Gender norms and the mental health of boys and young men
Authors: Simon Rice, John Oliffe, Zac Seidler, Rohan Borschmann, Jane Pirkis, Nicola Reavley, George Patton
Journal: The Lancet Public Health (2021)

Over the last half-century, the women's health movement has been a powerful driver in health policy linking gender norms to sex differences in health and wellbeing. Even though gender norms also affect males,1Heise L Greene ME Opper N et al.Gender inequality and restrictive gender norms: framing the challenges to health.Lancet. 2019; 393: 2440-2454Summary Full Text Full Text PDF PubMed Scopus (191) Google Scholar there has been little emphasis on gender in health policies for males, especially in relation to the mental health of boys and young men.2Patton GC Darmstadt GL Petroni S Sawyer SM A gender lens on the health and well-being of young males.J Adolesc Health. 2018; 62: S6-S8Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar Gender norms around masculinity commonly confer power and status to boys and young men, which might in part explain why norms around masculinity are difficult to shift. Paradoxically, these dominant masculinities carry risks for poor mental health.3Rice SM Purcell R McGorry PD Adolescent and young adult male mental health: transforming system failures into proactive models of engagement.J Adolesc Health. 2018; 62: S9-17Summary Full Text Full Text PDF PubMed Scopus (56) Google Scholar Globally, the rate of male suicide is two to four times that of females,4Ritchie H Roser M Ortiz-Ospina E Suicide.https://ourworldindata.org/suicideDate: 2015Date accessed: June 25, 2021Google Scholar and males fare poorly on indices of substance misuse, risk taking-related injury, conduct problems, violence, aggression, and by extension incarceration.3Rice SM Purcell R McGorry PD Adolescent and young adult male mental health: transforming system failures into proactive models of engagement.J Adolesc Health. 2018; 62: S9-17Summary Full Text Full Text PDF PubMed Scopus (56) Google Scholar Sex differences in mental health typically emerge across late childhood and adolescence. This time is also when gender norms become entrenched,1Heise L Greene ME Opper N et al.Gender inequality and restrictive gender norms: framing the challenges to health.Lancet. 2019; 393: 2440-2454Summary Full Text Full Text PDF PubMed Scopus (191) Google Scholar persisting into later life whereby they continue to shape mental health and help-seeking. Traditional gender norms commonly drive young men to present as strong, competitive, in control, and unburdened by vulnerability.1Heise L Greene ME Opper N et al.Gender inequality and restrictive gender norms: framing the challenges to health.Lancet. 2019; 393: 2440-2454Summary Full Text Full Text PDF PubMed Scopus (191) Google Scholar, 3Rice SM Purcell R McGorry PD Adolescent and young adult male mental health: transforming system failures into proactive models of engagement.J Adolesc Health. 2018; 62: S9-17Summary Full Text Full Text PDF PubMed Scopus (56) Google Scholar These cultural scripts prize toughness, anger, hostility, and emotional control. Conversely, emotions characterised by vulnerability, including sadness, anxiety, and fear, trigger shame and become a barrier to help-seeking.3Rice SM Purcell R McGorry PD Adolescent and young adult male mental health: transforming system failures into proactive models of engagement.J Adolesc Health. 2018; 62: S9-17Summary Full Text Full Text PDF PubMed Scopus (56) Google Scholar Modern social media and marketing might be making things worse. The media have long adopted images of masculinity in the promotion of gambling, alcohol, and tobacco use, but the capacity of the new media to shape peer norms is greater than ever before.5Bouguettaya A Lynott D Carter A et al.The relationship between gambling advertising and gambling attitudes, intentions and behaviours: a critical and meta-analytic review.Curr Opin Behav Sci. 2020; 31: 89-101Crossref Scopus (8) Google Scholar A pernicious accentuation of peer norms6Vandello JA Bosson JK Hard won and easily lost: a review and synthesis of theory and research on precarious manhood.Psychol Men Masc. 2013; 14: 101-113Crossref Scopus (336) Google Scholar is perpetuating outdated stereotypes of what it is to be a man. For these reasons there have been growing calls for the inclusion of boys and young men in policies to counter gender inequalities in health and wellbeing outcomes7Kennedy E Binder G Humphries-Waa K et al.Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region.Lancet Glob Health. 2020; 8: e1473-e1488Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar across media and marketing, in education, and in community settings including sport. Such approaches might begin to reshape gender norms for boys and young men by promoting a different kind of social and emotional engagement with male peers as well as with girls and young women.8Gwyther K Swann R Casey K Purcell R Rice SM Developing young men's wellbeing through community and school-based programs: a systematic review.PLoS One. 2019; 14e0216955Crossref PubMed Scopus (7) Google Scholar Collective values and competencies might extend to a fuller experience and expression of emotions, especially those self-perceived as unmanly or conveying vulnerability, without fear of a diminished social status.6Vandello JA Bosson JK Hard won and easily lost: a review and synthesis of theory and research on precarious manhood.Psychol Men Masc. 2013; 14: 101-113Crossref Scopus (336) Google Scholar Engaging boys and young men in familiar, safe, digital, school, or sport group-based settings, brings the scope to harness positive aspects of masculine socialisation including friendship and connection through sport.9Wilson M Gwyther K Swann R et al.Operationalizing positive masculinity: a theoretical synthesis and school-based framework to engage boys and young men.Health Promot Int. 2021; (published online April 11.)https://doi.org/10.1093/heapro/daab031Crossref Google Scholar Schools are important settings for the social development of boys. School-based peer group identities develop and strengthen over time, bringing a sense of status and belonging within particular social groups, which might also extend to the adoption of values, behaviours, and attitudes that carry mental health risks.10Bonell C Blakemore S-J Fletcher A Patton G Role theory of schools and adolescent health.Lancet Child Adolesc Health. 