Central Precocious Puberty Elevates Psychiatric Disorder Risk

Children diagnosed with central precocious puberty (CPP) are at significantly increased risk of developing psychiatric disorders, including depression, anxiety, attention deficit/ hyperactivity disorder (ADHD), and conduct disorders, according to study results published in JAMA Network Open.

Researchers conducted a retrospective cohort study analyzing claims data from approximately 6.5 million individuals in Germany (2010-2023). They focused on 1094 validated cases of CPP and 5448 matched control patients to evaluate the association between idiopathic CPP and psychiatric disorders on the basis of temporal onset.

Participants were excluded if they had prior CPP, psychiatric diagnoses, or conditions mimicking CPP during a 1-year pre-observation period. CPP and psychiatric disorders were identified via confirmed ICD-10 codes, with stricter validation requiring at least 2 outpatient or 1 inpatient diagnosis. Control individuals were matched according to sex, age interval, obesity, and insurance period.

Among the participants, 91.3% were girls and 22.8% had obesity, and the mean age at diagnosis was 8.24 years. The mean number of health exams was slightly higher among those with vs without CPP (4.07 vs 3.83).

Patients with vs without CPP had significantly increased risk of receiving a psychiatric disorder diagnosis, including:

• Depression (7.5% vs 4.6%; adjusted risk ratio [aRR], 1.73; 95% CI, 1.37-2.20);
• Anxiety (8.0% vs 5.7%; aRR, 1.45; 95% CI, 1.16-1.82);
• Oppositional defiant/conduct disorders (8.0% vs 4.5%; aRR, 1.76; 95% CI, 1.39-2.23); and,
• ADHD (11.2% vs 7.3%; aRR, 1.53; 95% CI, 1.27-1.86).

The overall risk for any psychiatric disorder was 24.7% among those with CPP vs 16.9% among those without CPP (aRR, 1.48; 95% CI, 1.30- 1.67).

Sensitivity analyses confirmed these findings across subgroups, including among boys (any disorder: 35.8% vs 21.1%; aRR, 1.69; 95% CI, 1.23-2.33). Exploratory analyses suggested bidirectional associations, with preexisting mental disorders increasing CPP risk (aRR, 1.46; 95% CI, 1.08-1.97) and CPP remaining linked to new psychiatric diagnoses even after adjusting for prior psychopathology.

The researchers found no association between age at CPP diagnosis and later mental health risk. Temporal trend analysis showed that rates of depression, ADHD, anxiety, and conduct disorders were elevated in CPP cases as early as 1 year before and up to 8 years after diagnosis, with the highest increase occurring around the time of CPP diagnosis.

Study limitations include potential surveillance bias due to higher health care utilization among CPP cases, inability to conclude causality, and reliance on administrative claims data, which may underreport or misclassify psychiatric diagnoses.

The study authors concluded, “This study found evidence of an elevated risk of psychiatric disorders in patients with CPP, underscoring the importance of long-term psychiatric monitoring even years after the initial CPP diagnosis.”

Disclosure: One study author reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Endocrinology Advisor