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Stress and Puberty
Prior studies have shown that pubertal status predicts development of depression and anxiety in girls beyond the effect of age, and rat models have shown that stress during puberty is associated with elevated risk for psychopathology, particularly anxious behaviors. The timing of trauma in terms of brain development may have a major impact on the type of psychopathology that develops since specific brain circuits may have unique periods of vulnerability to stress. For example, women who have experienced trauma during childhood have been found to be at higher risk for depression than for PTSD. Women have also been found to be 2 to 3 times more likely to develop PTSD than men and early trauma has been reported to sensitize girls, but not boys, to the effects of subsequent trauma.
This study focuses on anxiety, depression and PTSD given their temporal association with the onset of menarche (the first occurrence of menstruation). Girls are studied exclusively to extend earlier studies on women and to examine the higher rates of anxiety and
depression among adolescent girls in comparison to similar rates in both sexes during childhood. This is the first study which specifically examines pubertal stage in terms of timing of trauma and the development of subsequent psychopathology.
Study Design
2899 girls were selected from approximately 5000 females aged 13-18 who participated in the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). The NCS-A was the first national survey of US adolescents that used a structured diagnostic interview to assess DSM-IV psychiatric disorders. The NCS-A also assessed age of menarche and age of exposure to a wide range of potentially traumatic events.
Past-year psychiatric disorders and reports of age of trauma exposure were assessed using the Composite International Diagnostic Interview (CIDI) with a focus on diagnoses of depressive disorders, anxiety disorders and PTSD. Trauma exposure was measured during the PTSD portion of the CIDI. Participants reported whether they ever experienced each of 23 potentially traumatic events and their age the first time the event occurred.
Data on participants' earliest experience of trauma were analyzed using four scores representing the presence or absence of trauma during the post puberty, puberty, grade school or infancy-preschool periods. Trauma exposure during each period was used to predict past-year diagnoses of a depressive disorder, anxiety disorder and PTSD.
Results
(1)
Rates of trauma exposure increased across development with a notable increase after menarche.
(2)
Rates of psychiatric diagnoses were consistently higher in girls who experienced trauma. The most common diagnoses (Major Depressive Disorder, social phobia, specific phobia) were similar to the full NCS-A sample of girls.
(3)
Trauma during puberty conferred significantly more risk for past-year anxiety disorder diagnoses (particularly social phobia).
(4)
Trauma during the grade school period conferred significantly more risk for past-year depressive disorder diagnoses.
(5)
Trauma during each developmental period significantly increased risk for a past-year PTSD diagnosis. Risk for PTSD increased with the recency of trauma exposure.
(6)
Trauma during each developmental period, except infancy-preschool, significantly increased risk for a past-year depressive disorder diagnosis.
(7)
Age of menarche was earlier in girls who held past-year diagnoses of depressive disorder and anxiety disorder vs. girls who did not have these diagnoses. Trauma exposure was not associated with earlier menarche.
Limitations
This study has a number of limitations. Pubertal status was determined by retrospective, self-report thus rendering it imprecise. The findings do not address which aspects of puberty (e.g., biologic, social or psychological) are associated with elevated risk in relation to trauma exposure. It is unclear what effect current psychopathology had on reports of trauma exposure. Because these girls completed the study 2 years post-menarche, it is unclear what the long range effects of these findings will be.
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