Prepubertal Internalizing Symptoms and Timing of Puberty Onset in Girls

Julia A. Knight, Rebecca D. Kehm, Lisa Schwartz, Caren J. Frost, Wendy K. Chung, Sarah Colonna, Theresa H.M. Keegan, Mandy Goldberg, Lauren C. Houghton, Danielle Hanna, Gord Glendon, Mary B. Daly, Saundra S. Buys, Irene L. Andrulis, Esther M. John, Angela R. Bradbury, Mary Beth Terry

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Stressful environments have been associated with earlier menarche. We hypothesized that anxiety, and possibly other internalizing symptoms, are also associated with earlier puberty in girls. The Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study (2011-2016) included 1,040 girls aged 6-13 years at recruitment whose growth and development were assessed every 6 months. Prepubertal maternal reports of daughter's internalizing symptoms were available for breast onset (n = 447), pubic hair onset (n = 456), and menarche (n = 681). Using Cox proportional hazard regression, we estimated prospective hazard ratios and 95% confidence intervals for the relationship between 1 standard deviation of the percentiles of prepubertal anxiety, depression, and somatization symptoms and the timing of each pubertal outcome. Multivariable models included age, race/ethnicity, study center, maternal education, body mass index percentile, and family history of breast cancer. Additional models included maternal self-reported anxiety. A 1-standard deviation increase in maternally reported anxiety in girls at baseline was associated with earlier subsequent onset of breast (hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.09, 1.36) and pubic hair (HR = 1.15, 95% CI: 1.01, 1.30) development, but not menarche (HR = 0.94, 95% CI: 0.83, 1.07). The association of anxiety with earlier breast development persisted after adjustment for maternal anxiety. Increased anxiety in young girls may indicate risk for earlier pubertal onset.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalAmerican journal of epidemiology
Issue number3
StatePublished - Mar 1 2021


  • breast development
  • cohort study
  • girls
  • internalizing symptoms
  • puberty

ASJC Scopus subject areas

  • Epidemiology


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