Developing and Testing a Cross-Cultural Measure of Gender Norms and Mental Health in Adolescence

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Mental health problems affect up to 20% of adolescents (ages 10-19) worldwide, and represent a leading cause of health-related disability among this age group. Adolescence also marks the emergence of persistent gender inequalities in mental health, with girls generally demonstrating more emotional and boys more behavioral symptoms. A growing body of research suggests that in addition to biology, gender norms may play a critical role in contributing to these differences by influencing both the development and expression of adolescent mental health problems. Despite such evidence, significant research gaps remain, driven in part by the lack of existing measures for investigating gendered influences on adolescent mental health across diverse sociocultural contexts. To address these gaps, the proposed R21 will use a sequential mixed methods approach to develop, refine, and validate a novel measure of gender normative perceptions regarding mental health in adolescence across three countries: Chile, the Democratic Republic of Congo, and Indonesia. The study aims will be completed by leveraging the Johns Hopkins University (JHU) investigative team’s extensive expertise in adolescent development, gender norms, mental health, mixed methods, and scale development, and by capitalizing upon longstanding collaborations through the JHU Global Early Adolescent Study (GEAS) with the University of Santiago, Kinshasa School of Public Health, and University of Gadjah Mada. In Aim 1, we will conduct focus group discussions (FGDs) with adolescents across the three study countries to explore gender normative perceptions of mental health, including the ways in which boys and girls are conditioned to express psychological distress, socially accepted coping strategies, and social sanctions related to transgressing these norms. In Aim 2, we will develop a novel measure to assess adolescents’ perceptions of gender norms regulating various dimensions of mental health, with included items drawn from (a) qualitative findings from the FGDs and (b) a review of existing gender norms scales with relevance to mental health. This measure will be refined through participatory workshops with GEAS stakeholders and cognitive testing with adolescents across the three study countries. In Aim 3, we will evaluate the reliability and validity of the novel measure through a school-based pilot survey across the three study countries, with psychometric analysis used to evaluate and finalize the included items. The proposed study aligns with NIMH’s research priority to “identify novel intervention targets based on knowledge of neurobehavioral, psychological, and contextual mechanisms and trajectories, and the optimal time points for intervention.” This work will lay a strong methodological foundation for future longitudinal efforts to uncover biopsychosocial processes driving the emergence of gender disparities in adolescent mental health across diverse sociocultural contexts, including the United States. In doing so, it will ultimately inform the development and implementation of gender- transformative interventions to improve mental health among vulnerable adolescents around the world.