Research Article: The association between pubertal status and depressive symptoms and diagnoses in adolescent females: A population-based cohort study

Date Published: June 18, 2018

Publisher: Public Library of Science

Author(s): Gemma Lewis, Konstantinos Ioannidis, Anne-Laura van Harmelen, Sharon Neufeld, Jan Stochl, Glyn Lewis, Peter B. Jones, Ian Goodyer, C. Mary Schooling.


There is an association between puberty and depression, but many things remain poorly understood. When assessing puberty in females, most studies combine indicators of breast and pubic hair development which are controlled by different hormonal pathways. The contributions of pubertal timing (age at onset) and pubertal status (stage of development, irrespective of timing) are also poorly understood. We tested the hypothesis that stage of breast development in female adolescents, controlled largely by increased estradiol, would be more strongly associated with depression than pubic hair development which occurs in both males and females, and is controlled by adrenal androgens. We investigated whether this association was independent of pubertal timing.

ROOTS is an ongoing cohort of 1,238 adolescents (54% female) recruited in Cambridgeshire (UK) at age 14.5, and followed-up at ages 16 and 17.5. Depression was assessed using the Mood and Feelings Questionnaire (MFQ) and clinical interview. Breast and pubic hair development were assessed at 14.5, using Tanner rating scales.

For each increase in Tanner breast stage at 14.5, depressive symptoms increased by 1.4 MFQ points (95% CI 0.6 to 2.3), irrespective of age at onset. Pubic hair status was only associated with depressive symptoms before adjustment for breast status, and was not associated with depression in males. The same pattern was observed longitudinally, and for depression diagnoses.

We did not directly measure hormone levels, our findings are observational, and the study had a relatively low response rate.

Females at more advanced stages of breast development are at increased risk of depression, even if their age at pubertal onset is not early. Alongside social and psychological factors, hormones controlling breast but not pubic hair development may contribute to increased incidence of female depression during puberty.

Partial Text

Adult depression affects twice as many women as men [1]. In childhood, the prevalence of depression is similar in boys and girls but around the age of 12–13, incidence increases sharply in females [2]. There is evidence that this increase is more strongly associated with pubertal development than chronological age [3]. However, although studies report an association between pubertal development and depression, many things remain poorly understood.

We found evidence that girls at more advanced stages of breast development at age 14 had more depressive symptoms than girls at lower stages of breast development, irrespective of age at pubertal onset (pubertal timing). We also found that girls at more advanced stages of breast development at age 14 continued to report more depressive symptoms at 17.5 years of age. They were also more likely to meet criteria for incident clinical depression by age 17.5. We found no evidence that pubic hair development was associated with depressive symptoms and diagnoses, except before adjustment for breast development. This was supported by lack of evidence for an association between DHEA and depression (pubic hair development is controlled largely by DHEA). So, girls at more advanced stages of breast development were at increased risk of depression irrespective of their age at onset and level of pubic hair development / DHEA. There was no evidence that pubic hair development was associated with depressive symptoms in boys.




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