Early adolescence is a period associated with many physical changes and cognitive and social development of children. Puberty is one development process that occurs at this stage and significantly influences adolescent development (Goddings et al. 2014). Hormonal changes at puberty changes the physiology of the human body. It also results in psychological changes due to changes in brain structure and function at puberty. Psychological changes is also attributed to teenagers response to physiological changes Research studies gives evidence regarding the psychological changes in adolescence due to pubertal development. This is explained by the direct changes to the brain due to puberty. Several perspectives link pubertal changes to adolescent psychological development. For example effect of pubertal timings on adolescent behaviour, effect of pubertal status on behaviour and role of puberty on psychopathology has been explored in research (Berenbaum, Beltz and Corley 2015). In the field of development science, one important area of research is the way in which pubertal changes lead to psychological changes in adolescence. With the increase in problem behaviours in adolescent, the need to get in-depth information related to puberty and psychological changes is necessary. With this insight, the main purpose of this report is to conduct a critical review of research literature to understand the impact of puberty on mental health of girls. The aim is to adapt search methodology to select three articles specific to the research question and critically analyze these articles to get answers to the research question. The credibility, transferability and application of the work is analyzed by review of research methodology and study findings.
Adolescence is a period associated with physical, cognitive and social development. It is the transition of an individual from childhood stage to adulthood. The mental development that takes place during adolescence includes rapid development of memory and imagination, decision making capacity, ability to communicate and deal with abstract terms (Goddings et al. 2014). However, changes in hormones and physical appearance of adolescent people are associated with many psychological transitions too. The onset of puberty in girls is one natural phenomenon in early adolescence and series of endocrine events plays a role in the initiation of puberty. The period of puberty may vary between 8 to 14 years in females and secretion of various hormones during puberty results in changes in the reproductive organs too (Blakemore, Burnett and Dahl 2010). Michaud (2015) argues that puberty has psychological impact on girls and the timely of puberty can significantly affect psychological and behavioural development of adolescents. Based on early or late pubertal timing, the tendency to engage in risk behaviour among adolescents females also differ. Analysis of research done on association between pubertal timing and mental health outcome of females is essential to effectively integrate useful research findings into everyday care of adolescents.
Interest in research on the topic of puberty and mental health in adolescent has emerged due to changes in brain structure at puberty. Herting and Sowell (2017) did a longitudinal study to examine magnetic resonance of scans of individuals aged 7-20 years to detect changes in sub-cortical brain region due to puberty. Pubertal development was found to be associated with changes in structural volumes in all the six areas of the sub-cortical brain region. The study established role of puberty in structural brain development. Hence, taking cues from the above study, it is evident that puberty can significantly affect mental health of adolescent girls. To understand behavioural issues of adults and find out the reasons for risk taking behaviour or depression in early adolescent, critically evaluating research literature on the topic may shed light on the impact of puberty on mental development of girls.
Although initiation of puberty is associated with physiological changes in adolescent through changes in the brain structure, problem behaviour or mental issues in adolescent varies because of pubertal timing and many other factors. There might be different perspective explaining the role of puberty on behaviour or psychological outcome of adolescent females. To critically analyze and evaluate the role of different perspective on adolescent development, it is necessary to formulate a research question that favour identification research literature giving different idea about the role of puberty on mental health of girls.
The key research question for the literature review is ‘How puberty can affect mental health of girls?’.
This research questions enables identification of research literature that can explain different role of puberty on mental health and behaviour of adolescent girls.
Search terms/keyword
To get relevant articles related to the research question, the strategy is to search for research literatures from health care and biomedical databases like CINAHL, PubMed and PsychInfo. These databases published articles from the biomedical science, health science, behavioural science and mental health. High quality and peer reviewed articles specific to the research question can be obtained from these two articles. The search for articles was done by the use of key search terms such as ‘puberty and mental health’, ‘puberty and mental health in adolescent girls’ and ‘impact of puberty on mental development’. These were primary search terms used to retrieve research articles. Boolean operators like ‘AND’ and ‘OR’ were used for literature search from CINAHL databases. These were done to obtain research literature with similar or different meaning. The secondary search terms were further used based on review of literatures obtained from primary search term.
