Emotional and Behavioural Problems Including Anxiety and Depressive Symptoms Across Tanner Stages in Girls With Central Precocious Puberty: A Retrospective Clinical Study

Abstract

Background: To examine the Tanner stage–specific patterns of psychological and behavioural problems in girls with central precocious puberty (CPP) and to identify clinical predictors of clinically significant psychological impairment.

Methods: This retrospective cross-sectional study included 116 girls with CPP treated between January 2020 and December 2024. Clinical data were extracted from electronic medical records. Pubertal development was classified by breast Tanner staging into stage II (n = 32), stage III (n = 42) and stages IV–V (n = 42). Psychological outcomes were evaluated using the age-standardised Child Behavior Checklist (CBCL) T-scores. For participants aged ≥7 years, depressive and anxiety symptoms were assessed using the Children’s Depression Inventory and the Screen for Child Anxiety Related Emotional Disorders. The independent predictors of clinically significant psychological problems were identified through logistic regression analysis, defined as CBCL Total Problems T-score of ≥64, and model performance was assessed using receiver operating characteristic curve analysis.

Results: The mean CBCL Total Problems T-score was 58.6 ± 12.4, and 50 girls (43.1%) had clinically significant psychological problems. Psychological burden increased across Tanner stages. The CBCL Total T-scores were 52.4 ± 10.8 in stage II, 58.6 ± 11.6 in stage III and 65.8 ± 13.2 in stages IV–V (p < 0.001). The prevalence of clinically significant problems increased from 21.9% to 40.5% and 61.9% (p = 0.002). Internalising symptoms showed a stronger stage-related pattern than externalising symptoms. Early age at onset was associated with increased symptom severity (r = −0.385, p < 0.001). Multivariable analysis identified Tanner stages IV–V versus stage II (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.44–5.99, p = 0.003), younger age at onset (OR = 0.72, 95% CI: 0.55– 0.94, p = 0.016), higher peak luteinising hormone (LH) (OR = 1.45, 95% CI: 1.08–1.95, p = 0.014) and family history of early puberty (OR = 2.18, 95% CI: 1.26–3.77, p = 0.005) as independent predictors. The prediction model showed good discrimination (area under the curve = 0.812, 95% CI: 0.738–0.886). 

Conclusions: Girls with CPP experience substantial psychological burden, and risk increases with pubertal stage. Advanced Tanner stage, earlier pubertal onset, increase in peak LH and family history are indicators for enhanced psychological monitoring and support.