Modeling Pubertal Timing And Tempo And Its Prospective Associations With Psychopathological Symptoms

ObjectivesThe study aims to examine the prospective association and sex differences of pubertal timing and tempo with psychopathological symptoms.MethodsAdolescence pubertal development cohort from two primary schools in grade 1-3 were selected through clustering convenience sampling method in Bengbu,Anhui Province was established since 2013(Wave 1),with informed consent,1 332 boys and 956 girls were recruited(average age was 8.11 years),and follow-up surveys were conducted in2015(Wave 2),2017(Wave 3)and 2019(Wave 4)respectively.A total of 1 956adolescents in grades 7-9 were surveyed at Wave 4(average age was 13.94 years).Finally,there are 1 909 participants with complete date from baseline and follow-up questionnaires and pubertal development information.Demographic information and psychopathological symptoms were collected through questionnaire investigation,and pubertal development in boys and girls were evaluated by secondary sexual development(testicular volume for boys and breast development for girls).Height and weight were assessed during each wave and body mass index(BMI)was calculated.At baseline,internalizing and externalizing symptoms were evaluated by the Strength and Difficulty Questionnaire(SDQ).Depressive symptoms were interviewed through the Mood&Feeling Questionnaire(MFQ)at follow-up for grade 7-8,and Children Depression Inventory(CDI)for grade 9.Normalize MFQ and CDI score separately.Anxiety and externalizing symptoms were evaluated by Mac Arthur Health&Behavior Questionnaire-Child(HBQ-C).Using SAS PROC NLMIXED to fit nonlinear growth model to estimate pubertal timing and tempo.Dividing the puberty timing into early,on-time,and delayed groups;the puberty tempo into fast,average,and slow groups by the 15th and 85th percentile of the pubertal timing and tempo of boys and girls.Adjusted internalizing and externalizing symptoms,maternal education,household economic status,and adverse childhood experiences at baseline,and age,BMI,family warm parenting and PSQI score at follow-up.Multivariable logistic regression model were used to analyze the predictive effects of modeling pubertal timing and tempo on multi-disciplinary Psychopathological symptoms in adolescence boys and girls.ResultsBoys’depression symptoms:There was no statistical difference in the scores and rates of depressive symptoms among boys in different timing and tempo groups.Boys’anxiety symptoms:The score of on-time timing group(3.33±0.79)and early timing group(3.31±0.72)were higher than the late timing group(3.11±0.88)(F=3.32,P<0.05).The score of average tempo group(3.32±0.65)and fast tempo group(3.32±0.65)were higher than slow tempo group(3.01±0.90)(F=9.31,P<0.001).There was no significant difference in the detection rate of anxiety symptoms.Boys’externalizing symptoms:The score and rate of fast tempo group(2.25±0.59;26.11%)was higher than average tempo group(2.05±0.61;13.29%)and slow tempo group(2.10±0.62;12.73%)(F=7.37,χ~2=17.49,P<0.05).There was no statistical difference in scores and rates between different timing groups.Girls’depression symptoms:The z-score and rate of on-time timing group(0.11±1.03;17.11%)and early timing group(0.12±1.12;19.53%)were higher than the late timing group(-0.23±0.68;5.51%)(F=6.02,χ~2=22.61,P<0.05).The z-score and rate of average tempo group(0.04±1.02;15.47%)was slower than fast tempo group(0.34±1.09;29.69%)and higher than slow tempo group(-0.13±0.82;3.91%)(F=7.16,χ~2=37.74,P<0.05).Girls’anxiety symptoms:The score and rate of on-time timing group(3.38±0.67;14.78%)and early timing group(3.38±0.74;19.53%)were higher than the late timing group(3.08±0.66;1.57%)(F=9.37,χ~2=20.85,P<0.05);There was no statistical difference in scores and rates between different tempo groups.Girls’externalizing symptoms:The score and rate of average tempo group(1.93±0.58;13.14%)and fast tempo group(1.95±0.51;15.63)were higher than slow tempo group(1.76±0.51;5.47%)(F=5.22,χ~2=7.04,P<0.05).There was no statistical difference in scores and rates between different timing groups.According to the results of nonlinear growth model,the average modeling pubertal timing of girls(11.25 years)was earlier than boys(12.70 years),and girls’average pubertal tempo(1.47)was faster than boys’(1.28).After internalizing symptoms,maternal education,household economic status,and adverse childhood experiences at baseline and age,BMI,family warm parenting and PSQI score at follow-up adjusted,compared to girls with on time pubertal timing,girls in the late timing group had lower risk of depressive symptoms(OR=0.38,95%CI:0.15～0.98,P=0.045)and anxiety symptoms(OR=0.07,95%CI:0.01～0.48,P=0.008);Compared with girls in average pubertal tempo group,the fast tempo group associates with an increased risk of depressive symptoms(OR=2.54,95%CI:1.40～4.61,P=0.002),while the slow tempo group associates with an decreasing risk of depressive symptoms(OR=0.13,95%CI:0.04～0.41,P<0.001).After externalizing symptoms,maternal education,household economic status,and adverse childhood experiences at baseline and age,BMI,family warm parenting and PSQI score at follow-up adjusted,for boys,fast tempo associates with an increased risk of externalizing symptoms(OR=2.85,95%CI:1.53～5.31,P=0.001).For girls,slow tempo associates with an decreasing risk of externalizing symptoms(OR=0.33,95%CI:0.13～0.81,P=0.016).ConclusionThrough a 6-year follow-up of the adolescence pubertal development cohort,this study explores the prospective predictive effects of puberty timing and tempo fitted by nonlinear growth model on adolescent psychopathological symptoms.Late timing was a protective factor for girls’internalizing symptoms,and slow pubertal tempo was a protective factor for girls’depression and externalizing symptoms.While in boys,only fast tempo increases the risk of development of externalizing symptoms.Repeated measures of puberty across the span of pubertal development and more regions are necessary for clarifying the factors affecting the pubertal timing and tempo of adolescent boys and girls in China,and to fully reveal the longitudinal relationship between pubertal development and psychopathological symptoms,exploring the relative importance of dimensions of pubertal development to psychopathological etiology.