The search process was guided by the review of research question and use of relevant search terms specific to the research question. Inclusion and exclusion criteria were also used to determine the eligibility of the research. Inclusion and exclusion criteria were also used to determine the eligibility of the research papers for inclusion in the literature review. The main inclusion criteria were as follows:
To conclude, the research question helped to develop a search plan and identify sources and keywords to retrieved the article. The process of evaluation on the basis of inclusion and exclusion criteria helped to obtain desired research articles and gain answer to the research question. The search strategy can be summarized by the following diagram:
Figure 1: Search Strategy diagram for the literature review. Source: (library.dmu.ac.uk. 2018)
A total of three articles were selected for critical review and analysis. The summary of the retrieved articles were as follows:
Figure 2: Search summary diagram for the literature review
Title, description and analysis of article 1
Title:
Lee et al. (2017) aimed to study about the longitudinal effects of self-report pubertal timing on adolescent psychological and behavioural outcomes in female youths from Taiwan. This article is relevant to the research question as the study establishes relationship between pubertal timing and psychological and behavioural health problems during adolescent. The prevalence of mental issues in young people such as substance abuse, antisocial behaviour, substance abuse and depression is common today and finding the role of puberty timing of risk behaviour of adolescent might be useful to understand the reason for behavioural problems in girls.
Lee et al. (2017) conducted the research in Taiwan and South Asian context was chosen because of scarce research done in East Asian cultures. The main population of interest for this study were females and female participants were recruited from Taiwan Youth Project (TYP) where the longitudinal cohorts where students from 7th to 9th grade. Class-clustered and multi-stage stratified sampling method was applied to select participants from randomly selected schools. The advantage of using stratified sampling technique is that it reflects the population of interest and it also ensures that different sub-groups in a population receive better coverage (Robinson 2014). Hence, by the use of this method, 1545 participants were selected from 81 classes and 40 schools in Taiwan. To study the effect of pubertal timing, the sample was divided into three groups such as early puberty group, on-time puberty and late puberty group. The evaluation of pubertal changes was done by the use of Pubertal Developmental Scale (PDS). It is a self-report verbal questionnaire that is found reliable for assessment of physical stages of pubertal maturation. Use of this scale is effective as it is a validated tool and in parallel with the Tanner’s staging of puberty. The Tanner’s stage defines physical development of adolescents after achieving menarche (Herting and Sowell 2017). The tool has been used in much research to assess pubertal changes in males and females (Houghton et al. 2018).
The study had rigorous research methodology evident from the process adapted to classify participants according to grade and pubertal timing. For example, participants were classified into different groups as per pubertal timing. Secondly, achieving menarche was also classified by age or grade. For example, early menarche was defined by the presence of menarche during 4th grade, late menarche at 8th grade and on-time menarche between 5th to 7th grade. Furthermore, the rigour in research methodology is also understood from the multiple steps taken to assess problem behaviour in adults. For example, self-report questions were used to assess alcohol drinking, cigeratte smoking, sexual activity and socially problematic behaviours in participants. Mental health and psychological well-being was also evaluated by depression scale and assessment of mental health related symptoms like loneliness and depression. These steps were effective in determining whether a participant was psychologically troubled or psychologically stable. According to Monahan et al. (2014), problem behaviours like adolescents are now increasingly involved in problem behaviours like anti-social behaviour, substance abuse and alcohol use. Hence, proper assessment of these behaviours in relation to puberty can give many important data.
The analysis of data obtained from the longitudinal study revealed that majority of participant (84.3%) had on-time menarche and small proportion w2zwere in the early and late menarche group. However, the impact of pubertal timing on mental health and physical development is understood from the outcome regarding high occurrence of problem behaviour in participant in the early pubertal timing (PT) group. For example, early PT group had high smoking rate, occurrence of sexual activity compared to on-time and late puberty group. However, no association was found between socially problematic behaviour and pubertal timing. Problematic behaviour and poor psychological well-being was observed in those participants who engaged in sexual behaviour before the age of 20. This finding is consistent with other research as Jormanainen et al. (2014) had also proved that pubertal timing does not have any effect on involvement in problem behaviour in adults. The problem behaviour assessed in the study included engaging in bullying. Another study linking early female puberty and problem behaviour suggested that macro-cultural context plays a role in development of problem behaviour in adolescent females (Skoog et al. 2013).
The result obtained from this finding is important as it gives the implication that pubertal timing and menarche has link with adverse developmental outcome in adolescents. The justification for this is that early maturing adolescents do not possess adequate coping capabilities to deal with life challenges brought by puberty (Carr, 2015). However, the evidence gave positive link between temporary maladjustment but it did not linked early puberty with problematic behaviours like depression. The research outcome shows that social norms and social environmental also plays a role in mental health. Parental monitoring and time spent in schools can also result in unfavourable social and psychological behaviour in adolescent girls. Hence, these factors should be utilized in future research. Clinicians working with adolescents can benefit from the research finding as they can analyze problematic behaviour by review of pubertal timing as well as social environment of client.
