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Mental health
Early menarche is associated with an increased risk for depressive symptoms in adolescent girls in a UK cohort
  1. C. Joinson1,
  2. J. Heron2,
  3. R. Araya1,
  4. G. Lewis1
  1. 1
    Department of Community Based Medicine, University of Bristol, Bristol, UK
  2. 2
    Department of Social Medicine, University of Bristol, Bristol, UK

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    To examine whether girls experiencing earlier menarche than their peers have higher levels of depressive symptoms in adolescence.


    Longitudinal cohort study.

    Main Outcome Measures

    Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ). High levels of depressive symptoms were defined by scores on the SMFQ at or above 11. Age at onset of menarche was derived from regular questionnaires relating to pubertal development completed when the study children were 8 to 14 years old. An age at onset of menarche variable with three levels was derived (early: <11.5 years; on time: 11.5–13.4 years; late: >13.5 years).


    2331 girls (age range = 12.6–15.2 years; median = 13.8 years) from a UK cohort study – The Avon Longitudinal Study of Parents and Children (ALSPAC).


    The unadjusted odds ratios for SMFQ score at or above 11 were 2.15 (95% CI 1.43 to 3.24) for girls with an early onset of menarche and 1.62 (95% CI 1.15 to 2.26, global p value  = 0.0008) for girls with onset of menarche that was on time compared with girls with late onset of menarche. After adjusting for potential confounders of the association between onset of menarche and depressive symptoms (including socioeconomic disadvantage, absence of the biological father, body mass index and age at assessment of depressive symptoms), the odds ratios were 2.10 (1.37 to 3.21) for the early onset menarche group and 1.64 (1.16 to 2.32, global p value = 0.0015) for the “on time” onset group. There was an increase in strength of the association between onset of menarche and depressive symptoms from “on time” to “early onset” (p value for trend = 0.001).


    Early maturing girls are at increased risk for depressive symptoms in adolescence and could be targeted by school and family-based programmes aimed at early intervention and prevention. Adolescence is characterised by a marked rise in rates of depression in girls. This is of major concern to public health because depression has a chronic and recurrent course and is associated with impaired social functioning, low academic achievement, substance abuse and suicidal behaviour. Increased understanding of factors associated with the rise in rates of depressive symptoms in girls during adolescence is required to inform prevention programmes so that vulnerable individuals can be targeted.