Mental health and social relationships

The strength of one’s social relationships and one’s mental health are strongly related [14–21]. Mental health underpins “our individual and collective abilities to…build relationships” [14], and “includes our emotional, psychological, and social well-being” by helping us “relate to others” [15]. At the same time, whether or not one has positive relationships with others also shapes one’s mental health. This bidirectional relationship between social connections and mental health and illness is important across the lifespan [22]. For example, those who are socially connected appear to live longer and happier lives than those who experience social isolation [23]. Further, engagement in supportive social networks also protects against depression [23, 24] and those with a clinical depression diagnosis who perceive their social support as poorer have worse outcomes in terms of symptoms, recovery, and social functioning [25].

Youth mental health and social relationships

Young people’s social networks expand and develop as they reach adolescence and include their family, peers, and members of their community [26]. When youth feel connected to their social networks, it is positive for their mental health [27].

Parents are an important part of youth social networks. Positive support from parents correlates with a greater likelihood that young people will seek out help or adopt help-seeking behaviours [28]. This is especially the case for younger adolescents who tend to rely more heavily than older adolescents on parental support for help-seeking [29]. When parents are available to their children in both an emotional and physical capacity, youth are also more likely to disclose their mental health difficulties to them and engage in a collaborative help-seeking process [28]. Additionally, when youth report feeling connected to their parents, they also tend to report lower levels of depressive symptoms, suicidal ideation, and non-suicidal self-injury [30, 31].

Since young people spend much of their time in the school environment, teachers also play a critical role in advocating for their students’ mental health needs [32]. For example, teachers are able to engage in promotion (e.g. encouraging inclusivity and positive attitudes toward those with mental illness, promoting healthy lifestyle and exercise, etc.), prevention (e.g. assisting students to manage stress, talking about early warning signs of mental illness, identifying and stopping bullying, etc.), and early intervention (e.g. referring a young person to professional mental health services, asking students about their suicide risk, notifying parents of concerns about their child, etc.) around mental health [33]. When students report a supportive relationship between themselves and their teachers, they also report better mental health [34].

Finally, throughout adolescence, young people begin to place higher importance on their peer connections and are more likely to turn to their friends when they are facing mental health difficulties as they age [35, 36]. Peer support is a protective factor against suicide, depression, anxiety, and stress. It is also positively associated with general mental well-being, self-esteem, and optimism [37, 38]. Various studies indicate that interacting with friends is related to better health outcomes [39, 40]. However, the quality and focus of the friendship is highly important as those who engage with peers who participate in delinquent behaviour are more likely to exhibit mental health difficulties [39]. Overall, when adolescents are dissatisfied with their social contacts or experience poor levels of support, they are more likely to report psychological distress, depression, and anxiety [11].

Gender and social relationships

Relationships are approached, navigated, and experienced differently by girls and boys [41–44]. Girls appear to place an emphasis on emotional support in their relationships [44–46] and tend to value traits such as loyalty, self-esteem enhancement, and intimacy [47]. Boys on the other hand favour participating in activities with [47] and receiving tangible help and support from their friends [45, 46]. They rarely turn to their social relationships as a coping strategy [48]. Girls are more likely than boys to perceive that their teachers, classmates, and friends support them [49], yet they also report higher levels of stress in their relationships [48]. Exploring these gendered differences in relationships as a potential contributor to mental health disparities may give rise to a more comprehensive understanding of why these disparities exist.

Gender and adolescent mental health

The prevalence of depressive symptoms [2, 10, 11], anxiety [2, 11, 12], and self-harm [2] is higher among girls compared to boys. Relative to girls, boys have elevated rates of conduct disorder, substance use, interpersonal violence, and completed suicide [50]. They are also less likely to access or engage with professional mental health supports [51–54] and/or possess a strong level of mental health literacy [50]. Additionally, boys tend to experience more self-directed or societal stigma in relation to mental health [55–57]. When compared to their cisgender counterparts, gender diverse young people report experiencing extensive mental health challenges [58, 59], including higher levels of depression, anxiety, suicidality, non-suicidal self-injury, disordered eating, and substance use [59]. While these differences in prevalence among gender diverse youth are becoming well documented, the cause for them is less clear.

