زمان بلوغ، رفتار جنسی و افسردگی خود گزارش شده در اواسط نوجوانی

The associations between pubertal timing, sexual activity and self-reported depression were analysed in a population sample of 17,082 girls and 15,922 boys aged 14–16 as a par of a classroom survey. Pubertal timing was assessed by age at onset of menstruation (menarche) or ejaculations (oigarche). Sexual experiences elicited included kissing, light petting, heavy petting and intercourse. Self-reported depression was measured by the 13-item Beck Depression Inventory. Among girls, self-reported depression was associated with early puberty and intimate sexual relationship. Among boys depression was associated with very early and late puberty and experience of intercourse. Early puberty is a risk factor for self-reported depression. Intimate sexual relationships in middle adolescent are likely to indicate problems in adolescent development rather than successful adolescent passage.

The prevalence of major depression as diagnosed in clinical interviews increases from childhood to adolescence, from less than 3% amongst prepubertal children (aged 6–11 years) to 9% amongst adolescents (12–16 years) (Fleming & Offord, 1990; Whitaker et al., 1990; Garrison, Addy, Jackson, McKeown, & Waller, 1992; Lewinsohn, Clarke, Seeley, & Rohde, 1994). According to various depression self-rating scales the prevalence is somewhat higher, with up to 15% of adolescents obtaining scores suggesting moderate to severe depression (Ehrenberg, Cox, & Koopman, 1990; Connelly, Johnston, Brown, Mackay, & Blackstock, 1993; Olsson & von Knorring, 1997). During childhood, depression is equally common amongst girls and boys, and in some cases has been found to be even slightly more common in boys (Fleming & Offord, 1990; Angold, Costello, & Worthman, 1998). However, from adolescence, the prevalence of depression increases considerably and an adult type female preponderance emerges: adolescent and adult females suffer from depression twice as frequently as males (see for example Angold et al., 1998). The role of pubertal development in the emergence of sex differences in adult depression has been debated, and the findings so far are contradictory. While earlier studies have suggested that increasing age but not advancing pubertal status contributes to depression (Angold & Rutter, 1992), more recent research has linked changes in prevalence of depression with reaching more mature pubertal status (Angold et al., 1998). For example, Rierdan and Koff (1991) and Hayward et al. (1997) found that earlier pubertal timing was associated with an increased risk of depression, with girls who matured earlier than their peers being at increased risk of depression and other internalizing symptoms (such as anxiety and disturbed self-image). However, Canals et al. (1996) found no association between puberty development and depression. In contrast, among boys the effect of pubertal timing on depression risk may be opposite to that of girls. Specifically early maturation has been found to promote psychosocial adjustment among boys (Stattin & Magnusson, 1990), while later maturation has been reported to be a risk for poor adjustment (Nottelman et al., 1987). These finding suggest that depression among boys could also be associated with late maturation. However, in a Finnish study, very early puberty was associated with a variety of negative mental health outcomes among boys (Kaltiala-Heino et al., 2003). Thus, depression seems to be associated with a more advanced pubertal status, but amongst girls, early maturation also may independently increase the risk. The later assumption, however, needs to be further confirmed. For boys, it has been suggested that late maturation may increase risks of mental health problems (Nottelman et al., 1987; Stattin & Magnusson, 1990). However, studies addressing this issue are scarce and have not focused specifically on depression. The importance of pubertal timing for depression in boys is in need of further clarification. The significance of puberty for depression has been explored in terms of biological, psychological and social factors. Hormonal changes of puberty may contribute to depressive affect and may to a certain extent explain the sex differences as well. Psychologically, the need to adjust to one's own changing body and sexual maturation could be the challenge that increases the risk of depression. This task might be more challenging for girls in contemporary Western society, especially if they mature physically very early, perhaps without being mentally ready to face the challenges of being a woman instead of a girl. Finally, depression might be mediated by social factors, the reactions of others to the adolescent's puberty development, and the change in expectations of society on an individual who passes from childhood to adolescence. These expectations are likely to differ between the two sexes. In the last case timing of puberty is expected to be significant in its own right. Deviating from peer groups in either direction and facing the challenge of adjusting to one's own bodily changes without support from peers in a similar situation may make the puberty experience increasingly stressful. In clinical practice, depression is generally assumed to be associated with loss of sexual desire. Depression rating scales such as the Hamilton Depression Rating Scale and the 21-item Beck Depression Inventory include items eliciting sexual desire and activity, implying that reduced desire signifies depressiveness. However, empirical studies on sexual