Assessing Psychiatric Evaluations in Premature Thelarche and Idiopathic Central Precocious Puberty Cases: Exploring Depression, Anxiety, Quality of Life, and Coping Challenges

Background: The physical and hormonal changes associated with central precocious puberty (CPP) and premature thelarche (PT) can be a significant source of stress for young girls, who may not be developmentally prepared to understand these changes. This study aims to investigate the presence of psychiatric disorders, assess depression, anxiety, coping difficulties, and the quality of life in girls diagnosed with PT, and compare them with idiopathic CPP (ICPP).

Method: A total of 50 participants aged between 6-9 years (PT=33, ICPP=17) between July 2023 and December 2023 were included in the study. Both groups were evaluated by pediatric psychiatrists at a median of four months after diagnosis with ICPP or PT.

Results: The PT group (n=33) had a mean age of 7.81 ± 0.76 years, while the ICPP group (n=17) had a mean age of 8.15 ± 0.35 years (P=0.091). In the PT group, 90.9% were at Tanner stage 2 and 9.1% were at Tanner stage 3 of pubertal development. In the ICPP group, 35.2% were at Tanner stage 2, 58.8% were at Tanner stage 3, and 5.8% were at Tanner stage 4. As expected, compared to the PT group, the ICPP group had taller heights, higher body weights, higher basal and stimulated luteinizing hormone (LH) levels, and elevated follicle-stimulating hormone (FSH) and estradiol (E2) levels (p<0.05). The total Revised Child Anxiety and Depression Scale (RCADS) score was higher in the PT group compared to the ICPP group (P=0.003). The physical Pediatric Quality of Life (PedsQL) score, psychosocial PedsQL score, and total PedsQL scores were all significantly lower in the PT group (P=0.034, P=0.016, P=0.019, respectively). The total Strengths and Difficulties Questionnaire (SDQ) score, used to evaluate difficulties in coping with challenges, was statistically similar in both groups (P=0.063). Subjects with higher anxiety and depression scores had lower quality of life (P<0.001; R=-0.639). There was also a statistically significant positive correlation between RCADS scores and SDQ scores (P<0.001; R=0.648). We did not find a significant correlation between RCADS scores and hormonal profiles or age.

Conclusion: Despite the hypothalamic-pituitary-gonadal axis not being active, we believe that PT cases may experience psychological impacts due to body changes. While PT cases may not necessitate medical intervention from an endocrinological perspective, addressing their psychological needs can contribute to a healthier overall process for these individuals. The study's findings highlight the need for healthcare providers to monitor the psychological status of PT patients alongside their physical health. Larger-scale studies including control groups are needed to clearly evaluate the relationship between body changes and psychological symptoms.