Current study and rationale

In the current study, we hope to shed light on the gendered ways that youth in Canada are experiencing their social relationships. Our rationale is that these findings could provide insight into the social contexts that are maintaining and perpetuating gendered disparities in mental health. As Patalay and Demkowicz (2023) emphasize, “there is little evidence of critical interrogation around why” the gender mental health gap exists. Yet in order to close this gap, the why needs to “be understood in the context of complex social and societal pressures and power differentials around gender” [2]. By exploring one potential piece of the “why” around this gender gap, it is our hope that our findings can inform health promotion strategies that are attentive to the gendered ways that young people navigate their social worlds.

Sampling and recruitment

Participants were purposively recruited to represent various social identities, with particular attention paid to self-identified gender, between April and November 2021. Conducting interviews with individuals who hold varying and diverse social identities helped to enhance credibility through perspectival triangulation [63]. Due to research restrictions related to the COVID-19 pandemic, youth were initially targeted via emails that were sent to various community youth-based organizations (i.e. community youth centres, a soccer club, and a youth yoga studio). Since most of these organizations were running at a limited capacity during the pandemic, we also created a digital poster that was promoted via a social media campaign on both Twitter and Instagram. Digital posters were also posted through Brock University’s Lifespan Institute. Participants representing three Canadian provinces (Ontario, British Columbia, and Quebec) requested to participate in this project. If interested participants did not live in Canada, did not speak English, or were not between the ages of 11 and 17, they were excluded from the study.

Generating data

Participants completed a virtual semi-structured interview via Zoom with one interviewer (K.A.P). Prior to beginning the interview, a guardian of the participant provided verbal consent and the youth participant provided verbal assent. The interviews lasted between 45 and 60 minutes each. Participants were asked to reflect on, discuss, and provide stories about their own everyday lived experiences related to gender and mental health, which allowed them to guide the conversation in ways that were meaningful to them. Co-creating data with our participants in this manner enhanced data dependability. In keeping with our methodological approach, the specific questions that were asked evolved and became more focused as data collection progressed. Following the interview, each participant was given a $30 e-gift card to thank them for their time. Each audio recording was professionally transcribed verbatim for subsequent analysis. Data generation was complete once we reached data sufficiency, which was determined when we had adequate interpretive evidence to answer our research question [64].

Analysis

The main set of 20 transcripts was used to form a meta transcript of all project data. All data related to social interactions and relationships was then compiled into a sub data set for this specific analysis. We completed a first level of line-by-line coding on early transcripts, looking for initial codes in the data that we then discussed. As we engaged in this process, we were attentive to the intersection of different social locations (i.e. participant demographic characteristics such as gender). The first round of open coding focused on understanding and comparing what types of relationships the young people were discussing and how they experienced these relationships in their daily lives. As themes and categories were identified, a gendered analysis allowed for the similarities and contradictions within and between gender identities to be highlighted. In the second phase of coding, a conceptual level of analysis took place and the ways in which young people navigate various relationships were explored. This was also approached from a gendered lens in order to look for similarities, contradictions, inconsistencies, and patterns that were beginning to emerge. In the final phase of analysis, we moved to interpretation. Here we drew from the academic literature, direct participant quotes, and analytic memos to understand how young people appear to be navigating their relationships in gendered ways, and the implications that this may have for mental health.

Establishing rigor and validity

Throughout all stages of the research we (S.W., K.A.P., V.S., and V.M.) were reflexive about our own social locations and how they intersect with our own lived experiences to influence this work. Our diverse disciplinary backgrounds include academic training in sociology, health policy, law, and community health. As cisgender women of different ages and at different career stages, we had open and reflexive discussions about the different socio-cultural norms and expectations that we have experienced in our own lives. Rigor and validity were further enhanced by having many critical conversations within the research team. We used these conversations to assess what was going on in the data and to familiarize ourselves with the stories that were being told to see how these fit into the broader literature base. The detailed field notes that were taken initially by the interviewer (K.A.P.) were also referenced regularly. As a form of accountability, one author (S.W.) met with an established youth advisory panel. Her purpose was to discuss our analysis process to gain insights about what, from the experiences of the youth advisory members, we should be sensitive to in the data. This discussion added an element of trustworthiness [63] to our investigation. Finally, all researchers engaged in reflexivity throughout the research process and a detailed audit trail of decisions, discussions, and questions was maintained throughout the analysis and write-up of this manuscript. All of these strategies enhanced the validity of our data and contributed to the trustworthiness and integrity of our study.

