Making sense of the widening gender mental health gap: what teenage girls told us

Women experience greater low mood and anxiety than men. This longstanding gender mental health gap reflects a complicated mix of biological, psychological, social, and sociocultural factors – though we are still far from fully understanding it.

NHS data shows that young women aged 17-19 are twice as likely to have a mental health disorder as young men. Other national data shows steeper increases in symptoms of low mood and anxiety for girls.

Common explanations put forward include social media, increased sexualisation of girls and growing academic pressure. But girls themselves have rarely been asked what they think. This limits our understanding of their needs and experiences.

In a study on what girls themselves think about worsening trends in girls’ low mood and anxiety, I worked closely with two young women, Pratyasha and Jo, from start to finish. This was important to make sure we not only listened to girls, but that we also asked them the right questions in a constructive way and could better understand what they told us. We worked together throughout, to design how the research would run, to hold conversations with girls taking part and to interpret what we heard.

Our wider research team included people from many different academic and clinical backgrounds, but Pratyasha and Jo’s lived experience and hands-on input were central to every stage of the project. We spoke with 32 girls aged 16 to 18 across England, from varied ethnic and religious backgrounds, about their views on the worsening adolescent gender mental health gap.

Gender expectations

Girls described how sexist stereotypes shaped their lives from an early age. They described how they saw – and felt expected to conform to – narrow views of how girls “should” behave and present themselves. Many said they had been judged when they were seen as not conforming: they were told to smile, or mocked for liking football. They explained that these experiences shaped their lives in many ways, including normalising school-based sexual harassment and affecting their self-worth.

“People think that an insecure girl is just someone who thinks, ‘oh, my hair isn’t good enough’”, said Sunita, “but it’s so much deeper than that and I think a lot of the insecurities within girls that they just don’t feel like … a person because of how they’ve been treated.”

This echoes research showing that gender norms can be worrying and stressful for girls. This could partly explain higher rates of low mood among girls.

Girls also described considerable academic pressure: intense exams, a fear of mistakes and pressure to excel. They felt these issues could be compounded for girls, who are expected to both succeed and prove themselves. They said this can prompt feeling sad and worried, particularly as they worked towards high-stakes exams.

“In year nine I was perfectly fine,” Hannah recalled, “and then in year ten I was really sad and really depressed and I had so much anxiety because I really wanted to do well in my GCSEs”.

Evidence does suggest that academic pressure affects mental health, with some evidence of greater effects for girls. In the UK, there has been considerable concern about how education reforms in the 2010s might increase the pressure placed on young people.

Although the limited available evidence does not suggest young people are feeling more pressured than they used to, it seems that school satisfaction has dropped sharply in recent years. It’s important that we try to understand what that might mean for girls and their mental health.

Comparison, insecurities and social media

The girls reflected on social media engagement as a mixed experience with some positives. They highlighted that comparison and insecurity are normalised in social media spaces. They said that visual platforms, such as Instagram and TikTok, particularly reiterate gendered expectations for girls on how they should present themselves. They explained that while the standards set on social media about life and how one should look are unrealistic, it’s difficult to understand what is “real”.

“In your mind you’re comparing yourself without even thinking about it and that affects your mood,” reflected Kira. These insights from girls line up with growing evidence that social media’s mental health effects depend on specific experiences, not simply time spent online. Evidence also suggests that the elements of comparison involved in social media may be especially problematic for girls.

Given that girls’ mental health has been declining for several years, it is vital that we engage with and listen to their perspectives. In this project, that meant involving them directly in examining and discussing evidence, so that we can better make sense of trends in their mental health. Girls need meaningful opportunities to share their challenges and priorities on issues affecting their mental health.

For parents, teachers and others who support adolescent girls, it can mean making space for open conversation about the issues affecting them in life. The girls we spoke with repeatedly emphasised how important it is to have supportive environments where they can process and make sense of their worlds – and to be heard and advocated for.

The study was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (project reference NIHR135295). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR.