Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies.

Given the increased prevalence of mental health problems during adolescence, there is considerable interest in understanding potential biological mechanisms including the contribution of pubertal hormones. This systematic review of 55 papers aimed to synthesize the evidence for the effect of pubertal hormones on the risk for mental health problems in children and adolescents. The pattern of findings from included studies suggested associations of testosterone and estradiol with certain types of mental health problems, but with inconsistencies relating to DHEA and DHEA-S. However, the state of evidence for the causal effects of hormones was determined to be weak given assessment of bias from confounding, hormone measurement error, selection bias and missingness. Further investigations with careful consideration of study design and analysis, particularly accounting for short-term variation of hormone levels and appropriate selection of confounders, is necessary to advance our understanding of hormonal effects on mental health. Such efforts will improve knowledge of risk mechanisms, and may support the development of targeted intervention efforts for mental health problems.