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Understanding the relationship between gender and mental health in adolescence: the Gender Adherence Index (GAI)

European Child & Adolescent Psychiatry (2023)Cite this article

A Correction to this article was published on 25 May 2023

This article has been updated

Abstract

Half of all mental health disorders appear during adolescence, although it is still far from clear how they relate to gender (not sex) criteria. This study aims both to analyse the relationship between gender and adolescent mental health and to propose an index: the Gender Adherence Index (GAI). We used cross-sectional, secondary data from 3888 adolescents (aged 13–19) from the FRESC Health Survey on Adolescence in Barcelona. We analysed the interaction among sex, age and socio-economic status with several mental health indices. Additionally, we computed a Gender Adherence Index (GAI) to transcend the information-poor binary sex label, and thus assess to what extent mental health can be predicted by the gender expression of adolescents irrespective of their biological sex. We found that older age and lower economic status have a greater impact on the emotional distress of girls, who reported lower self-perceived mental health than boys. Nevertheless, girls obtained higher scores regarding their prosocial behaviour, which is protective against mental health problems. The GAI was retained in all statistical models stressing it as a relevant metric to explain the variability of adolescent emotional distress. Young people who showed adherence to normative femininity in their lifestyles showed higher prosocial behaviour but did not tend to present more emotional distress. Despite its limitations, this is a novel attempt to explore the relationship between gender expression and mental health. Better defined indices of gender adherence could help us to improve our predictive capacity of mental health disorders during adolescence.

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References

  1. Merikangas KR, He J-p, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J (2010) lifetime prevalence of mental disorders in U.S. Adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49(10):980–989. https://doi.org/10.1016/j.jaac.2010.05.017

    Article  PubMed  PubMed Central  Google Scholar 

  2. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual Research Review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56:345–365. https://doi.org/10.1111/jcpp.12381

    Article  PubMed  Google Scholar 

  3. Castro-Fornieles J (2015) Abstracts of the 16th International Congress of ESCAP European Society for Child and Adolescent Psychiatry. Eur Child Adolesc Psychiatry 24:1–303. https://doi.org/10.1007/s00787-015-0714-4

    Article  Google Scholar 

  4. Essau CA (2005) Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders. Depress Anxiety 22:130–137. https://doi.org/10.1002/da.20115

    Article  PubMed  Google Scholar 

  5. Rickwood D, Deane F, Wilson C (2007) When and how do young people seek professional help for mental health problems? Med J Aust 187(7):35–39. https://doi.org/10.5694/j.1326-5377.2007.tb01334.x

    Article  Google Scholar 

  6. Zachrisson HD, Rödje K, Mykletun A (2006) Utilization of health services in relation to mental health problems in adolescents: a population-based survey. BMC Public Health 16:6–34. https://doi.org/10.1186/1471-2458-6-34

    Article  Google Scholar 

  7. Zwaanswijk M, van der Ende J, Verhaak PF, Bensing JM, Verhulst FC (2003) Factors associated with adolescent mental health service need and utilization. J Am Acad Child Adolesc Psychiatry 4:692–700. https://doi.org/10.1097/01.CHI.0000046862.56865.B7

    Article  Google Scholar 

  8. Alonso J, Codony M, Kovess V, Angermeyer MC, Steven J, Haro JM, Haro G, de Girolamo R, de Graaf K, Demyttenaere G, Vilagut J, Almansa J, Lépine P, Brugha TS (2007) Population level of unmet need for mental healthcare in Europe. Br J Psychiatry 190:299–306. https://doi.org/10.1016/j.jad.2009.10.026

    Article  PubMed  Google Scholar 

  9. Martínez-Hernáez A, DiGiacomo SM, Carceller-Maicas N, Correa-Urquiza M, Martorell-Poveda MA (2014) Non-professional-help-seeking among young people with depression: a qualitative study. BMC Psychiatry 14:124. https://doi.org/10.1186/1471-244X-14-124

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moses T (2011) Stigma apprehension among adolescents discharged from brief psychiatric hospitalization. J Nerv Ment Dis 199(10):778–789. https://doi.org/10.1097/NMD.0b013e31822fc7be

    Article  PubMed  Google Scholar 

  11. Martínez-Hernáez A, Carceller-Maicas N, DiGiacomo SM et al (2016) Social support and gender differences in coping with depression among emerging adults: a mixed-methods study. Child Adolesc Psychiatry Ment Health 10:2

