Suicide is a significant and growing global health problem which has consistently ranked among the leading causes of death for older adolescent girls and boys globally. Mental health can impede all aspects of health, including overall well-being and development, leaving adolescents feeling socially isolated, stigmatized and unable to optimize their social, vocational and interpersonal contributions to society. Poor mental health in adolescence is strongly associated with higher rates of substance use, early pregnancy, school dropout, delinquent behaviors and suicide. It can contribute to more serious mental disorders and overall poor health later in life. Understanding adolescent girls’ and boys’ unique and common vulnerabilities to mental health risks, including the impacts of harmful gender norms and the factors that can protect and enhance their mental health and wellbeing, are crucial when considering appropriate policies and interventions. The gendered influences associated with mental health problems need to be better understood, particularly in low- and middle-income countries (LMICs), where both evidence and interventions are scarce. Particular focus must be paid to the impacts of harmful gender norms, as well as identifying factors that can protect and enhance their mental health and well-being.
With the support of USAID, YouthPower Learning conducted analyses of the Global School-based Health Surveys (GSHS) for six low- and middle-income countries (LMICs) - Cambodia, El Salvador, Ghana, Iraq, Maldives and Swaziland. The analysis investigated the interactions between bullying, violence and other risk and protective factors that contribute to poor mental health - including suicidality and feelings of loneliness and worry - among in-school adolescent girls and boys (ages 13−17). Stemming from these analyses, YouthPower Learning has developed a conceptual framework for understanding the context of adolescent mental health and wrote two briefs that synthesize these analyses and provide recommendations for programming and research.
DOWNLOAD BRIEF 1 - The Gendered Impacts of Bullying on Mental Health Among Adolescents in Low-and Middle-Income Countries: Recommendations for Programming and Research
DOWNLOAD BRIEF 2 - Gender and Adolescent Mental Health: An Opportunity to Achieve Sustainable Development
The Gendered Impacts of Bullying on Mental Health Among Adolescents in Low-and Middle-Income Countries: Recommendations for Programming and Research
The failure to address mental health problems in LMICs has wide-reaching consequences because failure to do so also impedes the achievement of basic development outcomes. The purpose of this brief is to discuss why gender and mental health is important to development and to provide recommendations to USAID on how to address mental health in research and programming.
This brief investigates the associations between bullying, violence and other risk and protective factors that contribute to poor mental health among in-school adolescent girls and boys (ages 13−17). The study includes GSHS data for in-school adolescents from a six-country analysis from different regions around the world—Cambodia, El Salvador, Ghana, Iraq, Maldives and Swaziland.
- Across five countries, in-school adolescent girls reported higher levels of loneliness than boys, as well as problems with sleep due to worrying.
- In Iraq, Ghana and El Salvador, adolescent girls were between two and six times more likely than boys ever to plan suicide.
- Across every region, bullying related to someone’s appearance or through sexual jokes, gestures and comments increased the risk of poor adolescent mental health.
The research demonstrates that the harmful mental health effects of bullying and violence disproportionately impact girls due to the socialization, norms, attitudes and perceptions of how they should behave within their society. Overall, the findings illuminate the gendered dimension of bullying. Interventions should take into account gender differences in the type of bullying and violence experienced and perpetrated.
- Integrate awareness-raising and educational campaigns within school-wide programming, which can help to provide a deeper understanding of types of bullying, the differential impact on boys and girls, and associated risks and consequences.
- Implement school-based psychosocial prevention interventions, which can reduce the level of bullying within schools and should be tailored according to the type of experience associated with being a bully/victim.
- Develop & implement evidence-based treatments targeting the mental health of adolescents.
- Develop & implement gender-responsive mental health interventions, which should be evidence-based treatments targeting the mental health of adolescents.
- Employ evidence-based PYD and social emotional learning strategies to strengthen children’s life skills and values.
- Implement capacity-building for teachers and administrators through professional development programs, to help address bullying incidents and the mental health issues that arise due to harassment at school.
- Create a nurturing and supportive environment through girls and boys clubs and “safe spaces.”
Mental health issues, particularly among adolescents, cannot be considered in isolation from other areas of development, such as education, employment, sexual and reproductive health, HIV, emergency responses and human rights. Poor mental health is linked with poor international development outcomes and contextual factors. There is growing recognition within the international community that mental health is a neglected, yet essential, lever for achieving the Sustainable Development Goals (SDGs). Yet, addressing mental health is critical for ensuring countries are on the journey to self-reliance. Additionally, the gendered influences associated with mental health problems need to be better understood, particularly in LMICs, where both evidence and interventions are scarce. This brief explains why the inclusion of mental health and substance abuse in the SDGs is an opportunity to prioritize and strengthen the prevention and treatment of mental health, and examines the multiple factors shape boys’ and girls’ risks of poor mental health.
Evidence from multiple countries demonstrates that exposure to gender discrimination, abuse, violence, and other precursors can increase mental health programs, with girls being at a greater risk than boys for all these precursors in many countries. Understanding adolescent girls’ and boys’ unique and common vulnerabilities to mental health risks, including the impacts of harmful gender norms and the factors that can protect and enhance their mental health and well-being, are crucial when considering appropriate policies and interventions. Here are three reasons why gender and mental health matters for USAID missions:
- Specific vulnerabilities of women, children, and adolescents living in fragile and conflict-affected settings threaten their health and well-being
- Investments in positive youth development (PYD) and mental health have shown to translate to benefits for society, by helping youth make successful transitions to adulthood.
- USAID has made substantial investments in youth-focused programming, and the failure to address mental health impedes sector-specific outcomes. In order to ensure progress towards reaching the SDGs, it is imperative to establish courses of action that will address distinct mental health challenges faced by adolescent girls and boys in a range of contexts. And this should be carried out through comprehensive implementation involving research, programming and policy.
Major gaps exist in research and programming, with data on the prevalence of mental disorders among children and adolescents being exceedingly limited. Several recommendations have been made for how program implementers can address the gaps in gender and mental health specifically within USAID:
- Tailor adolescent programming for vulnerable populations so that programs meet the unique psychosocial needs of boys and girls, and that hard-to-reach youth have access to said programs.
- Implement gender-responsive mental health interventions within education, health governance, countering violent extremism and preventing violent extremism, non-traditional sectors, cross-sectoral programs.
- Integrate gender and mental health into existing adolescent-focused interventions, providing increased attention to harmful gender norms and addressing masculinity in existing or newly designed programs across sectors.
- Strengthen the capacity for healthcare workers, teachers, school counselors and other frontline professionals through trainings, so they are better able to identify and manage mental health disorders among adolescents.
- Work with local health and child protection systems to strengthen referral structures for mental health treatment, building alliances between the public and private sectors that may improve identification and treatment of mental health problems.
- Implement evidence-based PYD and social-emotional learning strategies, which can help promote positive mental health by developing skills that can help reduces symptoms of behavior and mental health problems.
Recommendations for program design and implementation:
- Incorporate mental health outcomes and measurements into M&E plans of programs, which can help to understand the effects of gender norms and adolescent mental health on sector-specific outcomes.
- To help the international community respond more effectively to the gendered social norms that influence mental health outcomes, document what is known from existing and previous interventions through a programmatic review.
- Test and evaluate sectoral programs that have incorporated mental health and gender into interventions, in order to understand the impact of gender norms and mental health on development outcomes.