Last week the latest UK suicide statistics reminded us of the grim reality of the depths of teenage despair. Out of every 100,000 boys aged 15 to 19, more than seven took their own lives last year. The equivalent figure for girls was less than half that, at 2.9.
With that in mind, perhaps there should be no surprise that a government-funded study into mental health in teenagers has concluded that
Policy makers should take into account the differences between boys and girls in their experiences of mental ill-health at different ages.
And so say all of us. The only issue is that the very same recommendation continues like this:
Policy makers should take into account the differences between boys and girls in their experiences of mental ill-health at different ages. The report shows that between the ages of 11 and 14 girls are significantly more likely than boys to experience poor mental health.
The study, from UCL and University of Liverpool and apparently co-sponsored by a charity called the National Children’s Bureau is entitled ‘Mental ill-health among children of the new century’. Here is how it reported in the Guardian today:
Before we go any further let me spell out my premise here, indeed, pretty much my entire point:
IT IS NOT A COMPETITION.
I am not for a moment denying or disputing that somewhere up to a quarter of 14-year-old girls have severe depressive symptoms and I am not for a moment minimising the seriousness of that or the necessity for our society to take note of it and hopefully do something about it. I actively applaud all efforts to address these issues and alleviate the suffering it causes.
On the other hand I do have a bloody huge issue with government-funded research which goes out of its way to mimimise and misrepresent the evidence of mental ill-health among boys and which produces policy recommendations which more or less explicitly demand that fewer resources be devoted to boys in need than to girls.
The study concerned uses data from the longitudinal Millenium Cohort study and used something called the Short Mood and Feelings Questionnaire. This tool asks subjects to self-report whether they have felt each of 13 symptoms of depression. From this, the study established that girls (at age 14) are much more likely to be depressed than boys. Alongside the children’s self-report symptom inventory, the researchers got parents (to be more precise, in 90% of cases it was mothers) to fill in a matching questionnaire recounting whether they felt their child was showing the same symptoms.
It should be stressed at this point that the findings here are not especially new. Epidemiological studies of adolescent mental health using inventories and questionnaires have always found similar results – young boys and girls report similar rates of depressive symptoms until puberty, after which girls’ self-reported depression scores rise markedly and boys usually don’t. This has been true since the 1980s at least.
So, what is the problem?
Well, also since the 1980s at least, psychologists and psychiatrists have been aware that the tools which are sensitive in measuring or detecting depression in women and girls are not always equally sensitive in measuring depression in men and boys. Crucially, the male subjects who are found to be least accurately assessed by traditional depression inventories are those with the most marked and extreme masculine traits and attitudes. Like macho sportsmen, for instance. Or teenage boys, perhaps.
Firstly, there are huge question marks around the how male and female subjects behave when a self-report questionnaire is put in front of them. This is even true of physical symptoms, never mind psychological. There are numerous reasons for this. Perhaps the most significant is that boys are generally less likely to admit to vulnerabilities, weaknesses and perceived personal failings than girls are, even on an anonymised questionnaire. Some researchers go further, pointing to ‘male normative alexithymia’ – difficulty in identifying one’s own emotional state and then putting it into words.
One of the most striking claims made in the new study is that there was a marked difference between the results of the self-assessment questionnaires and those completed by parents.
According to self-reports, 24% of girls and 9% of boys showed high scores for symptoms of depression. According to parents the differences were much narrower, at 18% of girls and 12% of boys. The only explanation offered by the report’s authors is this:
“The fact that such a high proportion of girls – 24% – suffers from high levels of depressive symptoms suggests that some parents may not be aware of their daughter’s depression.”
Well, yes, that is one possibility. Another is that boys are failing to own up to their own depressive symptoms when even their mothers can see what is going on. The fact that the authors of the paper do not even raise this as a possibility is, frankly, scandalous. What is more, if one looks at the source research for the sMFQ, it says explicitly that “the parent-version of SMFQ-short was found to be a better predictor of depression than was the child self-report of this measure. However, the combination of both the parent and child versions of the SMFQ-short was a better predictor than was either measure when used alone.”
In recent years there has been a growing and immensely important body of academic work around gender-based expressions of depression. As a broad, widely accepted principle, men (and boys) with mental ill health tend to externalise those feelings into aggression, violence, criminality and drug and alcohol abuse, whereas women and girls are more likely to internalise into self-harm, self-reflection and dwelling on intrusive thoughts.
Perhaps the most influential and important work on this front has been the contributions of Lisa Martin who found that if we redefine depression to include symptoms more typically displayed by men, the 2:1 gender differences in reported depression pretty much vanish at a stroke.
Alongside this, many different researchers and clinicians have recently been developing instruments for detecting and measuring depression in boys and men, with names like the Male Depression Risk Scale and the Masculine Depression Scale. The tools are there, the knowledge is there, the research is there. All that is missing is the willingness to accept it
In short, if you want to know whether a 14-year-old boy is depressed, don’t ask him how often in the last month he has sat around feeling unhappy. Ask him how often he has chosen to sit in his room playing video games rather than seeing his friends and you are likely to get a very different answer. Ask him how often he has smoked weed on his own. Ask him how often he has wanted to punch someone – or did – or found himself smashing up some inanimate object.
The truth is you will get a better measure of boys’ mental health from asking how much harm they have done to others than to themselves. And here’s the kicker – this study today has a whole section on behavioural problems which notes that not only do boys significantly outnumber girls on that front, but that the difference increases steadily from age 5 through to 14. Presumably the authors of this report are aware that disruptive and anti-social behaviour is often a strong indicator of mental ill-health, since they went to the trouble of recording and reporting the statistics on behavioural problems. They then made a conscious decision to exclude those findings from their conclusions and recommendations.
I began this blogpost talking about suicide rates, as they are such a pressing issue, they should never be far from our thoughts. But these are only the most extreme and tragic indicator of a serious problems with our boys and young men. Their emotional and mental health is inescapably tied to their social engagement, their ambition, their academic performance. Read Zimbardo’s book Man (Dis)connected or Rebecca Asher’s Man Up for sheaths of evidence of how we are failing our boys and young men repeatedly and egregiously on those fronts. It is bad enough that we routinely turn our uninterested gaze away from these issues without government-sanctioned academia striving to actively divert us.
The shorter Mood and Feelings Questionnaire, used properly, is a perfectly valid and useful instrument. It is cheap, rough and ready and a perfectly acceptable instrument for collecting some rough and ready data on the mental health of a given group. To use it as a comparative measure between different groups who are known to approach it differently is questionable, to say the least.
To then use those findings to attempt to influence policy priorities, for instance by stating baldly and without qualification that girls are “significantly more likely than boys to experience poor mental health” is downright irresponsible.