8. Mental health and psychosocial wellbeing and gender norms

Mental health problems account for 16% of the global burden of disease and injury among adolescents, with depression the leading cause of their illness and disability, and suicide one of the leading causes of death among older adolescents. Many mental health disorders, such as depression and anxiety, start during adolescence and continue into adulthood with serious life consequences.

Gender differentials in mental health emerge at this time. While accurate data are scarce, girls are between 1.5 and 2 times more likely than boys to be diagnosed with depression and are more likely to have suicidal thoughts and engage in self-harm. Yet boys are more likely to die as a result of suicide. India is an exception, with suicide the leading cause of deaths among adolescent girls and young women, with married women accounting for the highest proportion in 2016.

WHO recognises the role of rigid gender norms in vulnerability to mental health risks for both women and men in contexts characterised by gender inequality, with young women feeling constrained and young men expected to repress their emotions.

Norms about feminine behaviours

Evidence from diverse settings across LMICs shows that lack of control over their life, lack of parental support, lack of social networks and exposure to violence lead to poor psychosocial wellbeing for girls, as well as suicidal behaviour. Puberty increases girls’ exposure to such factors.

One global study has estimated that women who have experienced intimate partner violence are almost twice as likely to experience depression as those who have not. Evidence from contexts with high rates of gender-based violence and early marriage reinforce this finding. A recent study in rural India found that high levels of psychological distress among young low-caste adolescent girls were linked to sexual harassment and abuse, school dropout and early marriage, with one third of girls reporting that they had no hope for the future. Similarly, research in Ethiopia found that girls who had ever been married, promised in marriage or had received marriage requests were twice as likely to have had suicidal thoughts as those who had not. An ALIGN-commissioned piece provides comprehensive information about how gender norms drive psychosocial distress among girls and identifies promising initiatives for its mitigation.

Norms about masculine behaviours

Traditional masculine norms require men to show resilience in the face of adversity, tolerate pain, manage negative emotions and refrain from seeking help or risk being seen as weak. Young men who are reluctant to seek psychological help may resort to social withdrawal and substance abuse to deal with their emotional pain.

Literature confirms that conformity to traditional norms contributes to poor mental health outcomes for men, including a study in Mexico, the UK and the US: in all three countries men who did what was expected of them, were far more likely to report depressive symptoms. Conformity to traditional norms can also inhibit men’s access to services and treatment: a systematic review noted that it affects their ability to recognise symptoms of depression, seek help and adhere to treatment.

Norms, sexuality and psychosocial wellbeing

Adolescents and youth whose sexual orientation does not conform to traditional gender norms often face increased stigma and discrimination, gender-based violence and exclusion. Studies also report an increased risk of mental health problems. A study in Viet Nam found that over 70% of LGBT students experienced physical and verbal abuse in school, with almost a quarter reporting suicidal thoughts and 15% attempting self-harm or suicide.