The Hidden Woes: Exploring Gender Disparities in Teen Depression

Abstract

Adolescence is a critical developmental stage associated with an increased susceptibility to depression, with notable gender disparities in its prevalence. This paper explores the multifaceted effects of biological, psychological, sociocultural, and media factors on adolescent depression, with a primary focus on gender differences. Biological determinants include variations in brain development and serotonin regulation. Psychological determinants encompass gender differences in experiencing and expressing depressed mood, with females typically bearing a heavier psychological burden. Sociocultural factors involve differences in social status and associated stressors, while the pervasive impact of social media exacerbates anxiety, especially among adolescent females. Our exploratory  survey of fifteen male and fifteen female high school students in China provides in-depth qualitative insights into gender-specific vulnerabilities to depression. Despite the small sample size, which reflects practical constraints and a focus on qualitative data, this study contributes to a deeper understanding of gender-specific differences in adolescent depression. It emphasises the need for multifaceted interventions.

Keywords: Gender Differences, Depression, Biology, Adverse Effects of Social Media

Introduction

In 2017, 13% of U.S. teens aged 12 to 17 (or 3.2 million) said they had experienced at least one major depressive episode in the past year, up from 8% (or 2 million) in 2007, according to a Pew Research Center analysis of data from the 2017 National Survey on Drug Use and Health. One in five teenage girls – or nearly 2.4 million – had experienced at least one major depressive episode (the proxy measure of depression used in this analysis) over the past year in 2017. By comparison, 7% of teenage boys (or 845,000) had at least one major depressive episode in the past 12 months.¹.

In a world where the facade of social media filters our reality and societal expectations dictate our every move, the struggles faced by teenagers often remain concealed beneath a carefully curated surface. Behind the smiles in Instagram photos and the laughter shared with friends lies a hidden world of adolescent woes, where the pressures of academic success, social acceptance, and self-discovery collide with the complexities of mental health. But what happens when we peel back the layers of this facade? What truths do we uncover when we dare to look beyond the surface? Adolescent depression is a growing concern globally, with research indicating a higher prevalence among females compared to males. While existing literature offers insights into the causes of adolescent depression and the gender disparity therein, there remains a paucity of studies focusing on the specific factors contributing to this gender imbalance among adolescents aged 12-18.

The findings suggest that the frequency of social media use may contribute to variations in the prevalence of depression between males and females, mediated by differences in glandular hormones, diverse manifestations of depression in adolescents, and their respective social statuses. Through this research, I seek to provide a deeper understanding of the complexities surrounding adolescent depression and the gender-specific factors shaping its occurrence and treatment outcomes. According to the National Insititute of Mental Health, depression (also known as major depression, major depressive disorder, or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working. Depressive disorder is a significant mental health condition that affects individuals globally. This disorder can have adverse effects on a person’s emotions, cognitive abilities, and actions³

 Historical records have shown that depression dates back to the time of Hippocrates. However, it was only in 1854 that French psychiatrists Falret and Baillarger independently and definitively described the condition⁴.

The manifestation of depressive symptoms encompasses comprising alterations in sleep patterns, namely insomnia or hypersomnia, fluctuations in appetite, diminished concentration, ambivalence, fatigue, psychomotor retardation, restlessness, sensations of inadequacy, maladaptive guilt, and recurring contemplations of mortality or self-harm⁵. Nevertheless, within the adolescent demographic, accounts frequently highlight variations in sleep, vitality, and dietary habits as integral components during the diagnostic assessment of depressive states⁶. It is noteworthy that gender disparities in clinical depression become apparent during adolescence, with the divide becoming more pronounced between the ages of 13 and 18⁷. Adolescence sees a notable discrepancy in depression prevalence between genders, with nearly double the incidence among females compared to males (16.8% vs. 8.5%, respectively)⁵. Furthermore, women exhibit elevated levels of depressive symptoms relative to men⁸. During this developmental stage, there exists a distinct contrast in the manifestation of depressive symptoms between males and females. Male adolescents commonly display symptoms such as anger outbursts, aggression, substance misuse, and engagement in risky behaviours as indicators of depression⁹.

