Mind the gender mental health gap
Rates of anxiety and depression are rising globally and one sex is at more risk than the other. Could bridging the gap help to bring levels down again?

Which gender suffers from higher levels of mental health issues? If you answered male, then it is true that men are more likely to commit suicide. Women also tend to have stronger social networks to turn to for support when they are feeling under pressure.

But when it comes to the world’s most common mental health issues – anxiety and depression – women are twice as likely as men to be grappling with them. And research shows that their numbers are rising, with young women especially at risk. In one paper, women between the ages of 16 and 24 were almost three times as likely to be experiencing a common mental health issue as men of the same age.

Is this greater propensity due biology, different lived experiences, or the environment that girls and women find themselves in? Here we explain some of the latest thinking.

Hormones and anxiety

Rates of mental health issues in women begin rising in puberty, with two notable hormone-related trigger points in life: giving birth and going through the menopause.

In 2012, Harvard University researchers explained why this might be after examining links between the female sex hormone oestrogen and anxiety. In one test, they found that women with higher levels of oestrogen in their blood were less likely to be startled when put through tests examining fear responses.

The researchers concluded that low or fluctuating oestrogen levels make women more vulnerable to anxiety and mood disorders. Men, on the other hand, were deemed less at risk since the male sex hormone testosterone is converted to oestrogen in the male brain and is more stable there than in women’s.

During a woman’s monthly cycle, oestrogen drops during the luteal phase between ovulation and the beginning of a period, potentially triggering anxiety and mood swings among other pre-menstrual symptoms (PMS). Similar drops occur immediately after childbirth and as women enter the perimenopause.

Is there a gender gap between life expectations and reality?

However, hormones cannot be the only factor, otherwise women the world over would record similar mental health levels. And they do not.

In 2021, University College London (UCL) academics highlighted this after analysing psychological well-being data covering just over half a million 15-year olds across 73 countries.

They found that there is always a gender gap, no matter how rich or gender equal a country is. They also discovered that countries with worse gender equality scores such as Saudi Arabia reported some of the narrowest gender mental health gaps, while those at the other end of scale such as Sweden and Finland reported the widest.

The team used the World Health Organisation’s definition of mental health as their starting point: where the young people felt they sat on the spectrum between ill health and positive wellbeing.

They looked at four metrics: overall life satisfaction, how often the 15-year olds felt sad, how often they felt happy and whether they felt their lives had meaning or purpose.

They concluded that girls and women in more gender equal countries are now faced with a double burden of balancing “both increased economic and political participation as well as the traditional female responsibilities and norms.” They also noted that while women have entered male dominated areas of employment, men have not done the same in female areas and do not undertake equal amounts of housework.

The impact of lived experiences

Recent research has also revealed clear gender differences in psychological responses to childhood emotional or physical abuse. While boys are more likely to exhibit disruptive or anti-social behaviour that gets them excluded from school, or in trouble with the police, girls are more likely to internalise their pain.

Girls that do not have an outlet to express their feelings, can turn to self-harm (three times more prevalent than boys), or develop eating disorders as coping strategies. Others enter early sexual relationships, which puts them at further risk of abuse or exploitation.

Closing the gap

An understanding of clear differences between the mental health experiences of men and women is now gaining wider currency. Health services are also now starting to respond by structuring their services differently, while acknowledging there is still a long way to go.

It is, for example, hard to provide support if it is not sought for in the first place. And in the UK, a government-commissioned Women’s Mental Health Taskforce found that women access mental health services less often than men.

The taskforce attributed this to services being designed “whether consciously or unconsciously” around the needs of men. Women’s role as carers, for example, can make them reluctant to access help for fear of their children being taken away, or being judged a bad parent.

And the solution: providing access to support in a de-stigmatised environment where women not only feel they will be safe and listened to and but also empowered with a voice in discussions about the range of options open to them from medication to talking therapies.


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