The gender gap in adolescent mental health: A cross-national investigation of 566,829 adolescents across 73 countries

Abstract

Mental ill-health is a leading cause of disease burden worldwide. While women suffer from greater levels of mental health disorders, it remains unclear whether this gender gap differs systematically across regions and/or countries, or across the different dimensions of mental health. We analysed 2018 data from 566,829 adolescents across 73 countries for 4 mental health outcomes: psychological distress, life satisfaction, eudaemonia, and hedonia. We examine average gender differences and distributions for each of these outcomes as well as country-level associations between each outcome and purported determinants at the country level: wealth (GDP per capita), inequality (Gini index), and societal indicators of gender inequality (GII, GGGI, and GSNI). We report four main results: 1) The gender gap in mental health in adolescence is largely ubiquitous cross-culturally, with girls having worse average mental health; 2) There is considerable cross-national heterogeneity in the size of the gender gap, with the direction reversed in a minority of countries; 3) Higher GDP per capita is associated with worse average mental health and a larger gender gap across all mental health outcomes; and 4) more gender equal countries have larger gender gaps across all mental health outcomes. Taken together, our findings suggest that while the gender gap appears largely ubiquitous, its size differs considerably by region, country, and dimension of mental health. Findings point to the hitherto unrealised complex nature of gender disparities in mental health and possible incongruence between expectations and reality in high gender equal countries.

Fig. 1

Average standardised gender difference (male – female) in mental health across each outcome by country and coloured by region Average gender difference in mental health outcomes (life satisfaction, psychological distress, hedonia, and eudaemonia) for each country coloured by region. Gender difference is calculated by subtracting the female from the male mean. The y-axis of the psychological distress scale is reversed to allow visual comparison with the other mental health outcomes as a more negative difference for psychological distress indicates worse outcomes for girls.

Fig. 2

Associations of country-level economic and gender equality indicators with average life satisfaction and psychological distress. Fig. 2: Country-level associations of economic indicators (GDP per capita and Gini) and gender equality indicators (GII, GSNI, and GGGI) with average standardised life satisfaction (a1-5) and psychological distress (b1-5) for females and males and coloured by region. The GII, GSNI and Gini scales are reversed so that all x-axis run from less equal to more equal. The psychological distress scale is reversed so that a negative relationship indicates worse mental health across all outcomes. A larger distance between the regression lines indicates a larger gender gap. Abbreviations: Gini = income inequality, GII = gender inequality index, GSNI = gender social norms index, GGGI = global gender gap index.

Fig. 3

Associations of country-level economic and gender equality indicators with average hedonia and eudaemonia. Fig. 3: Country-level associations of economic indicators (GDP per capita and Gini) and gender equality indicators (GII, GSNI, and GGGI) with average standardised hedonia (c1-5) and eudaemonia (d1-5) for females and males and coloured by region. The GII, GSNI and Gini scales are reversed so that all x-axis run from less equal to more equal. The psychological distress scale is reversed so that a negative relationship indicates worse mental health across all outcomes. A larger distance between the regression lines indicates a larger gender gap. Abbreviations: Gini = income inequality, GII = gender inequality index, GSNI = gender social norms index, GGGI = global gender gap index.