Psychological Resilience, Body Appreciation, and Associations with Anxiety and Depression in Pubertal Gynecomastia: A Case-Controlled Study

Abstract

Objective: Pubertal gynecomastia may have adverse psychosocial consequences, yet the influence of psychological resilience has been insufficiently explored. Methods: In this case-control study, 36 adolescents with clinically and ultrasonographically confirmed pubertal gynecomastia and 40 healthy controls (ages 11-18) were assessed. Body mass index (BMI) and gynecomastia severity (Rohrich classification) were recorded. Participants completed the Revised Child Anxiety and Depression Scale–Child Version (RCADS-CV), the Adolescent Psychological Resilience Scale (APRS), and the Body Appreciation Scale (BAS). Between-group comparisons and correlations were examined, and MANCOVA was conducted to control for potential confounders. Results: Adolescents in the pubertal gynecomastia group reported significantly lower levels of psychological resilience (F(1, 70) = 62.198, P <.001, ?²P = 0.471) and body appreciation (F(1, 70) = 5.21, P =.026, ?²P = 0.069) compared to the control group, even after controlling for BMI. Although overall anxiety and depression scores did not differ significantly, social phobia approached the significance threshold (t(74) = 1.893, P =.062). Gynecomastia severity was linked to reduced body appreciation (F(2, 28) = 6.621, P =.004, ?²P = 0.321). BMI independently predicted lower resilience (F(1, 70) = 4.77, P =.032, ?²P = 0.064) and body appreciation (r = ?0.308, P =.007) but did not directly contribute to anxiety or depression. Conclusion: While pubertal gynecomastia may not invariably manifest as clinical anxiety or depression, it appears to elevate social phobia risk and undermine both body image and resilience. Psychosocial interventions can mitigate these adverse effects, especially in adolescents who are not candidates for surgical intervention. © 2025 Elsevier B.V., All rights reserved.