Conversely, depressed females frequently exhibit disturbances in appetite, disrupted sleep patterns, and heightened severity of depressed mood compared to their male counterparts¹⁰. Notably, certain depressive symptoms demonstrate differential item functioning (DIF) between genders at ages 13 and 17. At 13 years, boys tend to score lower on items related to sadness and crying while scoring higher on items related to feelings of punishment and loss of interest in sex, compared to equivalently depressed girls.

Similarly, at 17 years, boys exhibit lower scores on items such as sadness, crying, self-dislike, and fatigue, contributing to a diminished disparity between genders in depression prevalence at this age¹¹.

The paper utilizes mixed-methods research, combining an extensive literature review relevant to to the topic with a questionnaire survey of a sample of 30 adolescents to arrive at the final conclusions. This study uses a literature review to explore the differences between male and female adolescents from 12-18 years old and to search how the biological, psychological, social culture and social media result in the difference. This discrepancy arises from a variety of factors, including biological parameters, psychological determinants, societal dynamics, and the multifaceted influences of media exposure, with particular emphasis on the impact of visual media on the aetiology and manifestation of depression. Moreover, the questionnaire also proved that biological, psychological, and social factors as well as social media do have an impact on the differences in the amount of depression in adolescent boys and girls. The results of questionnaire show that all of these factors contribute to some degree to the difference in depression between men and women and that women are twice as likely to be depressed as men and adolescents attribute their depression more frequently to depressive emotions. The small sample size was chosen to allow for a detailed, qualitative exploration of individual experiences, which can provide rich, in-depth insights that larger quantitative studies might overlook. Furthermore, the limited number of participants reflects practical constraints and the exploratory nature of this study, serving as a preliminary investigation into a complex issue. Despite the small sample size, the findings offer valuable perspectives on the frequency of social media use and its contribution to variations in the prevalence of depression between males and females, mediated by differences in glandular hormones, diverse manifestations of depression, and respective social statuses.

This study acknowledges the limitations associated with self-reported data, such as social desirability bias and the absence of objective measures like hormonal levels or brain imaging due to practical and ethical constraints. However, the use of validated psychological tools and comparisons with existing literature provide a robust foundation for understanding the complexities of adolescent depression and the gender-specific factors influencing its occurrence and treatment outcomes.

Literature Review

Biological Factors

The development of the brain throughout various life stages plays a crucial role in shaping an individual’s cognitive and emotional functioning. Understanding how the brain evolves over time is of significant importance. During adolescence, the brain undergoes significant changes, especially in areas associated with emotion regulation and decision-making, such as the prefrontal cortex. Interestingly, a recent meta-analysis showed that depressive disorders are 2–3 times more common in women than men, while no differences are reported among the age groups¹². The different changes in brain function in male and female can cause them to process emotions differently, which can lead to depression. Whole-brain volumes and volumes of the amygdala and cerebellum are commonly reported to be larger in males while exhibiting a high density of sex steroid receptors¹³. In fMRI studies, greater regional homogeneity (ReHo) in female orbitofrontal areas has been reported, which may be responsible for females’ higher emotion perception ability¹⁴. Reduced cortical thickness in the orbitofrontal cortex (OFC) is one of the most frequently documented brain structure correlate of depression¹⁵. By assessing cortical thickness in adolescents, further studies have reported gender differences in neuroimaging findings in depression. For example, a study examined OFC thickness in adolescents with depression and observed an inverse correlation between depressive symptoms and the left lateral OFC in males and a positive one between depressive symptoms and left medial OFC in females¹⁶.  It means that girls in adolescence more likely got depression than boys.

Major Depression Disorder manifests similarly in both adolescents and adults¹⁷. Sexual dimorphisms within the serotonin system have been known for the past four decades. Males and females exhibit different rates of serotonin synthesis¹⁸. As early as 1970, it was shown that central serotonin levels, as well as cerebrospinal fluid (CSF) concentrations of the serotonin metabolite 5-hydroxyindole-3-acetic acid (5-HIAA), were higher in female than male rats. Consistent with animal studies, in humans, the mean rate of serotonin synthesis in males has been estimated to be 52% higher than in females¹⁸. Furthermore, acute tryptophan depletion, which induces lower mood in recovered depressed patients by temporarily decreasing serotonin levels, leads to larger mood-lowering effects in women than in men¹⁹. It means that female more likely got depression.

