New index to explore relationship between mental health and gender in adolescents in greater depth

Half of mental health disorders first manifest themselves before the age of 14. Seventy per cent appear before the age of 18, according to data from the European Society for Child and Adolescent Psychiatry. The relationship between mental health, age, socio-economic status and gender is the subject of increasing research. But how do adolescents perceive their mental health in relation to their gender? And how does their gender influence the way that they deal with mental health issues?

Until now, most studies looked at this relationship through a binary sex labelling that has proven insufficient to understand the links between mental health and gender. A new study, published in European Child & Adolescent Psychiatry, explores these links and proposes an index to work with in the future that includes a broader and more complex view in this type of study of the relationship between mental health and gender. The study was led by Xavier Cela Bertran, who has a PhD from Universitat Rovira i Virgili (URV) and is a former course instructor with the UOC's Faculty of Psychology and Education Sciences. This article is based on his doctoral thesis, supervised by Ángel Martínez-Hernáez, professor in the Department of Anthropology, Philosophy and Social Work at URV, and by Asun Pié Balaguer, professor and researcher in the CareNet group of the Faculty of Psychology and Education Sciences at the Universitat Oberta de Catalunya (UOC), as part of URV's doctoral programme in Anthropology and Communication. Both thesis supervisors are also co-authors of the article.

The relationship between mental health and gender

Every four years, the Barcelona Public Health Agency (ASPB) produces a comprehensive report on adolescence and health: Risk Factors in Secondary School Students (FRESC). The ASPB conducts a survey with almost 4,000 adolescents aged between 13 and 19 years old that covers a very broad range of questions, from substance use patterns to eating habits. However, like other similar studies, it conceptualizes gender in a binary way, through a simple question: whether the respondent is a boy or a girl.

"The FRESC data are very interesting, but we found that they were not always analysed in detail. We believed they held much more valuable information," explained Cela. "The Barcelona Public Health Agency was delighted to be part of the analysis team and to provide us with the data. Based on this, our research team searched for trends in mental health." The study confirmed that both age and having a low socio-economic status have a negative impact on the self-perceived health and level of psychological distress or emotional well-being of young women.

"We can say that gender influences the ways in which people express mental suffering, but also the ways in which they seek help. As such, adolescents who identify as girls are more likely to suffer from emotional issues, although they behave in a more prosocial way [positive behaviour for socializing and communicating with others]," added Pié. "By contrast, adolescents identifying as boys are more likely to suffer from behavioural issues, symptoms associated with attention deficit and problems with their parents."

According to Pié, the poorer mental health or greater mental distress expressed in socialized women could be explained by two reasons. First, it is the result of a sexist and patriarchal social system, where gender inequalities and male violence against women have an impact on their mental health. Second, it is related to the capacity of girls to express vulnerability and affection, a trait associated with female socialization that is much more developed than in people who socialize as men.

A tool to look in more depth at the relationship between mental health and gender

The first objective of the study was to demonstrate the existence of a clear relationship between gender and mental health. The other objective was to take this further by creating a gender adherence index that proposes starting from a non-binary idea of mental health and gender that takes a deeper look at what it means to be a man, what it means to be a woman and what mental health is. "We were seeking to develop tools that could capture a non-binary reality at a scientific level," said Cela.

The study puts forward the Gender Adherence Index (GAI), an index based on a multivariate analysis of behaviours and social habits and beliefs associated with gender. "The calculation of this index is used to analyse the relationships between the mental health of adolescents, their behavioural patterns and their gender socialization, irrespective of their sex determination or, where appropriate, providing an accompanying explanation to this binary label," added Pié.

The general hypothesis of the study is that gender, as a social process, influences the level and ways of expressing mental distress among adolescents. As such, gender conditions the processes of seeking help, both formal and informal, as well as the strategies with which they confront difficult situations. Accordingly, the Gender Adherence Index is intended to add explanatory value to the data that can help to design better measures for prevention and care.

In this first study, the researchers acknowledge that, although the contribution of the GAI is significant, its effect is still moderate. This is mainly due to the fact that the available data are insufficient, since the FRESC report survey was not designed for this purpose. Moving forward, it is necessary to carry out a more detailed and in-depth study of the variables and their relationships in order to improve the interpretative power and to design the questions of the Gender Adherence Index appropriately.

"We aim to develop an effective tool for a more in-depth study of the relationship between gender and mental health in future editions of the FRESC or any other study of this kind. The end goal would be to integrate this tool into larger public health studies that typically address the gender issue very quickly, with a simple binary question," concluded Cela.

This research by the UOC supports Sustainable Development Goals (SDGs) 3, Good Health and Well-being, and 5, Gender Equality.

Reference article

Xavier Cela Bertran, Guille Peguero, Gemma Serral et al. "Understanding the relationship between gender and mental health in adolescence: the Gender Adherence Index (GAI)". European Child & Adolescent Psychiatry (2023). https://doi.org/10.1007/s00787-023-02150-7

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