    Article  PubMed  PubMed Central  Google Scholar 

  12. Riecher-Rössler A (2017) Sex and gender differences in mental disorders. Lancet Psychiatry 4(1):8–9. https://doi.org/10.1016/S2215-0366(16)30348-0

    Article  PubMed  Google Scholar 

  13. Rubin G (1986) El tráfico de mujeres: Notas sobre la “economía política” del sexo. Nueva Antropología Revista de Ciencias Sociales 30:95–145

    Google Scholar 

  14. Butler J (2006) Gender Trouble. Routledge

    Google Scholar 

  15. Bem SL (1974) The measurement of psychological androgyny. J Consult Clin Psychol 42:155–162. https://doi.org/10.1037/h0036215

    Article  CAS  PubMed  Google Scholar 

  16. Mahalik JR, Locke BD, Ludlow LH, Diemer MA, Scott RPJ, Gottfried M, Freitas G (2003) Development of the conformity to masculine norms inventory. Psychol Men & Mascul 4:3–25. https://doi.org/10.1037/1524-9220.4.1.3

    Article  Google Scholar 

  17. Kachel S, Steffens MC, Niedlich C (2016) Traditional masculinity and femininity: Validation of a new scale assessing gender roles. Front Psychol 7:1–19. https://doi.org/10.3389/fpsyg.2016.00956

    Article  Google Scholar 

  18. Haavik L, Joa I, Hatløy K, Stain H, Langeveld J (2017) Help seeking for mental health problems in an adolescent population: the effect of gender. J Ment Health 28:1–8. https://doi.org/10.1080/09638237.2017.1340630

    Article  Google Scholar 

  19. Kelly CM, Jorm AF, Wright A (2007) Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Aust 187(7 Suppl):S26-30. https://doi.org/10.5694/j.1326-5377.2007.tb01332.x

    Article  PubMed  Google Scholar 

  20. Payne S, Swami V, Stanistreet DL (2008) The social construction of gender and its influence on suicide: a review of the literature. J Mens Health 5:23–35. https://doi.org/10.1016/j.jomh.2007.11.002

    Article  Google Scholar 

  21. Reiss F (2013) Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med 1982(90):24–31. https://doi.org/10.1016/j.socscimed.2013.04.026

    Article  Google Scholar 

  22. Mar J, Larrañaga I, Ibarrondo O, González-Pinto A, las Hayas C, Fullaondo A, Izco-Basurko I, Alonso J, Mateo-Abad M, de Manuel E (2022) Socioeconomic and gender inequalities in mental disorders among adolescents and young adults. Revista de psiquiatría y salud mental. https://doi.org/10.1016/j.rpsm.2022.07.001

    Article  PubMed  Google Scholar 

  23. Santamarina-Rubio E, Serral-Cano G, Pérez C, Ariza C, FRESC 2016 (2017) survey collaboration group. La salut i els seus determinants en l'alumnat adolescent de Barcelona. Enquesta FRESC 2016. Agència de Salut Publica de Barcelona, Berlin

  24. López MA, Gabilondo A, Codony M, García-Forero C, Vilagut G, Castellví P, Ferrer M, i Alonso J (2013) Adaptation into Spanish of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and preliminary validation in a student sample. Qual Life Res 22(5):1099–1104

    Article  PubMed  Google Scholar 

  25. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345. https://doi.org/10.1097/00004583-200111000-00015

    Article  CAS  PubMed  Google Scholar 

  26. Ortuño-Sierra J, Fonseca-Pedrero E, Paino M, SastreRibaMuñiz SSJ (2015) Screening mental health problems during adolescence: Psychometric properties of the Spanish version of the Strengths and Difficulties Questionnaire. J Adolesc Health 38:49–56. https://doi.org/10.1016/j.adolescence.2014.11.001

    Article  Google Scholar 

  27. Rajmil L, López-Aguilà S, Penina AM, Bustos AM, Sanz MR, Guiteras PB (2010) Desigualdades sociales en la salud mental infantil en Cataluña. Anales de Pediatría 73(5):233–240. https://doi.org/10.1016/j.anpedi.2010.02.022

    Article  CAS  PubMed  Google Scholar 

  28. Burnham KP, Anderson DR (2002) Model selection and multimodel inference: a practical information-theoretic approach, 2nd edn. Springer-Verlag, New York. https://doi.org/10.1007/b97636

