Transdiagnostic psychiatric disorder risk associated with early age of menarche: A latent modeling approach

Abstract

Background: Earlier age of pubertal maturation in females is associated with increased risk for mental health problems in adolescence, compared with on-time or later maturation. However, most investigations of pubertal timing and mental health consider risk for individual disorders and fail to account for comorbidity. A latent-modeling approach using a large, nationally representative sample could better explain the transdiagnostic nature of the consequences of early-onset puberty.

Methods: Data on age of menarche and mental disorders were drawn from a population-representative sample of adolescents (n=4925), ages 13-17. Confirmatory factor analysis was used to fit four latent disorder categories: distress, eating, and externalizing, and fear disorders. Timing of menarche included those with earlier (age≤10, age 11) and later age of onset (age 13, 14+), relative to those with average timing of menarche (age 12). Associations between timing of menarche and latent disorders were estimated in a structural equation model (SEM), adjusted for age, income, race, parent marital status, BMI, and childhood adversity.

Results: The measurement model evidenced acceptable fit (CFI=0.91; RMSEA=0.02). Onset of menarche before age 11 was significantly associated with distress disorders (coefficient=0.096; p<0.0001), fear disorders (coefficient=0.09; p<0.0001), and externalizing disorders (coefficient=0.039; p=0.049) as compared to on-time or late menarche. No residual associations of early menarche with individual disorders over and above the latent disorders were observed.

Conclusion: The latent modeling approach illuminated meaningful transdiagnostic psychiatric associations with early timing of menarche. Biological processes initiated at puberty can influence cognitive and affective processes as well as social relationships for adolescents. Under developmentally normative conditions, these changes may be adaptive. However, for those out of sync with their peers, researchers and clinicians should recognize the potential for these processes to influence liability to a broad array of psychopathological consequences in adolescence.

Figure 1. Structural equation model of path coefficients from age of menarche to latent psychiatric disorder groups

n=4937. Adjusted for BMI, parent income, age, race/ethnicity, number of parents in the household, sexual activity, exposure to or experience of childhood threat and deprivation. GAD=general anxiety disorder, MDD=major depressive disorder, ODD=oppositional defiant disorder. Latent factors and exposure indicator variables were allowed to correlate with each other (p<0.01 for all correlations). *p-value <0.05, **p-value<0.01