Abstract
IMPORTANCE: 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. OBJECTIVE: 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. EXPOSURE: Diagnosis of CPP. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.