    Book  Google Scholar 

  29. Miles J, Gilbert P (eds) (2005) A handbook of research methods for clinical and health psychology. Oxford University Press. https://doi.org/10.1093/med:psych/9780198527565.001.0001

    Book  Google Scholar 

  30. R Core Team (2019) R: a language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria. https://www.R-project.org/. Retrieved 28 June 2019

  31. Bates D, Maechler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67(1):1–48. https://doi.org/10.18637/jss.v067.i01

    Article  Google Scholar 

  32. Barton K (2019) MuMIn: Multi-Model Inference. R package version 1.43.6. http://R-Forge.R-project.org/projects/mumin/. Retrieved 16 July 2019

  33. Wickham H (2016) ggplot2: elegant graphics for data analysis. Springer-Verlag, New York

    Book  Google Scholar 

  34. Lacerda-Poton W, Gonçalves-Soares AL, Gonçalves H (2018) Internalizing and externalizing behavior problems and substance use in adolescence. Cad Saude Publica. https://doi.org/10.1590/0102-311X00205917

    Article  Google Scholar 

  35. Kumar A, Nizamie SH, Srivastava N (2013) Violence against Women and Mental Health. Mental Health Prev 1:4–10. https://doi.org/10.1016/j.mhp.2013.06.002

    Article  Google Scholar 

  36. Oram S, Khalifeh H, Howard LM (2017) Violence against women and mental health. Lancet Psychiatry 4(2):159–170. https://doi.org/10.1016/S2215-0366(16)30261-9

    Article  PubMed  Google Scholar 

  37. Koskelainen M, Sourander A, Vauras M (2001) Self- reported strengths and difficulties in a community sample of Finnish adolescents. Eur Child Adolesc Psychiatry 10:180–185. https://doi.org/10.1007/s007870170024

    Article  CAS  PubMed  Google Scholar 

  38. Yao S, Zhang C, Zhu X, Jing X, McWhinnie CM, Abela JR (2009) Measuring adolescent psychopathology: psychometric properties of the self-report strengths and difficulties questionnaire in a sample of Chinese adolescents. J Adolesc Health 45:55–62. https://doi.org/10.1016/j.jadohealth.2008.11.006

    Article  PubMed  Google Scholar 

  39. Stratton KJ, Edwards AC, Overstreet C, Richardson L, Luong Tran T, Tu Trung L, Thanh Tam N, Tran T, Thi Buoi L, Thu-Ha T, Duc-Thach T, Amstadter A (2014) Caretaker mental health and family environment factors are associated with adolescent psychiatric problems in a Vietnamese sample. Physiol Res 220(1–2):453–460

    Google Scholar 

  40. Duinhof EL, Stevens GWJM, van Dorsselaer S, Monshouwer K, Vollebergh WAM (2015) Ten-year trends in adolescents’ self-reported emotional and behavioral problems in the Netherlands. Eur Child Adolesc Psychiatry 24(9):1119–1128. https://doi.org/10.1007/s00787-014-0664-2

    Article  PubMed  Google Scholar 

  41. Fonseca-Pedrero E, Paino MS, Lemos-Giráldez S, Muñiz J (2011) Prevalencia de la sintomatología emocional y comportamental en adolescentes españoles a través del Strengths and difficulties questionnaire (SDQ). Revista de Psicopatología y Psicología Clínica 16(1):15–25. https://doi.org/10.5944/rppc.vol.16.num.1.2011.10348

    Article  Google Scholar 

  42. Alpaslan AH, Kocak U, Avci K (2016) Gender-related factors for depressive symptoms in Turkish adolescents. J Child Adolesc Psychiatr Nurs 29(1):23–29. https://doi.org/10.1111/jcap.12131

    Article  PubMed  Google Scholar 

  43. Angold A, Rutter M (1992) The effects of age and pubertal status on depression in a large clinical sample. Dev Psychopathol 4:5–28. https://doi.org/10.1017/S0954579400005538

    Article  Google Scholar 

  44. Sourander A, Koskelainen M, Niemelä S, Rihko M, Ristkari T, Lindroos J (2012) Changes in adolescents’ mental health and use of alcohol and tobacco: a 10-year time-trend study of Finnish adolescents. Eur Child Adolesc Psychiatry 21(12):665–671. https://doi.org/10.1007/s00787-012-0303-8

    Article  PubMed  Google Scholar 

  45. Montero I, Aparicio D, Gómez-Beneyto M, Moreno-Küstner B, Reneses B, Usall J, Vázquez-Barquero JL (2004) Género y salud mental en un mundo cambiante. Gac Sanit 18(Supl. 1):175–181

