Association Between Psycosocial Stress With Puberty Timing In Children

Objective: To develop and test the reliability and validity of the Scale of Stressful Life Events for Primary School Students(SSLEPSS);to investigate the status of psychosocial stress in children of primary schools in urban Chongqing;to establish a development cohort in order to explore the association between psychosocial stress and puberty timing.Methods: By using purposive sampling,four representative urban primary schools in Jiulongpo District,Chongqing were selected,in which,all students in grades two to five were eligible to participate with written informed consent.Based on the open questionnaire from primary school students,their parents and teachers,as well as literature review,scale of the stressful life events for primary school students was constructed.Totally 386 students from one primary school participated in the pre-investigation.The initial scale was revised through item analysis and exploratory factor analysis.Totally 1419 students from the four target primary schools participated in the formal investigation.The construct validity of the formal scale was tested by confirmatory factor analysis,then,the reliability was tested.The criterion validity was tested with Mental Health Test for Primary and Middle School Student(MHT).The test-retest reliability was tested by 99 students 2 weeks later.After the development of the SSLEPSS,the baseline survey was conducted on the social-demographic characteristics,status of psychosocial stress and puberty timing of target children.After excluding students who have entered into puberty at the baseline survey,the other students were included in our cohort study.The median of total score of SSLEPSS was used as the cut off point between exposed group(higher level psychosocial stress)and control group(lower level psychosocial stress).Pubertal development,testicular development,first spermatorrhea,breast development and menarche were the outcome measures of the cohort study.A total of three follow up surveys were conducted every six months in all students included in the cohort studies to observe the influence of psychosocial stress on puberty timing.Results:(1)The SSLEPSS consisted of 30 items and 5 components,the factor loading of items were 0.43~0.77,and they could explain 51.14% of the total variance.Confirmatory factor analysis showed the scale had good fit indices(χ2/df=4.00,GFI=0.93,AGFI=0.91,CFI=0.85,IFI=0.86,RMSEA=0.05).The correlation between the total scores of SSLEPSS and MHT was 0.57(P<0.01).Except that there was no significant correlation between the scores of the teacher-student relation in SSLEPSS and the self-accusation tendency in MHT,the other factors of the two scales were positively correlated(r=0.24~0.53,P<0.01).The total internal consistency reliability was 0.88,and the Cronbach α of each factor ranged from 0.60 to 0.78.The total test-retest reliability(ICC)was 0.81,and each factor ranged from 0.63 to 0.74.(2)Rank sum test showed that the life events from teacher-student relation influenced boys more than girls(Z=2.616,P=0.009),while peer relation(Z=2.561,P=0.010)influenced girls more than boys.The elder students received more stress from learning adaptation(Z=5.078,P=0.000)and peer relation(Z=2.959,P=0.003)than younger ones did,while the younger students received more stress from life adaptation(Z=2.754,P=0.006).The students whose parents had lower education level were more influenced by stress from family life(Z=3.123,P=0.002;Z=3.376,P=0.001)and learning adaptation(Z=3.684,P=0.000;Z=4.349,P=0.000)and have higher total stress scores(Z=2.597,P=0.009;Z=2.815,P=0.005).The students with lower family economic status received more stress from family life(Z=3.208,P=0.001),learning adaptation(Z=2.972,P=0.003)and have higher total stress scores(Z=2.862,P=0.004).(3)Cox regression showed that,by controlling BMI,education level of father and mother as well as family economic status,it took less time for girls with higher level psychosocial stress in academic to enter into breast development(RR=1.269,95%CI:1.017~1.584)and experience menarche(RR=1.244,95%CI:1.041~1.485).There was no significant difference in testicular development and first spermatorrhea between higher level and lower level psychosocial stress boys(P>0.05).Conclusion: The SSLEPSS is easy to understand and has good reliability and validity,which can be used as an assessment tool for psychological stress level of primary school students.Psychosocial stress of primary students in urban Chongqing were different between boys and girls,high and low grades,high and low education levels of father and mother as well as high and low family economic status.The association between psychosocial stress and puberty timing was observed in girls.It took less time for girls with high level psychosocial stress in academic to enter into breast development and occur menarche.However,the association between psychosocial stress and puberty timing in boys is still not clear,and further follow-ups are needed to confirm the association.