Psychological Factors

Females are more inclined to share their experiences, while some male may conceal their depressive symptoms. The loss of efficiency of positive reinforcements would enhance the degree of depression²⁰. For instance, a child with depression initially receives a lot of attention from his social environment (family, friends…), with the unintended consequence of reinforcing behaviours such as crying, complaints or expressions of guilt. When these depressive behaviours increase in frequency, the people who used to accompany the child avoid being with him, which contributes to aggravating his depression²¹.

Even if both males and females face the same risk of depression due to experiences of defeat, humiliation and entrapment²².?in stress coping and/or coping techniques, gender-specific expectations and differences in social cognitive function, females presenting a greater sensitivity to rejection²³. Therefore, women are more prone to negative emotions when they are rejected.

Cultural Factors

In different countries, different social cultures engender different impacts on depression. By 2021, 20% of the 12-17-year-old American youth population will have experienced MDE at least once in the past year. A recent systematic review reported high rates of depression (26.9%) and anxiety (29.8%) among the general population of adolescents in sub-Saharan Africa²⁴. It can be seen that the relative unfairness of social status can affect mental health because the middle class in the United States has a larger population than the middle class in India and a lower concentration of class differentiation than in Indian society. Additionally, girls are more susceptible to sexual harassment than boys,²⁵., which is also the reason why the proportion of depression in women is higher than that in men due to social factors today. When women’s intimate relationships are damaged, such as fights between families, they will be more likely to suffer from it. If women want to achieve the same status of success as men, they need to maintain a wider social circle²⁶. This proves that women’s ability to handle relationships interpersonally and emotionally is extremely important and therefore they are more likely to be affected by emotion. In the case of adolescents between the ages of 15-18, girls are more likely to be influenced by friendships, romantic relationships, and the harmony of their family environment. In social relationships, the most important relationship for teenagers is the parent-child relationship, and the quality of parent-child relationships largely determines their behaviour. Parental depression negatively influences a young person’ s response to treatment for anxiety and depression²⁷.

In today’s society, no one can live without the internet, but for teenagers, especially those in middle school, the internet is more for socialising and entertainment. However, the internet provides a connection between people but also brings anxiety. In several large studies, heavy users of such technologies are more likely to be depressed²⁸ Stronger associations between digital media time and mental health indicators have been shown in girls compared with boys, perhaps because social media, used more frequently by girls, is more strongly linked to depression than gaming, used more frequently by boys. It is because the nature of social media – idealised images of peers, quantifiable feedback (e.g., number of likes, comments, etc.) – exacerbates girls’ anxiety about their looks and body image, which can lead to eating disorders that can have physical as well as mental health consequences for girls. Highly visual SM—such as Instagram, Snapchat, Tumblr, TikTok, and Facebook—are especially common among adolescent girls²⁹. Adolescents view highly edited images of peers, celebrities, and “influencers.” These images and videos often include thin and toned women, promoting exercise and healthy eating³⁰., or ultra-thin, sexually suggestive images of women encouraging weight loss³¹. It will cause them to be more critical of their physical appearance. A key theory for understanding body dissatisfaction is objectification theory, which proposes that in a culture that sexually objectifies women’s bodies, girls and women learn to adopt an observer’s perspective of their bodies and to habitually monitor their bodies—i.e., to engage in self-objectification³². Multiple longitudinal studies find support for self-objectification as a prospective predictor of adolescent girls’ depressive symptoms and disordered eating³⁰.

Quantifiable standards can also increase girls’ anxiety. Many adolescents interpret “likes” as indicators of attractiveness³³. Appearance-focused comments, “likes,” and other quantifiable metrics may reinforce cultural norms regarding the importance of beauty. In a recent experimental study, U.S. adolescents who received fewer “likes” reported more negative affect and negative thoughts about themselves, and those who experienced more negative reactions in the experiment reported greater depressive symptoms over time³⁴.

Methodology

Study Design

This study employs a mixed-methods approach, integrating both qualitative and quantitative research methods to comprehensively explore gender-specific experiences of depression among adolescents. The mixed-methods design facilitates a thorough understanding of the multifaceted factors influencing adolescent depression by combining findings from a detailed literature review with primary data collected through interviews. Adhering to ethical research practices, the study prioritized minimizing harm to participants by excluding potentially distressing questions. Given that the research was conducted in a high school setting without immediate mental health support, it was deemed inappropriate to include questions about suicidal ideation.

