title: Pubertal timing in girls and depression: a systematic review.
abstract: BACKGROUND
  Because the incidence of depression increases after puberty, it is possible that pubertal timing in girls influences the onset of depression. Our objective was to assess the effect of early and late puberty in girls on the incidence of depression.
  
  
  METHODS
  We systematically searched relevant databases for controlled studies that assessed the impact of pubertal timing in girls on the incidence of depression or depressive symptoms. The last search was completed in August 2013. Two authors selected the studies, extracted the data, and assessed the quality of the evidence. Meta-analyses of the adjusted and unadjusted results were calculated using random effects.
  
  
  RESULTS
  Four cohort studies were included (n=8055 participants). Early puberty significantly increased the risk of new cases of depression in the unadjusted meta-analysis (RR=1.33; CI 95%: 1.02, 1.73) but not in the adjusted estimate of two of the included studies (RR=1.48; CI 95%: 0.69, 2.28). For late puberty, no significant associations were found (unadjusted RR=1.28; CI 95%: 0.87, 1.88). Two studies assessed the effect of early puberty on depressive symptoms and found positive associations. The quality of the available evidence was rated as very low.
  
  
  CONCLUSIONS
  The polled results had wide confidence intervals, and the available evidence was of very low quality.
  
  
  CONCLUSIONS
  The available evidence supports little confidence regarding the impact of pubertal timing on the onset of depression in girls but suggests that early puberty in girls may increase the risk of depression. Further higher quality studies are needed to clarify the association between pubertal timing and the incidence of depression in girls and women.
authors.affiliation: Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil; Getulio Vargas University Hospital, Federal University of Amazonas, Manaus, Amazonas, Brazil.
authors.forename: Tais F
authors.initials: TF
authors.lastname: Galvao
authors.affiliation: Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil.
authors.forename: Marcus T
authors.initials: MT
authors.lastname: Silva
authors.affiliation: Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil.
authors.forename: Ivan R
authors.initials: IR
authors.lastname: Zimmermann
authors.affiliation: Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil.
authors.forename: Kathiaja M
authors.initials: KM
authors.lastname: Souza
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Martins
authors.affiliation: Faculty of Medicine, University of Brasilia, P.O. Box 4472, CEP 70904-970, Brasilia, Federal District, Brazil. Electronic address: mauriciogpereira@gmail.com.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D015331:Cohort Studies; D018849:Controlled Clinical Trials as Topic; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D011627:Puberty; D018570:Risk Assessment
keywords: Depression; Depressive disorder; Puberty; Puberty, Delayed; Puberty, Precocious; Review