Abstract Disclosure: H. Vanden Brink: None. K.C. McCormick: None. M.E. Lujan: None. J. Chang: None. L. Ipp: None. A. Alladeen: None. J. Mendle: None. Introduction: Depression, anxiety, and disordered eating are associated with Polycystic Ovary Syndrome in adults and adolescents with PCOS, and significantly impact quality of life as well as intervention and PCOS management success. Elevated AMH and obesity are known risk factors for future PCOS risk. Thus, the objective was to determine whether AMH was associated with the degree of psychological symptoms in the peri-menarcheal years across the adiposity spectrum. Methods: 40 females (n=12 pre-menarcheal, n=28 <2 years post-menarche) underwent a non-fasting blood draw, anthropometry, menstrual history, and a series of surveys to evaluate depression (CES-DC), anxiety (MASC), perceptions of pubertal-related change (POPS), and transdiagnostic psychological processes (rumination, emotional clarity) which can contribute to, and are risk factors for, psychopathology. Anti-mullerian hormone was measured using picoAMH assay (Motive Biosciences Inc). Linear regression analyses were conducted to determine whether AMH, body habitus (lean [n=26], overweight [n=7], obesity [n=7]) were associated with psychological symptoms. A BMI category-by-AMH interaction was included to test the hypothesis that relationship between psychological symptoms and AMH was greater among those living with obesity, who are at an increased risk of progression to PCOS. Results: In the full model, depression scores were positively associated with AMH (p=0.035), and an AMH*BMIcat interaction was trending (p=0.059), such that the association between AMH and depression scores among those with obesity was greater (p=0.026). POPS was positively associated with AMH, only after inclusion of BMI (p=0.029). Lower body appreciation scores and a higher drive for thinness were associated with higher AMH only among those with obesity (BAS: interaction term p=0.087; parameter estimate AMH*OB p=0.045; EDI: interaction term: 0.061, AMH*OB parameter estimate, p=0.019). Rumination and anxiety also demonstrated a BMI-dependent association with AMH; both were positively associated with AMH among participants with obesity (rumination, interaction p=0.014, AMH*OB parameter estimate p=0.007; anxiety interaction p=0.0009, AMH*OB parameter estimate p=0.0002), but the inverse was detected in lean participants (rumination AMH*Lean parameter estimate p=0.014; anxiety AMH*Lean parameter estimate p=0.009). Conclusion: While preliminary, these findings suggest that obesity and elevated AMH in the pre- and early post-menarcheal years is associated with increased symptoms that could affect psychological well-being symptoms. Research is ongoing to validate these findings in a larger, more diverse cohort and to assess subsequent PCOS risk. Presentation: 6/3/2024