An analysis of Danish population data has found that an earlier start to puberty and a faster tempo in girls are linked to a higher risk of anxiety disorders and social anxiety symptoms, while a later onset and slower tempo are associated with a lower risk. The findings, published in the Journal of Affective Disorders, emphasise puberty timing and tempo as potential influences on adolescent mental health.
Puberty is a major developmental transition marked by rapid physical, hormonal, emotional and social changes. The age at which puberty begins (pubertal timing) varies between individuals and has been falling in many Western populations, while tempo describes how quickly these changes unfold once started. The study notes that both timing and tempo may shape how adolescents adapt to adolescence, with earlier development repeatedly linked to greater anxiety risk in girls; evidence for boys remains less clear, and social anxiety disorder often emerges during adolescence.
To tackle shortcomings of previous work, researchers used data from a large population‑based study: the Puberty Cohort within the Danish National Birth Cohort. Between 1996 and 2002, Danish‑speaking pregnant women were invited to participate at their first antenatal visit. About 50% of general practitioners in Denmark participated, enrolling around 92,000 women and their unborn children—a participation rate of roughly 60% among eligible women and about 30% of all children born in Denmark during that period.
The participating women were interviewed about health and health‑related behaviours in four telephone rounds around gestational weeks 17 and 32, as well as six and 18 months after birth. Questionnaires were mailed to them when their children were 7 and 11 years old. When their children reached 18, young adults were invited to complete a further digital survey on mental health, family and social factors, with 49,963 participants in total.
The Puberty Cohort consisted of single‑birth children born between 2000 and 2003 to mothers who took part in the first pregnancy interview. In total, 15,818 children completed at least one web‑based questionnaire on pubertal development from 11.5 years of age, with follow‑ups every six months during puberty; among them, 8,123 were girls.
Of these, 13,208 completed at least two pubertal development questionnaires, enabling calculation of puberty tempo and its relation to mental‑health diagnoses recorded in the Danish National Patient Register. A smaller subset completed mental health questionnaires when they were 18, allowing exploration of associations with self‑reported mental health characteristics.
The results showed that children who entered puberty earlier tended to have parents with lower socioeconomic status and were less likely to live with a partner at age seven. Their mothers also tended to have an earlier age at menarche and were more likely to have experienced a psychiatric disorder during the first trimester of pregnancy. These children were more often bullied at age seven compared with peers with average pubertal timing; those with later puberty tended to show the opposite pattern.
By age 19, 4% of girls had an anxiety disorder diagnosis, 8% had contact with a private practice psychologist or psychiatrist, and 4% had redeemed prescribed psychotropic medications. In boys, the corresponding figures were 1.5%, 3.5% and 1.4% respectively.
In girls, an earlier start and faster tempo of pubertal development were associated with a higher risk of any anxiety disorder diagnosis and self‑reported social anxiety disorder symptoms, as well as a higher likelihood of seeking psychological or psychiatric treatment and being prescribed psychotropic medications. Specifically, for each year earlier that breast development began, the odds of an anxiety disorder diagnosis were 26% higher, while each year of earlier pubic hair development was linked with 49% higher odds of self‑reported social anxiety disorder symptoms compared with the average. Later pubertal development was associated with a lower risk of anxiety and social anxiety symptoms.
Findings in boys were inconsistent, and researchers could not establish firm links between pubertal timing and anxiety disorder risk in male participants.
“If earlier and faster puberty increases the risks of an anxiety disorder diagnosis and SAD [social anxiety disorder] symptoms, targeted interventions are warranted for girls with early/fast puberty and sub‑clinical anxiety. Findings for boys need further exploration,” the study authors concluded.
The study contributes to understanding the links between pubertal development and mental health, though the authors note that the design does not allow any definitive causal inferences to be drawn from the results.
The paper, “Pubertal timing and tempo and anxiety symptoms, disorders and treatments in Danish adolescents: A population-based follow-up study,” was authored by Anne Marie Ladehoff Thomsen, Andreas Ernst, Katrine Strandberg‑Larsen, Charlotte Ulrikka Rask, Anne Gaml‑Sørensen, Pernille Jul Clemmensen, Thea Emily Benson, Nis Brix, Onyebuchi A. Arah, and Cecilia Høst Ramlau‑Hansen.
