Developmental timing sets the clock for self- injury: A retrospective cohort study on stress asymmetry in early-menarche and depressive disorder girls

Abstract

Objective

To investigate the independent and interactive effects of menarche timing and stress exposure on non-suicidal self-injury (NSSI) in female depressive disorder adolescents, identifying risk factors and optimal intervention windows.

Method

106 female depressive disorder adolescents were stratified by menarche age (early:≤11 years, n = 32; normal:12–14 years, n = 74) and stress level (high/low). Generalized Linear Models and survival analysis compared NSSI incidence, onset age, and risk. Analyses were adjusted for potential confounders including body mass index (BMI) and depression severity.

Result

Early menarche independently increased NSSI risk HR = 4.68, and advanced the median self-injury age by 1.5 years. Critically, stress exhibited a selective, asymmetric effect: it significantly amplified NSSI risk exclusively in the early-menarche group, while showing no significant impact in the normal-menarche group. Survival curves further revealed distinct developmental risk windows, with the early-menarche group exhibiting a sharp increase in NSSI onset at age 12.0, compared to a later onset at 13.0 years in the normal-menarche group.

Conclusion

Menarche timing serves as a developmental clock for NSSI onset, while stress selectively exacerbates risk in early menarche individuals. The findings support the “development-environment mismatch” theory and suggest that early menarche females (≤11 years) should be prioritized for screening, with staged interventions tailored to developmental and stress profiles.