), depression (82 patients [7.5%] vs 252 controls [4.6%]; aRR, 1.73; 95% CI, 1.37-2.20), anxiety disorders (88 patients [8.0%] vs 312 controls [5.7%]; aRR, 1.45; 95% CI, 1.16-1.82), ODD/CD (87 patients [8.0%] vs 243 controls [4.5%]; aRR, 1.76; 95% CI, 1.39-2.23), and ADHD (123 patients [11.2%] vs 397 controls [7.3%]; aRR, 1.53; 95% CI, 1.27-1.86). Temporal trends showed increased incidence rates for ODD/CD even before the diagnosis of CPP. For depression and ADHD, incidence rates remained increased for at least 8 years after the initial CPP diagnosis.
Conclusions and Relevance
In this retrospective cohort study of patients with CPP, CPP was associated with an increased risk of psychiatric disorders, with evidence supporting long-term mental health outcomes, suggesting that caretakers of children with CPP should be vigilant for the emergence of psychiatric symptoms to initiate psychiatric care at an early stage.
JAMA Network Open article – Central Precocious Puberty and Psychiatric Disorders (Open access)
Medscape article – Early Puberty Onset Linked to Higher Mental Health Risk (Open access)
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