    Article  PubMed  Google Scholar 

  46. Prior PM (2005) Gender and Mental Health. Macmillan, London

    Google Scholar 

  47. Fausto-Sterling A (2000) Sexing the body: Gender politics and the construction of sexuality. Basic Books, New York

    Google Scholar 

  48. Amin A, Kågesten A, Adebayo E, Chandra-Mouli V (2018) Addressing gender socialization and masculinity norms among adolescent boys: policy and programmatic implications. J Adolesc Health 62(3S):S3–S5. https://doi.org/10.1016/j.jadohealth.2017.06.022

    Article  PubMed  PubMed Central  Google Scholar 

  49. Courtenay WH (2000) Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med 50(10):1385–1401. https://doi.org/10.1016/S0277-9536(99)00390-1

    Article  CAS  PubMed  Google Scholar 

  50. Sabo D (2000) Comprender la salud de los hombres Un enfoque relacional y sensible al género. Organización Panamericana de la Salud - Harvard Center for Population & Development Studies, Washington

    Google Scholar 

  51. Días-Aguado MJ (2004) Prevención de la violencia y lucha contra la exclusión desde la adolescencia. Instituto de la Mujer, Madrid

    Google Scholar 

  52. Días-Aguado MJ (2006) Sexismo, violencia de género y acoso escolar. Propuestas para una prevención integral de la violencia. Revista de estudios de juventud 6(73):38–58

    Google Scholar 

  53. Días-Aguado MJ, Martínez R (2001) La construcción de la igualdad y la prevención de la violencia de género contra la mujer desde la educación secundaria. Instituto de la Mujer, Madrid

    Google Scholar 

  54. Duque E, Teixido J (2016) Bullying y Género. Prevención desde la Organización Escolar. Multidiscipl J Educ Res 6(2):176–204. https://doi.org/10.17583/remie.2016.2108

    Article  Google Scholar 

  55. Cerezo-Ramírez F (2008) Agresores y víctimas del bullying. Desigualdades de género en la violencia entre escolares. Revista información psicológica 94:49–59

    Google Scholar 

  56. Chacón-Cuberos R, Martínez-Martínez A, Castro-Sánchez M, Espero-Garcés T, Valdivia-Moral PA, Zurita-Ortega F (2015) Relación entre bullying, género y actividad física: Estudio en escolares de la provincia de Granada. Trances 7(6):791–810

    Google Scholar 

  57. León R, López MJ (2003) Los adolescentes y los videojuegos. Apuntes de Psicología 21(1):1–10

    Google Scholar 

  58. Gil-Juarez A, Feliu J, Vitores González A (2010) Performatividad Tecnológica de Género: Explorando la Brecha Digital en el mundo del Videojuego. Quaderns de Psicologia 12(2):209–226. https://doi.org/10.5565/rev/qpsicologia.758

    Article  Google Scholar 

  59. Sánchez-López MP, Rivas-Diez R, Cuéllar-Flores I (2012) Masculinity and femininity as predictors of tobacco and alcohol consumption in Spanish university students. Health Addict 13(1):15–22. https://doi.org/10.21134/haaj.v13i1.189

    Article  Google Scholar 

  60. Vazquez V, Castro R (2009) Masculinidad hegemónica, violencia y consumo de alcohol en el medio universitario. Rev Mex Investig Educ 14(42):701–719

    Google Scholar 

  61. Chacón-Cuberos R, Arufe-Giráldez V, Cachón-Zagalaz J, SánchezCastro-García ZS (2016) Estudio relacional de la práctica deportiva en escolares según el género. SPORT TK-Revista EuroAmericana de Ciencias del Deporte 5(1):85–92. https://doi.org/10.6018/249161

    Article  Google Scholar 

  62. Vidiella J, Herraiz F, Henrández F, Sancho JM (2010) Masculinidad hegemónica, deporte y actividad física. Movimento 16(4):93–115

    Article  Google Scholar 

  63. FARAPI (CONSULTORÍA DE ANTROPOLOGÍA APLICADA) (2007) Siniestralidad vial, velocidad y masculinidad. Incidencia de la masculinidad en la conducción temeraria. Diputación Foral de Gipuzkoa

  64. Balkmar D (2018) Violent mobilities: men, masculinities and road conflicts in Sweden. Mobilities 13(5):717–732. https://doi.org/10.1080/17450101.2018.1500096