Participants and their parents were fully informed about the study’s nature, and consent was obtained with assurances that sensitive questions would be excluded. While these modifications deviate from the standard Beck Depression Inventory-II (BDI-II), they were crucial for conducting the research ethically. The adapted and retained questions provided valuable data on depressive symptoms, ensuring the study’s validity and relevance while prioritizing the safety and well-being of the participants.

Participants

In this study, we conducted interviews with a sample of thirty high school students, comprising fifteen boys and fifteen girls, to explore gender-specific experiences of depression. The participants were selected from a single high school in China, ensuring that they were within the age range of 12-18 years.

The following table provides a summary of the demographic details of the participants:

Participants ID	Gender	Age	Grade	Ethnic Background
1	Male	18	11	Han Chinese
2	Male	15	10	Han Chinese
3	Male	17	11	Canadian
4	Male	17	11	Han Chinese
5	Male	15	10	Han Chinese
6	Male	15	10	Han Chinese
7	Male	16	10	Han Chinese
8	Male	17	11	American
9	Male	14	9	Han Chinese
10	Male	15	9	Han Chinese
11	Male	15	10	Han Chinese
12	Male	16	10	Han Chinese
13	Male	17	11	Han Chinese
14	Male	17	11	American
15	Male	18	12	Indian
16	Female	15	10	Han Chinese
17	Female	15	9	Han Chinese
18	Female	16	10	Han Chinese
19	Female	16	9	Han Chinese
20	Female	17	11	Han Chinese
21	Female	17	11	Han Chinese
22	Female	17	11	Han Chinese
23	Female	16	10	American
24	Female	17	11	Han Chinese
25	Female	16	10	Han Chinese
26	Female	15	9	Han Chinese
27	Female	18	12	Han Chinese
28	Female	18	12	Han Chinese
29	Female	13	8	Han Chinese
30	Female	15	9	Han Chinese

Interview

The empirical data gathered from research interviews conducted at an international high school in China offer insights into gender-specific manifestations of depressive emotions. Thirty participants, comprising 15 boys and 15 girls, were interviewed, with the interview questions derived in part from the Beck Depression Inventory-II (BDI-II). Notably, questions deemed excessively biased, particularly those about extreme suicidal ideation, were excluded from the inquiry process to ensure impartiality.

Nonetheless, the resulting data substantiates discernible gender differentials in experiences of depressive affect. Analysis of responses to inquiries regarding crying behaviour amidst depression reveals a marked contrast between male and female participants. The majority of boys reported a tendency to refrain from crying when experiencing depressive states, while most girls acknowledged either occasional or frequent bouts of tearfulness. Additionally, responses from male participants often indicated infrequent experiences of depression. In contrast, female participants expressed varied sentiments, including cyclic patterns of depressive episodes, attributions to academic and relational stressors, and coping mechanisms involving physical activities or musical engagement. Nonetheless, a consistent theme across both genders pertained to heightened anxiety levels attributed to academic pressures, a sentiment echoed by nearly all participants. This underscores the salience of academic stressors as a significant contributor to adolescent depressive vulnerability, irrespective of gender.

Furthermore, an examination of participants’ leisure activities revealed a predominant reliance on social media platforms for relaxation, reflecting contemporary digital trends among adolescents. Engagements with platforms such as Instagram and WeChat were recurrently cited, offering avenues for social connection, entertainment, and self-expression. However, amidst the apparent benefits of digital connectivity, discussions during interviews unearthed a notable downside: the potential exacerbation of anxiety stemming from comparison and self-evaluation prompted by curated online personas. Particularly among female respondents, narratives unfolded detailing feelings of inadequacy induced by the meticulously crafted images and lifestyles showcased on social media. These sentiments manifested in heightened levels of stress regarding appearance, social status, and academic performance, imparting a profound impact on overall well-being. Such findings underscore the nuanced dynamics at play within the digital landscape, highlighting the imperative for comprehensive understanding and management of the psychological ramifications associated with social media engagement among adolescents.

