The Impact of Age and Gender on Mental Health

January 13, 2024

Mental illness affects everyone—all genders, young and old. But not everyone experiences mental disorders the same way. More and more, researchers are trying to find out why disparities exist and what those differences mean for treatment and outcomes.

“Historically, sex, gender, and age differences have been grossly understudied in health in general,” says McLean’s R. Kathryn McHugh, PhD.

McHugh explains that research efforts have long focused on male subjects. For decades, studies were conducted mostly, sometimes exclusively, in male humans and animals.

Things are changing because of mandates by agencies that fund research, like the National Institutes of Health. Nevertheless, McHugh emphasizes that we have a very long way to go in understanding sex and gender in mental health.

Keep Reading To Learn

  • How mental illness differs depending on age and gender
  • What causes these differences and how it could impact treatment

What’s Different?

Despite the historical lack of focus on sex and gender disparities, mental health researchers understand some of the ways mental illnesses affect people of different ages and genders.

For example, McHugh says, “We know women are more likely than men to have depression, anxiety, and traumatic stress-related disorders. Men are more likely to struggle with addiction.”

On the other hand, she says, “Men and women are affected at about the same rate for many conditions, like bipolar disorder. There is evidence that some of the sex differences in the rate of mental health disorders are changing.”

For example, the gap between men and women in the occurrence of substance use is shrinking in the U.S. and other countries in the global north.

More differences become evident when researchers study both gender and age.

“For some domains of mental health, before puberty, boys and girls look quite similar, but differences emerge later in life,” McHugh says. “For other disorders, you see stark differences in youth based on sex and gender.

These disparities are obvious in conditions like substance misuse. McHugh points out that the condition is often similar in young men and women, but that starts to diverge in early adulthood, with more men than women struggling from problematic substance use.

There are similar differences with depression. McHugh shares that, in general, women are more likely than men to experience depression. However, this sex difference varies across the life span and is particularly strong in adolescence.

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Cause and Effect

Biology plays a role in creating these disparities.

“We know that the hormones estrogen and progesterone have a significant impact on mood, stress, and cognition. Studies are beginning to identify ways that these hormones may impact mental health factors, ranging from development of fear and anxiety to risk for drug and alcohol use,” McHugh says.

Despite these findings, McHugh cautions against focusing on biology alone, noting that biology is not the only piece of the puzzle.

“There are also many social and cultural factors that play a role in mental health and wellness, such as social role expectations, discrimination, and violence. We cannot assume that differences are strictly biological, nor can we assume that they are strictly cultural.”

Understanding age and gender differences and underlying causes could improve mental health treatment. However, the impact of these on treatment is not well understood.

McHugh says that part of the reason is because of historical underrepresentation of women in clinical trials. For example, disulfiram, a medication for alcohol use disorder, has been studied almost exclusively in men.

“There is a real need for studies that consider how men and women may have different treatment needs, ranging from medication doses and types to behavioral and psychosocial treatments,” says McHugh. In general, she says, “Research has not suggested men and women have substantively different treatment responses overall.”

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Closing the Data Gap

Still, there is growing evidence for the benefits of sex- or gender-informed treatment. For example, McHugh suggests that men and women may respond differently to smoking cessation medications, citing studies by McLean’s Shelly F. Greenfield, MD, MPH, that show benefits for gender-specific behavioral treatment for women with substance use disorders.

“There are so many questions on the role of sex and gender in etiology, neurobiology, natural history, and treatment of psychiatric disorders,” says Greenfield.

“Gender-specific factors can make a difference in implementation of treatment services.” Because of this, she says, “More research in this area is important. It’s critical for studies to include potential sex and gender differences in questions, design, methodology, and analysis in order to advance our knowledge.”

“There is really exciting work being done,” McHugh says. “We are just seeing the tip of the iceberg right now.” To reveal more of the “iceberg,” McHugh believes that researchers must incorporate data on age and gender as a regular part of their investigations.

McHugh points out that understanding how age, sex, and gender impact mental illness requires continued and much-expanded efforts to increase the diversity of research participants, as well as the expansion of studies specifically designed to test these questions.

“Questions about age and sex/gender differences are usually secondary aims—add-ons—in addition to the main study question. Studies with sex, age, and gender as a focus are essential to answering important questions about mental health.”