Dinkelbach Lars, Grasemann Corinna, Kiewert Cordula, Leikeim Lisa, Schmidt Börge, Hirtz Raphael
Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Institute of Sex- and Gender-Sensitive Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
JAMA Netw Open. 2025 Jun 2;8(6):e2516679. doi: 10.1001/jamanetworkopen.2025.16679.
Within the physiological range, early pubertal timing is associated with an increased risk of mental health issues. Previous studies examining the associations of central precocious puberty (CPP) with mental health have yielded inconclusive results.
To describe the risk for development of psychiatric disorders in patients with CPP and to identify periods during which patients with CPP are at heightened risk of developing psychopathological conditions.
DESIGN, SETTING, AND PARTICIPANTS: In this population-based, retrospective cohort study, patients with CPP and matched controls were identified from German health insurance data (approximately 6.5 million individuals) and followed from January 2010 to June 2023. Individuals were included if they had continuous insurance coverage for at least 2 years during the study period. Data were analyzed from July 2024 to March 2025.
Diagnosis of CPP.
Diagnosis of depression, anxiety disorders, oppositional defiant and conduct disorders (ODD/CD), and attention deficit/hyperactivity disorder (ADHD). Incidence rates for psychiatric disorders before and after the diagnosis of CPP were compared between patients and controls exactly matched for sex, birth year interval, insurance period, and obesity.
After the application of validation criteria, 1094 patients with idiopathic CPP (438 born from 2010-2014 [40.0%]; 999 female [91.3%]; 249 [22.8%] with obesity) were identified and compared with 5448 controls (2184 born between 2010-2014 [40.1%]; 4975 female [91.3%]; 1242 with obesity [22.8%]). Compared with controls, patients with CPP were more likely to receive a diagnosis of any mental disorder (270 patients [24.7%] vs 920 controls [16.9%]; adjusted risk ratio [aRR], 1.48; 95% CI, 1.31-1.67), depression (82 patients [7.5%] vs 252 controls [4.6%]; aRR, 1.73; 95% CI, 1.37-2.20), anxiety disorders (88 patients [8.0%] vs 312 controls [5.7%]; aRR, 1.45; 95% CI, 1.16-1.82), ODD/CD (87 patients [8.0%] vs 243 controls [4.5%]; aRR, 1.76; 95% CI, 1.39-2.23), and ADHD (123 patients [11.2%] vs 397 controls [7.3%]; aRR, 1.53; 95% CI, 1.27-1.86). Temporal trends showed increased incidence rates for ODD/CD even before the diagnosis of CPP. For depression and ADHD, incidence rates remained increased for at least 8 years after the initial CPP diagnosis.
In this retrospective cohort study of patients with CPP, CPP was associated with an increased risk of psychiatric disorders, with evidence supporting long-term mental health outcomes, suggesting that caretakers of children with CPP should be vigilant for the emergence of psychiatric symptoms to initiate psychiatric care at an early stage.
在生理范围内，青春期提前与心理健康问题风险增加相关。先前研究中枢性性早熟（CPP）与心理健康之间关联的结果尚无定论。
描述CPP患者发生精神障碍的风险，并确定CPP患者发生精神病理状况风险增加的时期。
设计、设置和参与者：在这项基于人群的回顾性队列研究中，从德国医疗保险数据（约650万人）中识别出CPP患者和匹配的对照组，并从2010年1月至2023年6月进行随访。如果个体在研究期间连续参保至少2年则纳入研究。数据于2024年7月至2025年3月进行分析。
CPP诊断。
抑郁症、焦虑症、对立违抗和品行障碍（ODD/CD）以及注意力缺陷多动障碍（ADHD）的诊断。比较患者和在性别、出生年份间隔、保险期限和肥胖方面完全匹配的对照组在CPP诊断前后精神障碍的发病率。
应用验证标准后，确定了1094例特发性CPP患者（438例出生于2010 - 2014年[40.0%]；999例女性[91.3%]；249例[22.8%]肥胖），并与5448例对照组（2184例出生于2010 - 2014年[40.1%]；4975例女性[91.3%]；1242例肥胖[22.8%]）进行比较。与对照组相比，CPP患者更有可能被诊断为任何精神障碍（270例患者[24.7%]对920例对照组[16.9%]；调整风险比[aRR]，1.48；95%置信区间[CI]，1.31 - 1.67）、抑郁症（82例患者[7.5%]对252例对照组[4.6%]；aRR，1.73；95% CI，1.37 - 2.20）、焦虑症（88例患者[8.0%]对312例对照组[5.7%]；aRR，1.45；95% CI，1.16 - 1.82）、ODD/CD（87例患者[8.0%]对243例对照组[4.5%]；aRR，1.76；95% CI，1.39 - 2.23）和ADHD（123例患者[11.2%]对397例对照组[7.3%]；aRR，1.53；95% CI，1.27 - 1.86）。时间趋势显示，甚至在CPP诊断之前，ODD/CD的发病率就有所上升。对于抑郁症和ADHD，在首次CPP诊断后至少8年发病率仍持续上升。
在这项针对CPP患者的回顾性队列研究中，CPP与精神障碍风险增加相关，有证据支持长期心理健康结局，这表明CPP患儿的照料者应警惕精神症状的出现，以便在早期启动精神科护理。