Moreover, the pervasiveness of social media usage among adolescents has precipitated a reevaluation of its impact on mental health, particularly concerning anxiety levels. Notably, discussions during interviews revealed a discernible correlation between prolonged social media exposure and heightened feelings of apprehension and self-doubt, with female participants disproportionately affected. Instances of comparison with peers’ curated online personas and the relentless pursuit of unattainable beauty standards emerged as recurrent themes, contributing to an exacerbation of anxiety symptoms. These revelations underscore the importance of fostering digital literacy and promoting healthy online behaviours among adolescents to mitigate the adverse effects of social media on psychological well-being. Additionally, interventions aimed at cultivating

Cultivating resilience and self-esteem are warranted to equip adolescents with the necessary tools to navigate the digital landscape effectively while safeguarding their mental health.

The patient is first assessed for the degree of depression as well as suicide risk to ensure a safer and more efficient treatment approach. Treatment modalities include lifestyle management, psychotherapy and medication. Lifestyle management entails controlling the patient’s diet so that he or she eats a balanced and regular diet. Observational studies have shown an association between unhealthy eating patterns and more severe depressive symptoms.³⁵ A randomised controlled trial (RCT) of a dietary intervention for adults with major depressive disorder showed that diets lower in sugary beverages, processed foods, and meats and higher in vegetables, fruits, and legumes were associated with lower depressive symptoms. Life modification also involves controlling the patient’s sleep schedule to ensure that it is regular and adequate. Increased exercise is also an essential part of the program, and regular moderate to vigorous physical activity can improve mood in adolescents.³⁶. Some studies suggest that even short periods of exercise may be effective. The potential benefits of physical activity as a stand-alone intervention are greater when the severity of depressive symptoms is mild to moderate.

Psychotherapy includes behavioural activation, cognitive behavioural therapy, and interpersonal psychotherapy. Pharmacotherapy is used when lifestyle management as well as psychotherapy, is not effective. Pharmacotherapy includes fluoxetine, and for adolescents with depression, only fluoxetine plus CBT or fluoxetine alone is more effective than placebo and other interventions³⁷. Other selective serotonin reuptake inhibitor (SSRI) randomised controlled trials showed similar efficacy to fluoxetine but different response rates to placebo, suggesting that the identification of fluoxetine as the only effective SSRI may be the result of different study designs in SSRI trials.³⁸.

According to the American Psychological Association, Society of Clinical Psychology (APA 2017 ), treatments that have modest research support and can be used in children are listed below:

Rational Emotive Behavior Therapy. This short-term, present-focused therapy works to change the thinking that leads to emotional and behavioral problems using positive guidance, philosophy, and empirical intervention models. Using the ABC model (A: the event observed by the individual; B: the individual’s interpretation of the observed event; C: the emotional consequences of the interpretation), the goal is to cognitively restructure erroneous thoughts so as to replace them with more rational ones. The most commonly used techniques are cognitive, behavioral and affective.

Self-Systemic Therapy. Depression occurs as a result of an individual’s chronic failure to achieve set goals. During treatment, the patient reviews his or her situation, analyzes his or her beliefs, and, based on the results, changes his or her regulation and moves toward a new vision of self. Treatment usually consists of 20 to 25 sessions.

Short-term psychodynamic therapy. This therapy aims to help the patient understand how past experiences affect current functioning and to analyse the expression of feelings and emotions. The therapy focuses on healing relationships, promoting insight, avoiding uncomfortable topics, and identifying core conflicting relationship themes. It is often combined with medication to relieve depressive episodes.

Emotionally Focused Therapy (Emotion Regulation Therapy or Greenberg Experiential Therapy). According to Greenberg, this therapy combines elements of client-based practice, Gestalt therapy, affect theory and dialectical constructivist metatheory. The aim is to create a safe environment that reduces the individual’s anxiety, thereby enabling them to face difficult emotions, increase their awareness of said emotions, explore their emotional experiences more deeply and identify maladaptive emotional responses. The therapy is delivered in 8 to 20 sessions.

Acceptance and Commitment Therapy. This theory has become increasingly popular in recent years and is the contextual or third-generation therapy supported by the largest body of empirical evidence. It is based on the recognition of the importance of human language in experience and behaviour. It aims to change an individual’s relationship with depression and their own feared or avoided thoughts, feelings, memories, and bodily sensations. Strategies are used to teach patients to reduce avoidance and negative cognitions and to increase attention to the present moment. The goal is not to modify the content of the patient’s thoughts but rather to teach them how to change the way they analyse their thoughts because, paradoxically, any attempt to correct them may only reinforce them.

