Girls take action on mental health: Gender and the mental health of young Canadians

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By Lia De Pauw and Juniper Glass

From Girls Action Foundation

In June 2008, Girls Action Foundation, published The Need for a Gender-Sensitive Approach to the Mental Health of Young Canadians. The following excerpt provides a summary of the report, including recommendations.

Mental health and mental illness are leading health issues faced by Canadian youth. Yet, the child and youth mental health system is fragmented and under-funded, leading to the dubious distinction of “the orphan of the orphan” of the Canadian health care system. Efforts to address these shortcomings need to go beyond enhancing early intervention and treatment to also focus upstream to understand and address the factors that affect young people’s mental health.

The Need for a Gender Sensitive Approach to the Mental Health of Young Canadians is intended to help inform and increase the effectiveness of policies, programs and services to promote mental health and prevent mental illness among young people. The report seeks to illustrate the need to take gender and other intersecting forms of diversity into account to truly meet the needs of Canada’s young people by examining how mental health outcomes are affected by social and economic characteristics. Recommendations, promising practices, and gaps in the evidence base are also identified.

The report presents current evidence on mental health outcomes among young Canadians aged 10 to 24 as well as some of the pathways that contribute to inequities in these outcomes. Evidence was collected from peer-reviewed and grey literature examining mental health and mental illness among young people, published between 2000 and 2008. In some cases, evidence from prior to 2000 was included and research on young people from the United States was used where sufficient Canadian evidence was not available.

Does gender matter in youth mental health?

A Snapshot: Gender differences in mental health and mental illness among Canadian young people

Data collected through national and provincial surveys provide a snapshot of mental health among Canadian young people.

Mental Health

  • Young women are more likely to report feeling constantly stressed than young men
  • (44.0% vs. 28.7%)
  • Aboriginal girls are more likely to feel seriously distressed than the general population of girls in BC (14% vs. 10%); among Aboriginal youth, more females experience severe distress compared to males (14% vs. 5%).
  • As girls grow older, they experience a steady decline in their confidence that is not seen in their male counterparts. In 2002, 4.7% of Grade-6 girls reported not feeling confident compared to 17.5% of Grade 10 girls.

Mental Illness

  • Higher rates of depression are consistently documented among adolescent girls and women than their male counterparts. The female-to-male incidence of depression averages 2 to 1.
  • Young women are more likely to report having thought about (18.6% vs. 12.1%) and attempted (5.9% vs. 2.2%) suicide than their male counterparts. Girls 10 to 14 years are 5 times as likely to be hospitalized as their male counterparts. The mortality rate due to suicide for young men, however, is 2.8 times higher than young women.
  • Young men are half as likely to be hospitalized for problems related to mental health or substance abuse than young women (1.9% vs. 4.1%).
  • Young women aged 15 to 24 are more likely to report an unmet service need related to their mental health or substance use than young men (27.6% vs. 17.5%).

It is clear that differences exist between male and female youth on many indicators of mental health and mental illness. Generally, the data reveal that girls and young women are more likely to ‘act-in’ or internalize mental health issues and mental illnesses, while boys and young men are more likely to ‘act-out’ or externalize mental health issues. shot of metal ealth amon

Lifetime Prevalence of Selected Mental Illnesses among Youth 15 to 24 (2002 Canadian Community Health Survey)

Mental Illness                                                   Female                               Male

Depression                                                        13.9%                              6.6%

Anxiety disorder                                                 14.7%                              9.6%

Eating disorder                                                   1.5%                                N/a

Proportion of population meeting criteria for           5.5%                              11.6%

alcohol or illicit drug use during lifetime

 

Prevalence of Selected Externalized Indicators of Mental Health among Ontario Students (2005 Ontario Student Drug Use and Health Survey)

Indicator                                                         Female                              Male

Delinquent behaviour                                        10%                                 16%

Violent behaviour                                              7%                                  16%

Bullying                                                           25%                                 29%

Gambling problem                                             2%                                   7%

Gender also intersects with other key factors. While most surveys do not provide data disaggregated by ethno-racial groups or newcomer status, available data suggest that there are differences in mental health and mental illness outcomes based on these factors. Findings from BC, for example, indicate that Aboriginal youth experience poorer mental health and mental illness compared to their non-Aboriginal counterparts. American studies suggest that this may also be true of other racialized young people: depression, for example, is more common in both male and female racialized youth than their white counterparts.

‘Racialization’ is defined as the complex processes through which ethno-racial groups are seen as different and treated unequally, resulting in social, economic, and political inequities; “racialized” refers to groups subjected to these processes (Access Alliance, 2007).

The evidence raises important questions, including why are there differences in these indicators between groups of young people, what do these differences indicate, and are the causes behind these differences problematic. Answers to such questions were sought through available qualitative research studies and inequality theory.

Why do mental health differences exist between different groups of boys and girls?

Understanding how the intersections of gender, poverty, racialization, Aboriginal status and other factors affect youth mental health. There is great diversity among Canadian children and youth, including differences due to gender, ethno-racial background, Aboriginal status, poverty, ability, newcomer status, and sexual orientation. These characteristics are valued and responded to differently by Canadian society, contributing to inequalities in young people’s exposure to risk and protective factors, health outcomes, and their access to health services.

