The Association Between Off-Time Pubertal Timing And Behavioral And Emotional Problems

ObjectiveTo investigate the prevalence and related influencing factors of off-time pubertal timing and behavioral and emotional problems.The study aims to explore gender specific adverse psychological effects of off-time puberty. MethodsParticipants of study came from five research sites including Beijing, Shenyang, Chongqing, Zhengzhou, Guangzhou. By cluster sampling, students from grade 7 to 8 in the selected schools participated in this investigation.Written informed consents were obtained from all participants parents. Anthropometry indices(height and weight) were examined by trained physicians. Data on demographic characteristic(age, family economic status, parents education, and so on), physical activity and screen time were collected. Subjective pubertal timing were assessed by scores of Pubertal Development Scale(PDS) and by self-perecived compared with peers.The Strengths and Difficulties Questionnaire(SDQ)was used to assess the behavioral and emotional problems. Descriptive statistics were developed to describe the prevalence of off-time puberty timing and the abnormal detection rate of behavioral problems, χ2 test was used to reveal related influencing factors of off-time pubertal timing and behavioral and emotional problems. The effects of on were estimated using The relationships between off-time pubertal timing and behavioral and emotional problems were investigated by use of Multinomial logistic regression.The odds ratios were presented with their 95% confidence intervals. ResultsAcquire 4087 complete questionnaires, including 2009 girls and 2078 boys,the mean age of girls and boys were 13.3±0.78, 13.4±0.77 respectively. Acquire 3925 complete PDS questionnaires, including 1931 girls and 1994 boys.Acquire 4080 complete questionnaires, including 2009 girls and 2071 boys.The prevalence of early puberty timing,on-time puberty timing and late puberty timing among girls was 13.4%(259), 75.0%(1449), 11.5%(223) respectively.The prevalence of early puberty timing,on-time puberty timing and late puberty timing among boys was 16.5%(330), 70.1%(1397), 13.4%(267),respectively. Multinomial logistic regression analysis showed that obesity may increase the risk of early pubertal timing among girls(OR=2.463,95%CI:1.605~3.778),but there was no association between obesity and pubertal timing among boys. Risk of early pubertal timing was higher in both gender whose family economic status below average(OR=2.368,95%CI:1.361~4.120;OR=2.078,95%CI:1.070~4.037)。The prevalence of perceived early puberty timing,perceived on-time puberty timing and perceived late puberty timing among girls was 24.2%(480), 48.2%(954), 27.6%(546) respectively.The prevalence of perceived early puberty timing,perceived on-time puberty timing and perceived late puberty timing among boys was 21.0%(433), 48.8%(1006), 30.2%(623), respectively. The prevalence of perceived early puberty timing among girls was higher than boys, while the prevalence of perceived late puberty timing among boys was higher than girls, the differences were significant(c2=7.210,P=0.027).Abnormal detection rate of emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, pro-social behaviors and total difficulties were 11.7%(476),9.7%(396),8.4%(342),13.3%(543),8.8%(358),16.6%(677) respectively. Abnormal detection rate of each factor except emotional symptoms was higher among boys, and the difference was significant(P <0.05).Multinomial logistic regression analysis showed that early pubertal timing significantly increased the risk of abnormal detection rate of emotional symptoms(OR=1.518,95%CI:1.014~2.273), hyperactivity/inattention(OR=2.018,95%CI:1.223~3.330), peer relationship problems(OR=1.708,95%CI:1.144~2.550), and total difficulties(OR=1.600, 95%CI:1.084 ~ 2.361) while pubertal timing assessed based on PDS scores, but there were no significant association between pubertal timing and psychological effects among boys. Additionally, significant correlations with abnormal detection rate of emotional symptoms(OR=1.931,95%CI:1.345~2.773),peer relationship problems(OR=1.545,95%CI:1.076~2.220), total difficulties(OR=1.749,95%CI:1.231~2.486)were found in self-perceived early puberty girls, risk of abnormal detection rate of emotional symptoms(OR=1.738,95%CI:1.198 ~ 2.522), conduct problems(OR=1.937, 95%CI:1.201 ~3.125),hyperactivity/inattention(OR=1.788,95%CI:1.112~2.874), total difficulties(OR=1.828,95%CI:1.272~2.628) were higher in self-perceived late puberty girls than self-assessment as on-time peers. Results of the logistics regression indicated that self-perceived early puberty significantly increased the risk of abnormal detection rate of emotional symptoms(OR=1.921,95%CI:1.275~2.895) and total difficulties(OR=1.641,95%CI:1.181~2.280) among boys,while self-perceived late puberty significantly increased the risk of abnormal detection rate of emotional symptoms(OR=2.120, 95%CI:1.471 ~ 3.056),hyperactivity/inattention(OR=1.595,95%CI:1.102~2.307) and total difficulties(OR=1.768,95%CI:1.316~2.375). ConclusionObesity may increased the risk of early pubertal timing among girls,the association between obesity and pubertal timing exists gender differences. Additionally, abnormal detection rates of behavioral and emotional problems were high, abnormal detection rate of each factor except emotional symptoms was higher among boys. At the time of the intervention in adolescents psychological and behavioral problems, may need to focus more on behavioral problems among boys, while pay much more attention to emotional problems for girls. Our findings provide some evidence that self-perceived early and late puberty were both risk factors for behavioral and emotional problems among boys and girls. Considering gender difference while conducting psychological intervention among adolescents with off-time puberty timing is meaningful for improving their physical and mental health.