    Article  Google Scholar 

  65. Lozano LM, García-Cueto E, Muñiz J (2008) Effect of the number of response categories on the reliability and validity of rating scales. Methodology 4:73–79. https://doi.org/10.1027/1614-2241.4.2.73

    Article  Google Scholar 

  66. Muñiz J, Fidalgo AM, García-Cueto E, Martínez R, Moreno R (2005) Análisis de los ítems. La Muralla, Madrid

    Google Scholar 

  67. Muñiz J, García-Cueto E, Lozano LM (2005) Item format and the psychometric properties of the Eysenck Personality Questionnaire. Pers Individ Differ 38:61–69. https://doi.org/10.1016/j.paid.2004.03.021

    Article  Google Scholar 

  68. Boe T, Hysing M, Skogen JC, Breivik K (2016) The Strengths and Difficulties Questionnaire (SDQ): Factor Structure and Gender Equivalence in Norwegian Adolescents. PLoS ONE 11:e0152202. https://doi.org/10.1371/journal.pone.0152202

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Ortuño-Sierra J, Fonseca-Pedrero J, Aritio-Solana R, Moreno A, Chocarro de Luis E, Schumann G, Cattrell A, Herta Flor H, Nees F, Banaschewski T, Bokde A, Whelan R, Buechel C, Bromberg U, Conrod P, Frouin V, Papadopoulos D, Gallinat J, Garavan H, Heinz A, Walter H, Struve M, Gowland P, Paus T, Poustka L, Martinot J, Paillère-Martinot M, Vetter NC, Smolka MN, Lawrence C, the IMAGEN consortium (2015) New Evidence of Factor Structure and Measurement Invariance of the SDQ Across Five European Nations. Eur Child Adolesc Psychiatry 24:1523–1534. https://doi.org/10.1007/s00787-015-0729-x

    Article  PubMed  Google Scholar 

  70. Rønning JA, Handegaard BH, Sourander A, Mørch WT (2004) The Strengths and Difficulties Self-Report Questionnaire as a screening instrument in Norwegian community samples. Eur Child Adolesc Psychiatry 13:73–82. https://doi.org/10.1007/s00787-004-0356-4

    Article  PubMed  Google Scholar 

  71. Ortuño-Sierra J, Aritio-Solana R, Fonseca-Pedrero E (2018) Mental health difficulties in children and adolescents: The study of the SDQ in the Spanish National Health Survey 2011–2012. Psychiatry Res 259:236–242. https://doi.org/10.1016/j.psychres.2017.10.025

    Article  PubMed  Google Scholar 

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Acknowledgements

Data from the FRESC study were used. The FRESC report was prepared by the Barcelona Public Health Agency (ASPB). The article was translated by M. ª Aranzazu Ubieta (Aulang Traductores). AM-H acknowledges the financial support it received from the Catalan Institution for Research and Advanced Studies (ICREA) under the ICREA Academia Award.

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Authors and Affiliations

  1. Departament d’Antropologia, Filosofia i Treball Social, Medical Anthropology Research Centre (MARC), Universitat Rovira i Virgili de Tarragona, 43002, Tarragona, Spain

    Xavier Cela-Bertran & Angel Martínez-Hernáez

  2. Department of Evolutionary Biology, Ecology and Environmental Sciences, Universitat de Barcelona, 08028, Barcelona, Spain

    Guille Peguero

  3. Agència de Salut Pública de Barcelona, Barcelona, Spain

    Gemma Serral

  4. CIBER d’Epidemiologia i Salut Pública (CIBERESP), Madrid, Spain

    Gemma Serral

  5. Institut d’Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain

    Gemma Serral & Esther Sánchez-Ledesma

  6. Estudis de Psicologia i Ciències de l’Educació, Care and Preparedness in the Network Society (CareNet), Universitat Oberta de Catalunya, 08018, Barcelona, Spain

    Asun Pié-Balaguer

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  1. Xavier Cela-Bertran
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All the authors made substantial contributions to the conception or design of the work, to the acquisition, analysis, and interpretation of data for the work, and had an active role in drafting the work or revising it critically for important intellectual content, and approved the version to be published.

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Cela-Bertran, X., Peguero, G., Serral, G. et al. Understanding the relationship between gender and mental health in adolescence: the Gender Adherence Index (GAI). Eur Child Adolesc Psychiatry (2023). https://doi.org/10.1007/s00787-023-02150-7

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