Gender socialization has a particularly important impact in a young person’s life and their mental health. Every day, young people encounter messages about the roles, attributes, identities, and expectations considered appropriate for people of their sex, through media images; treatment by educational, health, immigration and other institutions and systems; interactions with parents, teachers, and other adults; and peer relationships.

This creates pressures that can lead to negative impacts on the mental health of girls and, as is increasingly recognized in the research, the mental health of boys. The evidence also suggests that male and female youths are taught to cope with life’s challenges in different ways, often resulting in the internalization of problems among girls and the externalization of problems among boys.

Gender intersects with other socio-economic factors influencing mental health, such as ethno-racial background, Aboriginal status, poverty, (dis)ability, newcomer status, and sexual orientation. Aboriginal youth, for example, face many social, political, and economic inequities related to a history of cultural oppression, including poverty, racism, inter-generational effects of residential schools, and lack of access to health, social, and educational programs.

These conditions heighten the likelihood that Aboriginal young people will encounter a wide range of risk factors that affect their mental health. As a result of the concentration of poverty and income insecurity in racialized communities, racialized youth are more likely to grow up in environments with more risk factors and fewer protective factors. Social biases that privilege whiteness and white culture also affect the mental health of young people from racialized communities. While all young people struggle to develop a sense of self, racialized youth “face added challenges, such as being labelled ‘other,’ ‘dissimilar,’ and ‘foreign’”.

In addition to often experiencing racialization, newcomer youth face additional stresses related to settlement and cultural adaptation processes. Refugee youth may also be coping with trauma related to having lived in war-torn countries and entering a formal school system for the first time or after a long break.

Conclusions and recommendations

Available research suggests that there are marked differences in mental health outcomes between female and male youth, and that these differences are related to inequalities and inequities in the lives of young Canadians, as a result of gender and several intersecting social and economic attributes. There is a need for a gender- and diversity-sensitive approach to designing policies, programs and services to promote mental health and prevent mental illness among young people. The following recommendations emerged from the review of available evidence.

1. Develop and coordinate policy frameworks to promote mental health and prevent mental illness among children and young people

According to the World Health Organization (2005), policy and legislation are important for children and young people’s mental health. Such a framework should take a public health approach. This would involve broadening the current emphasis on treatment to focus more heavily upstream on the promotion and prevention by supporting healthy development among all young people and targeting of resources and services towards vulnerable young people.

2. Base the policies, programs, and services of the youth mental health systems on an analysis of gender and other forms of diversity

The effectiveness of the mental health system and policy frameworks is contingent on their ability to be responsive to gender differences and other forms of diversity and inequalities within Canada’s child and youth population. A thorough gender-based analysis (GBA) involves identifying and understanding differences in health outcomes, pathways, and access to services related to gender and the intersecting factors of socioeconomic status, ethno-racial background, Aboriginal status and other inequalities.

3. Enhance the evidence base to increase understanding of the influence of gender and other forms of diversity on young people’s mental health

The availability and quality of evidence impacts the effectiveness and efficiency of efforts to promote mental health and prevent mental illness among children and youth. There is a need to enhance the Canadian evidence base on health outcomes, health inequities among groups of youth and the pathways that contribute to these differences, and the effectiveness of mental health policy frameworks, programs, and services.

4. Invest in gender-specific, diversity-sensitive programs that promote youth mental health and empowerment at the community level

More and better programs are required to promote young people’s mental health. The evidence from both the health promotion and youth development fields suggest that the young people’s active and meaningful engagement in their community has positive impacts on their health and development. Community participation and taking action on issues that impact their lives contributes to young people’s empowerment, which is critical for mental health.

To address challenges to girls’ health and development, some youth-serving organizations have developed all-girl programs that enhance empowerment through community action. These programs typically include activities that build the capacity of female youth by enhancing their knowledge, critical-thinking, and skills; safer spaces in which girls can acknowledge their experiences and find out they are not alone; interaction with supportive role models; and learning and empowerment through community action. There is potential that such program elements could be transferred to programs seeking to enhance the mental health of other groups of young people, such as newcomer youth and male youth.

It is recommended that multi-year pilot projects be supported that use an approach informed by gender and diversity analysis to empower young people and increase their resilience. Adequate resources are required for testing, evaluation and knowledge transfer to ensure that successful programs can be initiated in other communities across Canada.

5. Create supportive environments

Interventions are also required at the community-level to create environments that support young people’s development and mental health, such as ensuring availability and access to health promoting social and material resources. Universal and targeted programs are required to bolster protective factors and reduce risk factors in key social environments—namely the family, school, and community. This includes reducing poverty and violence, enhancing student readiness and engagement, and providing a wide range of accessible extracurricular activities and non-formal learning opportunities.

This article was adapted from the Executive Summary of The Need for a Gender-Sensitive Approach to the Mental Health of Young Canadians published by Girls Action Foundation in June 2008.

Juniper Glass is a Montreal writer, mother, and the Development Director of Girls Action Foundation. Lia De Pauw, MHSc, consults on youth health promotion in Canada and globally. She works with young people to understand and take action on the broad social, economic, political, and historic factors that influence their lives and health.

For a copy of the full report, including references, visit:

Girls Action Foundation website: www.powercampnational.ca/en