Running head: UNDERSTANDING MENTAL HEALTH 1 Relationships between Gender, Education Level, Self-Esteem, and Mental Health Outcomes

Males and females tend to manifest distinct mental health outcomes. Specifically, females report higher levels of psychological distress, whereas males report higher levels externalizing symptoms. The purpose of this study is to explore how gender, education level, and self-esteem relate to psychological distress and externalizing symptoms. This study used data from a 2015 nationally representative survey, National, Health, Well-being and Perspectives Study, which includes over 1,000 adult’s respondents. We found a significant interaction between gender, education level, and self-esteem level on psychological distress. However interestingly, we did not find an interaction on externalizing symptoms using the same set of independent variables. This research help us better understand the relationship between gender and mental health outcomes. UNDERSTANDING MENTAL HEALTH 3 Relationships between Gender, Education Level, Self-Esteem, and Mental Health Outcomes Males and females tend to manifest distinct mental health outcomes. Many previous studies had provided evidences to explain the gender differences in mental health. Besides gender, we further explore alternative independent variables like education level and self-esteem in this study to see whether they are related to the different pattern of psychological distress and externalizing symptoms that were often found in both gender. In previous studies, researchers often found a relationship between gender and both mental health outcomes (psychological distress and externalizing symptoms). Studies showed that females report higher levels of psychological distress, such as depression and anxiety than males, whereas males report higher levels externalizing symptoms, such as alcohol abuse and aggression compared to females (Rosenfield, Lennon, & White, 2005; Rosenfield & Smith, 2010). For the relationship between self-esteem and mental health outcomes, findings of previous researches showed negative association between self-esteem and psychological distress (Munford, 1994; Orth, Robins, & Roberts, 2008). In the study of Orth, Robins, and Roberts (2008), they found that low self-esteem helps to predict individuals’ depression level. Consistent with Orth and team’s study, Munford’s (1994) found a significant difference between selfesteem and depression, such that participants who scored lower in self-esteem reported higher depression scores. However, both of these studies failed to find a significant difference of this relationship across gender (Munford, 1994; Orth, Robins, & Roberts, 2008). Researchers from both studies explained that depression level varies across males and females, such that males showed lower in depression level than females, while Orth and his team also found that males tend to score higher in self-esteem. However, these researches agreed that the relationship UNDERSTANDING MENTAL HEALTH 4 between self-esteem and depression level (low self-esteem predicts higher depression) is unaffected by gender (Orth, Robins, & Roberts, 2008; Munford, 1994). Furthermore, Donnellan (2005) and his team found a negative relationship between selfesteem and externalizing symptoms based on the reports from participants’ parents and teachers. Results showed consistency with other previous studies such that low self-esteem individuals were more likely to engage in aggressive behaviors. Supporting Donnellan’s (2005) findings, other researchers also tied low self-esteem to higher risk of externalizing problems such as antisocial behaviors and substance/alcohol abuse (Rosenfield, Lennon, & White, 2005). Zhang, Chen, & Feng (2015) examined the relationship between education level and psychological distress among older Chinese population and they found a negative relationship in their study. The pattern of high levels of education showed low distress level over time is true for males, urban residents and aged from 65 to 79. However, education level does not showed a significant differences in psychological distress among rural females who have high initial level of distress (Zhang, Chen, & Feng, 2015). Besides that, the results of Brannlund and Hammarstorm’s (2014) study showed consistency with previous research. The results of their study revealed a relationship between education level and psychological distress, such that individuals in Sweden who continue to pursue secondary education showed lower psychological distress compared to those with compulsory school only. This pattern was found in both males and females. However, this relationship weakens as age increases (Brannlund & Hammarstorm, 2014). According to Huerta and Borgonovi’s (2010) study, there is a relationship between education level and alcohol use, such that higher educational attainment is associated with increased number of daily alcohol consumption and drinking problem. Researchers explained UNDERSTANDING MENTAL HEALTH 5 that “the more educated individuals are, the more likely they are to drink on most days” (Huerta and Borgonovi, 2010, pg. 147). Their results showed that females who have higher education level (degree level) tends to drink more on most days than females with lower education level (secondary or advanced level). Even though higher education level is associated with increased number of daily alcohol individuals consumed, Huerta and Borgonovi (2010) found that educational attainment is not significantly associated with alcohol abuse (drink more than the maximum recommended) for males and females. Besides that, their findings also revealed that female participants with the highest educational qualifications is significantly associated with drinking problems. Females with higher degree level are more likely to experience problems caused by drinking than those without degree qualification (Huerta and Borgonovi, 2010). Contrary to Huerta and Borgonovi’s study, McCarthy, Aarons, and Brown (2001) found a significant negative association between education and alcohol use among participants who are currently in the alcohol and drug treatment programs. However, participants who are recruited from the community did not showed a significant correlations between education and alcohol use (McCarthy, Aarons, and Brown, 2001). Furthermore, Baillie (2005) collected participants’ education level in his study to examine whether the pattern of mental health outcomes across gender varies after adding another possible variable. He found a significant interaction between gender and education level in psychological distress. In his research, female participants who did not complete the highest level of secondary schooling showed highest psychological distress compared to both males and females who had completed secondary education (Baillie, 2005). Baillie’s (2005) finding suggested that females with lower education level had higher psychological distress compared to males and females who earned higher education level. However, result from a similar study that UNDERSTANDING MENTAL HEALTH 6 was conducted by Linander, Hammarstrom, and Johansson (2014) is not consistent with the pattern found in Baillie’s (2005) study. In Linander and her team’s (2014) study, she and her team found that low education level was not significantly related to individual’s psychological distress and there was no difference between education level and psychological distress for both males and females. Research that examined the interaction of gender and education level on externalizing symptoms was no found. Based on results of prior researches that showed a negative association between gender or self-esteem on psychological distress or externalizing symptoms, some researchers focused on studying the interaction between gender and self-esteem. Overall, researchers found significant difference between these variables such that males reported higher self-esteem than females (Bachman, O’Malley, Freedman-Doan, Trzesniewski, & Donnellan, 2011; Collison, Banbury, & Lusher, 2016; Sprecher, Brooks, & Avogo, 2013). Contrary to prior researches that were mentioned above, Munford (1994) failed to found a significant differences between gender and self-esteem. Most of these studies further examined the relationship between gender and selfesteem by taking into account of individuals’ race, age, and social class (Bachman, O’Malley, Freedman-Doan, Trzesniewski, & Donnellan, 2011, Munford, 1994; Sprecher, Brooks, & Avogo, 2013). There was no prior research found that studied the interaction of self-esteem and education level on psychological distress and externalizing symptoms. Research that examined 3-way interaction of gender, education level, and self-esteem on both mental health outcomes was also not found. The purpose of this study is to understand the relationship of gender, education level, self-esteem, and mental health outcomes. Researcher looked at the main effect of gender, selfUNDERSTANDING MENTAL HEALTH 7 esteem, and education level on psychological distress and externalizing symptoms respectively. 2-way interactions of gender and self-esteem, gender and education level, and self-esteem and educations on both mental health measurements were also included in this study. Furthermore, research also analyzed the 3-way interaction of gender, education level, self-esteem on both psychological distress and externalizing symptoms.