Ethical considerations

Ethical approval was received from Brock University (19–099), Queen’s University (EPID-688-19), and the University of Ottawa (S-12-19-5329). To protect the privacy of each participant, any identifying information was removed from the transcripts prior to analysis by the research team and each participant’s name was replaced with a pseudonym. Additionally, any personal information that was used throughout the recruitment process was stored on a password protected computer, separate from the audio files and transcripts.

Characteristics of study population

We interviewed twenty young people between the ages of 11 and 17 years. Nine participants self-identified as girls, 10 participants self-identified as boys, and one participant self-identified as non-binary gender. Geographically, one participant was from Quebec, one was from British Columbia, and 18 were from Ontario. We asked participants to self-identify their ethnocultural background on a pre-study demographics form. Thirteen of the participants self-identified as being “Caucasian” or “White” and three participants self-identified as being “racialized.” The other four participants self-identified in ways that did not describe race (such as “Catholic Canadian” or “French Canadian”). Throughout the text the participant’s gender and age are indicated in parenthesis (G: girl, B: boy, NB: non-binary).

Young people’s experiences navigating social relationships

Findings from our study demonstrate the strong, persistent, and often implicit ways that gender shapes social relationships. This involves how youth describe the ways that gender and social relationships interact to shape behaviours and experiences (theme 1), the ways that youth navigate the conflicts that they experience in their social relationships (theme 2), and the ways that girls describe their dissatisfaction with gender stereotypes, particularly those that are directed at boys and gender diverse youth (theme 3). All themes are described in detail in the following sections.

Theme 1: Gender and social relationships interact to influence behaviours and experiences

The youth in this study spoke about the many different types of relationships they maintain, including those with their friends, family, and community members such as coaches and teachers. Through our analysis, it became apparent that gender norms, expectations, and social relationships interact with and reinforce one another.

Theme 2: The way participants navigate conflict is gendered

Participants described various scenarios where they were in conflict with people who they saw on a daily basis such as family members, friends, and peers, or those that they interacted with less frequently such as members of their church community or customers at their job. Although all young people experienced some type of conflict in their relationships, how they navigated this conflict appeared to be different depending on their gender identity.

Theme 3: Some girls described dissatisfaction with gendered stereotypes, expectations and norms that boys and non-binary youth experience

Some of the girls in this study described dissatisfaction with—and resistance to—the gendered stereotypes and norms that their peers encounter in their daily lives. They also expressed recognition of the ways that their peers’ gendered experiences may differ from their own. For example, Sierra (16G) explained that while she identified as cisgender, she recognized that there might be scenarios in which her gender diverse peers could be uncomfortable. She said, “there are times when in general people are like, girls go to that side and guys go to that side. And I am like, what if there are people who don’t identify as either? Or switch?” Ashley and Haley identified the stereotypical emotional repression boys are subjected to. Ashley (13G) described that:

there is a big main thing where some people think that boys should be this big tough muscular man or person that doesn’t cry that much or barely gets emotional. But reality is, boys are human like us, and they have feelings and emotions. So, some people think they should be big and tough and don’t get emotional, but they still have feelings and emotions.

Haley (16G) echoed these thoughts as well.

Even for boys, for example not crying or not being emotional is a thing, which is sad. I feel like we are starting to get rid of that thought. But still, it’s like, oh you have to tough and stuff like that for boys. And when they show an emotional side it’s like, oh my god they are not robots.

A noteworthy feature of our data was that while some of the girls described their dissatisfaction with gendered norms and expectations that they perceived boys and non-binary people experience, none of the boys or expressed this level of recognition, reflexivity, or resistance to gender norms and stereotypes that the girls or non-binary youth may be experiencing.

Nicholas (17B) was an anomaly among the boy participants in that he articulated how he was attentive to the gender stereotypes that influenced his own understanding of gender. For instance, Nicholas (17B) explained that:

There is the classic stereotype of the strong man and super manly like ‘errr’. But as being a gay person, I am not really attached to that stereotype because of the other stereotype that gay boys are flamboyant and girly. So, I try to be in the middle. I don’t identify as girly, more manly…Stereotypically, for example I don’t enjoy watching sports and I like painting and stuff like that. I also wrote for the student journal, and it was almost only girls. So, I do girly things that are not considered manly.

It may be that due to certain aspects of his social position (i.e., sexual orientation), Nicholas displayed a level of gendered resistance in the way that his portrayal of his self-identified gender did not align with what he deemed the dominant depiction of a boy.