Timing of menarche and self-harm in adolescence and adulthood: a population-based cohort study

Abstract

Background Previous studies of pubertal timing and self-harm are limited by subjective measures of pubertal timing or by the conflation of self-harm with suicide attempts and ideation. The current study investigates the association between an objective measure of pubertal timing – age at menarche – and self-harm with and without suicidal intent in adolescence and adulthood in females. Method Birth cohort study based on 4042 females from the Avon Longitudinal Study of Parents and Children (ALSPAC). Age at menarche was assessed prospectively between ages 8 and 17 years. Lifetime history of self-harm was self-reported at ages 16 and 21 years. Associations between age at menarche and self-harm, both with and without suicidal intent, were examined using multivariable logistic regression. Results Later age at menarche was associated with a lower risk of lifetime self-harm at age 16 years (OR per-year increase in age at menarche 0.87; 95% CI 0.80–0.95). Compared with normative timing, early menarche (<11.5 years) was associated with an increased risk of self-harm (OR 1.31, 95% CI 1.04–1.64) and later menarche (>13.8 years) with a reduced risk (OR 0.74, 95% CI 0.58–0.93). The pattern of association was similar at age 21 years (OR per-year increase in age at menarche 0.92, 95% CI 0.85–1.00). There was no strong evidence for a difference in associations with suicidal v. non-suicidal self-harm. Conclusions Risk of self-harm is higher in females with early menarche onset. Future research is needed to establish whether this association is causal and to identify potential mechanisms.

A Systematic Literature Review of Factors Affecting the Timing of Menarche: The Potential for Climate Change to Impact Women’s Health

“…Diseases/conditions associated with late menarche include osteoporosis [83] and two fertility-related conditions, including fetal loss [84] and longer time to first baby [84], and hirsutism (excessive body hair growth) [85]. Diseases/conditions associated with early menarche include short stature [86], elevated BMI [87], fertility-related diseases/conditions including increased antral follicle count (typically a sign of increased fertility) [87], premature menopause [88], hysterectomy [89], and mental health conditions including depression [90], thoughts of self-harm (but not suicidality) [91], fear [92], distress [92], externalizing disorders [92], and behavioral problems [93]. Short stature is more a characteristic of the patient state and can indicate lack of adequate nutritional intake [86].…”

Pubertal timing and self-harm: a prospective cohort analysis of males and females

“…The current finding of an association between earlier pubertal timing (indicated by earlier aPHV) and an increased risk of self-harm at age 16 years is consistent with earlier research investigating the association between pubertal timing and self-harm in females (Roberts et al ., 2019), and some studies that have examined pubertal timing and self-harm in males (e.g. Michaud et al ., 2006).…”

“…We did not find any evidence that the association between aPHV and self-harm differs according to whether or not self-harm is accompanied by suicidal intent. This result is consistent with previous research (Larsson and Sund, 2008; Roberts et al ., 2019) and implies that although some risk factors differ for suicidal and NSSH (Mars et al ., 2014), pubertal timing is one of the many risk factors shared by both. Our results also provide no evidence that adverse effects of early pubertal timing persist into early adulthood in males, but some weak evidence that associations persist in females.…”

“…Few studies, however, have examined potential sex differences in the association between pubertal timing and self-harm. Previous research has reported a consistent association between early pubertal timing and an increased risk of self-harm in females (Roberts et al ., 2019), but few studies include males or stratify by sex. Those that do find varying results in males, with an increased risk of self-harm having been reported in individuals experiencing early puberty (Michaud et al ., 2006) and late puberty (Wichstrøm, 2000), or being unrelated to pubertal timing (Graber et al ., 1997).…”

Suicide assessment and treatment in pediatric primary care settings

“…The timing of puberty also plays a significant role, as girls who are found to mature earlier than peers are at increased risk of depression, substance use, and early sexual behavior, and boys with asynchronous (i.e., early or late), pubertal development, may also have more psychopathology (Graber, 2013; Mendle, Ryan, & McKone, 2017). In a large British longitudinal study, early menarche was associated with increased incidence of self‐harm, with and without suicidal intent (Roberts, Fraser, Gunnell, Joinson, & Mars, 2019). And for males, late puberty has been associated with poorer mental health outcomes, including depression and anxiety (Zhu & Chan, 2017).…”