Gender Differences in Mental Health: Prevalence and Development among Young Adults in Kenya, Namibia and South Africa

This study aims to investigate how mental health problems vary among young adults of different gender in Sub-Saharan Africa over time. It does so by examining data from young adults in three different African contexts, namely Kenya, Namibia and South Africa. The longitudinal data of our study allows us to analyse gender differences in mental health symptoms at several time points, and also variations in the trajectories of mental health over time. Study Rationale One out of five adolescents and young adults are estimated to suffer from mental health problems in Sub-Saharan Africa (Hunduma et al., 2021). Among these, women are disproportionately affected, reflecting the global tendency for women to suffer a higher burden of mental health problems, especially depression and anxiety, across almost all age groups (Baxter et al., 2013; Copeland et al., 2014; Jorns-Presentati et al., 2021; Meyer et al., 2019; Moultrie & Kleintjes, 2006; Perestrelo et al., 2023; Platt et al., 2021; Tomlinson et al., 2007; World Health Organization, 2000). Young men, however, have an increased risk of developing substance-use disorders and other externalizing disorders, such as ADHD, conduct disorders and intermittent explosive disorders, across world regions (Meyer et al., 2019; Moultrie & Kleintjes, 2006; Norona et al., 2015; Seedat et al., 2009). From the sparse literature that covers the Sub-Saharan population, there exists inconclusive prior evidence whether gender differences exist with regards to post-traumatic stress disorders (Ng et al., 2020). Gender differences in cultural concepts of distress particular to Sub Saharan Africa like “thinking too much” (kufungisisa) or suffering from bewitchment (amafufunyana) have not yet been described (Tomlinson et al., 2007). Biological, social and cultural factors have been discussed as causal factors for these differences. For example, the hormone testosterone, which rises drastically during puberty in boys and has a higher concentration in males from this stage onwards, may have a protective effect against the development of depressive symptoms (John et al., 2023; Schubert et al., 2017). Mental health is also strongly socially determined: The conceptual framework of Social Determinants of Mental Health established causal factors including poverty, violence or lack of education (Lund et al., 2018; Moultrie & Kleintjes, 2006; Perestrelo et al., 2023). Women are disproportionately affected by these factors, or their mental health is more heavily impaired through them (John et al., 2023; Lund et al., 2018; Moultrie & Kleintjes, 2006; Perestrelo et al., 2023; Tjimuine, 2023; Tomlinson et al., 2007; Too et al., 2021). The Gender Inequality Index, a measure of gender disparities in health, empowerment and the labour market, quantifies these inequalities. It indicates that the Sub-Saharan nations have the highest gender disparity in comparison to other world regions (United Nations Development Programme, 2024). According to the gender role hypothesis, the higher prevalence of mental disorders in women is directly attributed to these inequalities, and gender differences in mental disorders will narrow as the status of women becomes more equal to men’s. Cautious support for this hypothesis has been found regarding major depressive disorder and substance abuse disorder in 15 countries including South Africa (Seedat et al., 2009). As we have seen, there exist gender differences in the time-point prevalence of mental health problems. But do mental health problems also develop differently over time between women and men? While studies in Germany or Iceland found no gender difference in mental health’s developmental trajectories (Gestsdottir et al., 2015; Ravens-Sieberer et al., 2015) other findings in Western samples indicate that gender differences depend on disorder: A meta-regression analysis and a systematic review on Western samples show that girls experience a more pronounced increase in depressive symptoms than boys during adolescence (13-17 years) and a sharper decrease in symptoms thereafter. This implies a reduction in the depression gap during young adulthood (Platt et al., 2021; Schubert et al., 2017). Regarding anxiety disorders only tentative statements are possible: In a single US-based study, females between the age of 19 and 26 show a sharper increase in anxiety disorders than males (Copeland et al., 2014). Finally, a study examining a US sample in the age range of 15-26 years found that the odds to abuse substances increase with age for males compared to females (Needham, 2007). These studies however only represent findings from a Western context. Research conducted in other cultural settings is sparse, especially in Sub-Saharan Africa. Mental health problems in Sub-Saharan Africa are expected to increase in the upcoming decades further exacerbating the treatment gap resulting from poorly resourced mental health services (Charlson et al., 2014; Dzinamarira et al., 2024). Ensuring efficient treatment interventions is therefore paramount, especially for young adults who are particularly vulnerable to mental health problems (Skehan & Davis, 2017). Only by learning more about the development of mental health in young adults it is possible to design efficient mental health interventions tailored to the individual’s needs.