2019; 3: 742-748Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Schools have great scope to shape the culture of male peer groups. Older male students can buddy with younger students, or young facilitators can run school-based workshops promoting positive male identities, perhaps re-establishing a rite of passage to maturity, largely absent from contemporary society. Such mentorship might extend to promoting openness, advice seeking, and constructive action when faced with emotional challenges. Cultivating emotional intelligence might also be coupled with respect for diversity of gender identity, roles, and emotional expression. This approach would improve mental health for peers who do not conform to gender roles and extend the repertoire of accepted emotional expression in the peer group. Engagement around the value systems of boys and young men should avoid shaming responses9Wilson M Gwyther K Swann R et al.Operationalizing positive masculinity: a theoretical synthesis and school-based framework to engage boys and young men.Health Promot Int. 2021; (published online April 11.)https://doi.org/10.1093/heapro/daab031Crossref Google Scholar such as labelling masculinity as toxic. Engagement should also thread concepts of gender equity to confront positions of assumed privilege and disrespect. Mental health risks to an individual and others arise from traditional male stoicism and dominance, including entitlement to power over women, girls, and other men. Changes in attitude and behaviour can be reinforced by honouring and leveraging the bravery and courage (positive masculine norms) of those boys and young men who reject harmful norms and challenge and change stereotypes such as that men don't cry and that boys will be boys in public and private arenas. Formative work is currently underway testing relevant programmes in Australia (panel). If proven effective, these programmes might serve as models, countering depictions of men's toughness in mainstream media (eg, sport, politics, business).PanelMale-specific approaches for boys' and young men's mental healthTrials in Australia are evaluating the effect of programmes that counter normative socialisation for boys and young men by interrogating gender norms and facilitating positive attitude development toward help-seeking for mental health. These programmes are intentionally delivered in settings where boys and young men learn or play. The Ahead of the Game (Australian Clinical Trials Registration Number [ACTRN] 12617000709347) programme is sensitised to boys and young men (with a focus on helping out a friend) via delivery of a mental health literacy programme purposefully based in sporting club settings (eg, club rooms). The Ahead of the Game programme is being tailored and scaled (in Australia, Canada, New Zealand, and the UK), supported by leading men's mental health charity Movember. Breaking the Man Code (ACTRN12620001134910) is a school-based workshop programme in which adolescent boys are encouraged to critique, reappraise, and redefine the use of gender norms, reflecting on associated social and health-related effects. Entourage (ACTRN12619000923167) is a digital intervention also supported by Movember, designed for young men with social anxiety. Entourage leverages a purposely developed therapeutic online social network and the intervention seeks to normalise and encourage mental health help-seeking through strength-based clinical and peer support, implemented through a gender lens. Silence is Deadly (ACTRN12617000658314) is a school-based programme for adolescent boys that uses role modelling, personal histories, and accounts from influential males to shift help-seeking attitudes and increase the likelihood of accessing peer and professional support for mental health concerns. The mental health effects of these and other innovative approaches are still emerging. Once effects are known, efforts to develop culturally sensitive and acceptable adaptations or bespoke interventions in other languages or linguistic settings, including low-income and middle-income countries, are needed.7Kennedy E Binder G Humphries-Waa K et al.Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region.Lancet Glob Health. 2020; 8: e1473-e1488Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar Trials in Australia are evaluating the effect of programmes that counter normative socialisation for boys and young men by interrogating gender norms and facilitating positive attitude development toward help-seeking for mental health. These programmes are intentionally delivered in settings where boys and young men learn or play. The Ahead of the Game (Australian Clinical Trials Registration Number [ACTRN] 12617000709347) programme is sensitised to boys and young men (with a focus on helping out a friend) via delivery of a mental health literacy programme purposefully based in sporting club settings (eg, club rooms). The Ahead of the Game programme is being tailored and scaled (in Australia, Canada, New Zealand, and the UK), supported by leading men's mental health charity Movember. Breaking the Man Code (ACTRN12620001134910) is a school-based workshop programme in which adolescent boys are encouraged to critique, reappraise, and redefine the use of gender norms, reflecting on associated social and health-related effects. Entourage (ACTRN12619000923167) is a digital intervention also supported by Movember, designed for young men with social anxiety. Entourage leverages a purposely developed therapeutic online social network and the intervention seeks to normalise and encourage mental health help-seeking through strength-based clinical and peer support, implemented through a gender lens. Silence is Deadly (ACTRN12617000658314) is a school-based programme for adolescent boys that uses role modelling, personal histories, and accounts from influential males to shift help-seeking attitudes and increase the likelihood of accessing peer and professional support for mental health concerns. The mental health effects of these and other innovative approaches are still emerging. Once effects are known, efforts to develop culturally sensitive and acceptable adaptations or bespoke interventions in other languages or linguistic settings, including low-income and middle-income countries, are needed.7Kennedy E Binder G Humphries-Waa K et al.Gender inequalities in health and wellbeing across the first two decades of life: an analysis of 40 low-income and middle-income countries in the Asia-Pacific region.Lancet Glob Health. 2020; 8: e1473-e1488Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar Promoting a different kind of social and emotional development for boys and young men is likely to be an intergenerational agenda. Increasingly, boys and young men will need to become active in sharing power and status with women. There are some encouraging developments. Women's sport professionalisation increasingly exposes boys to female athletes, widening their perspectives on women's capabilities. Ultimately redefining and reshaping the socialisation of boys and young men will promote their better mental health and those of others around them. In a world that needs men with different social and emotional capacities, this approach could promise to lay a foundation for greater productivity and wellbeing across men's life-course. We declare no competing interests.