Conclusion

This study has illuminated the multifaceted nature of adolescent depression, with a particular focus on the differing experiences and influences between genders. The data and literature reviewed suggest a significant gender disparity in the prevalence and manifestation of depressive symptoms among adolescents, which can be attributed to a complex array of biological, psychological, social, and digital media factors. Biologically, gender differences in brain development and neurotransmitter dynamics, particularly involving serotonin and sex hormones, appear to influence emotional processing and vulnerability to depression. Psychologically, the study has highlighted that societal expectations and coping mechanisms differ significantly between genders, with females often facing greater emotional distress and males possibly underreporting symptoms due to cultural norms.

Culturally, the impact of societal structure and expectations plays a crucial role in shaping the mental health outcomes of adolescents, with females often experiencing higher stress levels due to social and sexual dynamics. The influence of social media emerged as a particularly potent factor, exacerbating feelings of inadequacy and anxiety, especially among female adolescents, who are more frequently exposed to and affected by idealized images of peers and celebrities. The interviews conducted provided real-life insights into how these factors are perceived and experienced by adolescents themselves, underscoring the significant role of academic pressures and social media in shaping their mental health landscape. The findings from this study suggest the need for targeted intervention strategies that address the specific needs and challenges faced by each gender. These interventions should involve tailored psychological therapies and lifestyle adjustments and education about and regulation of social media use to mitigate its negative impacts.

In conclusion, addressing adolescent depression effectively requires a comprehensive understanding that incorporates the multifaceted influences on mental health. Interventions should be designed to support both males and females in navigating the challenges posed by societal expectations, academic pressures, and the pervasive effects of digital media. Future research should delve into the development of gender educational curricula and digital media literacy programs, while policy interventions should consider the implementation of comprehensive mental health policies in schools and the regulation of social media platforms to promote healthier online environments for adolescents.

Limitations

The use of a relatively small sample of thirty participants (fifteen boys and fifteen girls) limits the generalizability of the findings. This limited number of participants reflects practical constraints and the exploratory nature of this study, aimed at providing in-depth qualitative insights. Future research with larger and more diverse samples is necessary to confirm and expand upon these results.

Additionally, if all participants were from a similar demographic or cultural background, the results might not reflect the experiences of adolescents in different socio-economic or cultural settings. Future studies should aim to include a more diverse range of participants to enhance the applicability of the findings across various contexts.

The reliance on self-reported measures, such as responses to the Beck Depression Inventory-II and interviews, can introduce bias. Participants might underreport or overreport symptoms due to social desirability bias or misunderstanding of the questions.

As the study seems to be cross-sectional, it captures only a snapshot in time. This design limits the ability to infer causality between observed factors and depression. Longitudinal studies would be more effective in observing how depressive symptoms and related factors evolve over time.

The absence of objective measures (like hormonal levels, brain imaging data) to complement self-reported and interview data means that the biological discussions are based more on existing literature than on new empirical data specific to the sample.

The presence of interviewer bias can affect the responses of participants, especially in sensitive topics like mental health. The way questions are framed or the interviewer’s reactions can influence how participants respond.

While the study explores the impact of social media, it may not fully account for all aspects of digital media influences, such as different types of social platforms or the content type (positive vs. negative exposure). The study might also benefit from distinguishing between passive and active social media use.

The study focuses on gender in a binary way (male vs. female), which may not capture the experiences of non-binary or transgender adolescents whose experiences with depression may differ significantly.

To address these limitations, future research should employ larger and more diverse samples to enhance the representativeness of the findings, utilize a longitudinal design to observe changes over time and infer causality, combine self-reported data with objective biological measures for a more robust analysis, implement standardized interviewing techniques to minimize interviewer bias, and broaden the scope of digital media examination to include a wider range of platforms and interactions. By taking these steps, future research can provide a more accurate, comprehensive, and nuanced understanding of adolescent depression and its multifaceted influences.

Acknowldegements

Thank you for Dr. Meghna Middha’s guidance in the development of this research paper.

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