Division of Psychiatry, University College London, London, United Kingdom.
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
PLoS One. 2018 Jun 18;13(6):e0198804. doi: 10.1371/journal.pone.0198804. eCollection 2018.
There is an association between puberty and depression, but many things remain poorly understood. When assessing puberty in females, most studies combine indicators of breast and pubic hair development which are controlled by different hormonal pathways. The contributions of pubertal timing (age at onset) and pubertal status (stage of development, irrespective of timing) are also poorly understood. We tested the hypothesis that stage of breast development in female adolescents, controlled largely by increased estradiol, would be more strongly associated with depression than pubic hair development which occurs in both males and females, and is controlled by adrenal androgens. We investigated whether this association was independent of pubertal timing.
ROOTS is an ongoing cohort of 1,238 adolescents (54% female) recruited in Cambridgeshire (UK) at age 14.5, and followed-up at ages 16 and 17.5. Depression was assessed using the Mood and Feelings Questionnaire (MFQ) and clinical interview. Breast and pubic hair development were assessed at 14.5, using Tanner rating scales.
For each increase in Tanner breast stage at 14.5, depressive symptoms increased by 1.4 MFQ points (95% CI 0.6 to 2.3), irrespective of age at onset. Pubic hair status was only associated with depressive symptoms before adjustment for breast status, and was not associated with depression in males. The same pattern was observed longitudinally, and for depression diagnoses.
We did not directly measure hormone levels, our findings are observational, and the study had a relatively low response rate.
Females at more advanced stages of breast development are at increased risk of depression, even if their age at pubertal onset is not early. Alongside social and psychological factors, hormones controlling breast but not pubic hair development may contribute to increased incidence of female depression during puberty.
青春期与抑郁症之间存在关联，但许多方面仍未得到充分理解。在评估女性青春期时，大多数研究将乳房和阴毛发育的指标结合在一起，而这些指标受不同的激素途径控制。青春期开始的时间（发病年龄）和青春期的状态（发育阶段，不论时间如何）也未得到充分理解。我们检验了以下假设：青春期女性的乳房发育阶段，主要由雌激素增加控制，与阴毛发育相比，与抑郁症的相关性更强，阴毛在男性和女性中都会发生，并且由肾上腺雄激素控制。我们研究了这种关联是否独立于青春期的开始时间。
ROOTS 是一个正在进行的队列研究，共有 1238 名青少年（54%为女性）在英国剑桥郡于 14.5 岁时招募，并在 16 岁和 17.5 岁时进行随访。使用情绪和感觉问卷（MFQ）和临床访谈评估抑郁症状。14.5 岁时使用 Tanner 评分量表评估乳房和阴毛发育。
在 14.5 岁时，Tanner 乳房发育阶段每增加一级，抑郁症状增加 1.4 个 MFQ 点（95%置信区间 0.6 至 2.3），与发病年龄无关。阴毛状态仅在调整乳房状态之前与抑郁症状相关，而与男性的抑郁无关。同样的模式在纵向观察和抑郁诊断中都观察到。
我们没有直接测量激素水平，我们的发现是观察性的，并且该研究的响应率相对较低。
即使青春期发病年龄不早，乳房发育阶段更先进的女性患抑郁症的风险也会增加。除了社会和心理因素外，控制乳房但不控制阴毛发育的激素可能会导致青春期女性抑郁症的发病率增加。