Title:
The main purpose of the study by Oldehinkel, Verhulst and Orme (2011) was to investigate about the association between mental health problems and pubertal stage in adolescents. The main rational for inclusion of this article in research is that it answers the research question ‘How puberty affects mental health of girls?’. By conducting interview with research participants, the study gave idea about the impact of puberty on emotional and behavioural problems in adolescents.
The research was done by Oldehinkel, Verhulst and Orme (2011) and the main research setting was North of the Netherlands. The sample group for the study were taken from the Tracking Adolescents Individual Lives Strategy (TRAILS), which was a prospective cohort study of Dutch and data was collected from the first and second assessment wave of TRAILS. To find out the link between mental health and puberty, questionnaires and interview data from first and second assessment wave were collected. Youth self-report was used as tool to assess emotional and behavioural problem in the study. The stage of pubertal development in adolescent was analyzed by parent’s ratings and these ratings were influenced by the Tanner stages of pubertal development. Based on the use of data from the study, difference in mental health problems were observed in girls and boys. Internalizing problems were prevalent in girls and externalizing problems were prevalent in boys. Another significant finding was that mental health problems increased in higher Tanner stages and puberty had an impact on girls more negatively than boys.
The critical analysis of research methodology used by Oldehinkel, Verhulst and Orme (2011) indicates that the use of Youth Self Report increased the validity of research finding as it helped to get clear data irrespective of parent-reported problem behaviour. Parent reported problem behaviour may not be valid because children entering into adolescence stage often spend less time with parents and this may affect the validity parent reported response. However, in case of assessment of pubertal development, response from parent’s were taken. The limitation of this approach was that reliable response cannot be obtained as all parents may not be aware about the Tanner’s stage of pubertal development. There was a need to use tools like PDS to get reliable and acceptable scores related to physical development of participants. Tanner’s stages were used to classify adolescents into early or late maturing groups, but using this for physical assessment was also necessary. Overall, the main limitation of the research methodology is that Tanner’s stage ratings were taken either by self-reports or parents report. There was a need for assessment by health professionals who had full understanding about the stages to increase the reliability of the findings.
Oldehinkel, Verhulst and Orme (2011) gave answer to the research question and showed gender differences in the development of internalizing problems among participants. For example, internalizing problem was more prevalent in girls and externalizing problem was more common in boys. Another significant finding of the study is that problems were found to remain constants in girls across Tanner’s stages and it decreased in case of boys. By these findings, the study proved that adolescent period is associated with hormonal and morphological changes and these developments have an impact on mental health problems. The presence of behaviour problem was also found linked to pubertal timing as early maturing adults were more likely to possess internalizing behaviour. This is consistent with the research findings by Lee et al. (2017) too. Internalizing behaviour is related to withdrawal and depression and van der Voort et al. (2014) has argued that parental sensitivity and child inhibited temperament predicts internalizing behaviour in adolescent girls. Hence, this research can give important clue relate to the etiology of specific behavioural and mental symptoms in adolescent and enable mental health professionals to effectively deal with the problem according the etiology identified.
Title:
The study by Mrug et al. (2013) was also found relevant to answer the research question as it aimed to determine how early puberty relate to aggressive behaviour in adolescent girls. By the review of this study, important ideas can be obtained regarding the effect of puberty on mental health of girls.
Mrug et al. (2013) used longitudinal research design to conduct interviews with girls and their parents in three metropolitan areas such as Birmingham, Houston and Los Angeles. Participants were selected using 2-stage probability sampling technique. As the aim of research was also to determine relationship of puberty and aggressive behaviour across ethnicity, the stratified sampling was used to achieve similar number of ethnic participants. Interviews were conducted with parents and child separately and the main outcome measured included delinquency, aggression, best friend’s deviant behaviour and early maturation. The analysis of interview transcript revealed association between early puberty and delinquent behaviour and physical aggression.
The analysis of research gave idea regarding impact on early puberty and best friend’s deviance on high likelihood of problem behaviour in adolescents. Higher level of delinquency and physical aggression was particularly found at age 11. However, physical aggression declined with time and increase or decreased in delinquency depended on friend’s deviance. The study by Negriff and Trickett (2010) also has given similar findings as the result showed links between early pubertal timing and higher delinquency. The study further clarified that maltreatment did not influence the relationship; however it gave the direction to examine contextual factors affecting mental health of adolescent girls. The significance of the study by Mrug et al. (2013) is that it gave the implication that limiting interaction with deviant peers can help to reduce negative behaviour and promote mental health of adolescents. However, prospective study design was the main limitation of the study.
The three research articles selected for literature review has given unique results to answer the research question. The first study linked puberty to mental issues because of prevalence of problem behaviour in early maturing adolescents. The second study revealed prevalence of internalizing behaviour in girls and the effect of pubertal timing was also found. The third study linked these outcomes with friend’s deviant behaviour too. However, all the three articles also gave the direction to consider other contextual factors such as friend’s deviance, parental monitoring and social environment to evaluate behaviour and mental health of adolescent girls.