behaviour in depression are lacking even among adults, not to mention adolescents. The association between sexual behaviour and depression may be different among young people, and the association may vary by age and cultural norms and attitudes. The timing of sexual debut has, during the past few decades, occurred much earlier than before, with evidence suggesting that this trend towards earlier sexual maturation has resulted in a 3–4 years drop in the age at first intercourse for young men and young women living in Western countries during the latter half of the 20th century (Wellings & Field, 1996; Goodson, Evans, & Edmundson, 1997). The major change occurred in the late 1960s and early 1970s, and changes have been minor since then (United Nations, 1988). Two international comparisons concluded that in Nordic countries, age at initiation of sexual intercourse was lower than in other parts of Europe and that girls engaged in sexual intercourse slightly earlier than boys (Jones, Forrest, & Goldman, 1985; United Nations, 1988). For example, both Finnish and Swedish studies have shown that the proportion of adolescents having had sexual intercourse increases steeply between 14 and 16 years (Edgardh, 1993; Kosunen, Rimpel, & Liinamo, 1998). The most recent Finnish survey of 9th grade students (mean age 15.8 years) showed that 30% of girls and 24% of boys had already experienced sexual intercourse (Kosunen et al., 1998). Several research findings suggest that early sexual activity more likely reflects problems in adolescent development than successful adolescent passage. Adolescents may engage in sexual activity before they are ready for a variety of reasons, including peer pressure, unfavourable family background and substance use (Goodson et al., 1997; Kinsman, Romer, Furstenberg, & Schwartz, 1998). Expectations of reaching the transition to adulthood earlier than peers has also been suggested as a further reason for early sexual debut (Rosenthal, Smith, & Visser, 1999). In addition, other studies have associated early sexual activity with different externalizing and internalizing symptoms and disorders. In particular, Capaldi, Crosby, and Stoolmiller (1996) and Tubman, Windle, and Windle (1996) found that early sexual activity was associated with both previous (during childhood) and current (during adolescence) antisocial behaviour. In addition, Tubman et al. (1996) reported that once adolescents had started sexual activity, their antisocial behaviour increased, and that sexually active adolescents also displayed more depressive symptoms. Ramhakra, Caspi, Dickson, and Paul (2000) also found that subjects in their late adolescence diagnosed with substance dependence, schizophrenia spectrum and antisocial disorders had an increased risk of engaging in risky sexual intercourse, and retrospectively reported an early onset of intercourse. While these studies tend to suggest that early sexual debut might be associated with mental health problems, the relation between sexual activity and depression in adolescence has nevertheless been studied very little. It should also be noted that the timing of puberty may contribute both to the timing of sexual debut and to depression. Therefore, it is necessary to control for pubertal timing when analysing the role of sexual activity in depression in young people. In discussing adolescent sexual behaviour, intercourse is not the only indicator of sexual experiences. First sexual intercourse is typically preceded by various practices of kissing and petting for several years before adolescents experience their first intercourse (Moore & Rosenthal, 1993; Wellings & Field, 1996; Schwartz, 1999). In Finland, half of 13 year-old teenagers had kissed on the mouth, while 16% of boys and 13% of girls at this age had experienced intimate fondling under clothes or when naked (Pötsönen, 1998). These proportions rise from year to year so that almost a half of 15-year-old adolescents have had these intimate experiences (Kosunen et al., 1998). In general, these gradually advancing sexual experiences have been studied far less than sexual intercourse. The aim of this study is to examine associations between pubertal timing, sexual behaviour and self-reported depression in a large unselected community sample of 14–16 year old adolescents. The study addresses the following questions (1) Is early puberty (early menarche/oigarche) a risk factor for depression among middle adolescents? (2) Is early advancing sexual behaviour associated with depression in middle adolescence? (3) Are the associations in (1) and (2) similar or different for girls and boys?

Adolescents maturing off time, especially very early, are at increased risk of self-reported depression that indicates a risk for clinically diagnosable depressive disorders. Early maturing adolescents may benefit from health education concentrating on biological development and adjustment to it. They are likely to need information earlier and in a different form than do their later developing peers. In counselling, focusing on coping with the challenges of maturation may be helpful for early maturing girls and off-time maturing boys. Advanced sexual behaviour in middle adolescence should be seen as behaviour suggestive of mood problems. Evaluation of depression and need for treatment is advisable among sexually active adolescents. Future research should focus on assessing in follow-up design how the association between depression and sexual activity in adolescence is formed, and whether the association is specific to depression.