Conclusion
To conclude, finding the links between puberty and mental health through literature review was necessary to determine reason for high prevalence of problem behaviours like depression and social withdrawals in adolescent girls. The review of research studies related to the research question established significant relationship between pubertal timing and negative psychological and behaviour in adolescent. The critical review and analysis discussed about methodological rigour, credibility, significance of research and clinical implication of research findings. The literature review also gave the insight that that social context and parental closeness also determined mental health of early adolescent girls. In future, analysis of contextual factors along with pubertal timing is necessary to understanding the aetiology of mental health issues in adolescent girls.
References
Berenbaum, S.A., Beltz, A.M. and Corley, R., 2015. The importance of puberty for adolescent development: conceptualization and measurement. In Advances in child development and behavior (Vol. 48, pp. 53-92). JAI.
Blakemore, S.J., Burnett, S. and Dahl, R.E., 2010. The role of puberty in the developing adolescent brain. Human brain mapping, 31(6), pp.926-933.
Carr, A., 2015. The handbook of child and adolescent clinical psychology: A contextual approach. Routledge.
Goddings, A.L., Mills, K.L., Clasen, L.S., Giedd, J.N., Viner, R.M. and Blakemore, S.J., 2014. The influence of puberty on subcortical brain development. Neuroimage, 88, pp.242-251.
Herting, M. M., and Sowell, E. R. 2017. Puberty and structural brain development in humans. Frontiers in neuroendocrinology, 44, 122-137.
Houghton, L.C., Knight, J.A., De Souza, M.J., Goldberg, M., White, M.L., O’Toole, K., Chung, W.K., Bradbury, A.R., Daly, M.B., Andrulis, I.L. and John, E.M., 2018. Comparison of methods to assess onset of breast development in the LEGACY Girls Study: methodological considerations for studies of breast cancer. Breast Cancer Research, 20(1), p.33.
Jormanainen, E., Fröjd, S., Marttunen, M. and Kaltiala-Heino, R., 2014. Is pubertal timing associated with involvement in bullying in middle adolescence?. Health Psychology and Behavioral Medicine: An Open Access Journal, 2(1), pp.144-159.
Lee, C.T., Tsai, M.C., Lin, C.Y. and Strong, C., 2017. Longitudinal effects of self-report pubertal timing and Menarcheal age on adolescent psychological and behavioral outcomes in female youths from Northern Taiwan. Pediatrics & Neonatology, 58(4), pp.313-320.
library.dmu.ac.uk. 2018. How to undertake a literature search and review for dissertations and final year projects. Retrieved from: https://www.library.dmu.ac.uk/Images/Howto/LiteratureSearch.pdf
Michaud, P.A., 2015. Pubertal Timing, Exploratory Behavior and Mental Health: A View from a Clinician and Public Health Practitioner. In Brain Crosstalk in Puberty and Adolescence(pp. 45-56). Springer, Cham.
Monahan, K.C., Rhew, I.C., Hawkins, J.D. and Brown, E.C., 2014. Adolescent pathways to co?occurring problem behavior: The effects of peer delinquency and peer substance use. Journal of research on adolescence, 24(4), pp.630-645.
Mrug, S., Elliott, M.N., Davies, S., Tortolero, S.R., Cuccaro, P. and Schuster, M.A., 2013. Early puberty, negative peer influence, and problem behaviors in adolescent girls. Pediatrics, pp.peds-2013.
Negriff, S. and Trickett, P.K., 2010. The relationship between pubertal timing and delinquent behavior in maltreated male and female adolescents. The Journal of early adolescence, 30(4), pp.518-542.
Oldehinkel, A.J., Verhulst, F.C. and Ormel, J., 2011. Mental health problems during puberty: Tanner stage-related differences in specific symptoms. The TRAILS study. Journal of adolescence, 34(1), pp.73-85.
Robinson, O.C., 2014. Sampling in interview-based qualitative research: A theoretical and practical guide. Qualitative Research in Psychology, 11(1), pp.25-41.
Skoog, T., Stattin, H., Ruiselova, Z. and Özdemir, M., 2013. Female pubertal timing and problem behaviour: The role of culture. International Journal of Behavioral Development, 37(4), pp.357-365.
van der Voort, A., Linting, M., Juffer, F., Bakermans-Kranenburg, M.J., Schoenmaker, C. and van IJzendoorn, M.H., 2014. The development of adolescents’ internalizing behavior: Longitudinal effects of maternal sensitivity and child inhibition. Journal of youth and adolescence, 43(4), pp.528-540.
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