This literature review will examine how mental health can be influenced by differences in gender, while being viewed through a sociological lens. The paper is organized by the themes of gendered mental illness, consequences, and recovery

Fusco, Julianna

English

University of New Hampshire

Perspectives
2017 Article 6
8-1-2017
How Gender Differences Affect Mental Health
Outcomes
Julianna Fusco
University of New Hampshire, Durham
Follow this and additional works at: https://scholars.unh.edu/perspectives
This Article is brought to you for free and open access by the Student Journals and Publications at University of New Hampshire Scholars' Repository.
It has been accepted for inclusion in Perspectives by an authorized editor of University of New Hampshire Scholars' Repository. For more information,
please contact nicole.hentz@unh.edu.
Recommended Citation
Fusco, Julianna (2017) "How Gender Differences Affect Mental Health Outcomes," Perspectives: Vol. 9 : Iss. 1 , Article 6.
Available at: https://scholars.unh.edu/perspectives/vol9/iss1/6
Julianna Fusco 
SOC 599 
Professor van Gundy 
10/20/2016 
How Gender Differences Affect Mental Health Outcomes 
Abstract 
This literature review will examine how mental health can be influenced by differences in 
gender, while being viewed through a sociological lens.  The paper is organized by the 
themes of gendered mental illness, consequences, and recovery. 
Introduction 
 Mental illness is an important topic, particularly because of how pervasive the 
issue has become recently all over the world, particularly in American news and media 
topics. Mental illness is stigmatized worldwide in a variety of ways and therefore can be 
overlooked in terms of research. While mental health is an individualized topic, 
demographics can influence it in a number of ways. Socioeconomic class, race, 
geographic location, occupation, sexuality, and a variety of other factors impact on an 
individual’s mental health outcome. This paper will look specifically at how gender can 
affect mental health.  
Gender differences are not innate; they are a result of socialization and gender-
specific experiences. Mental illnesses and their symptoms can be gendered in a way 
similar to how race is gendered; the way that African Americans are seen as the most 
masculine and Asians as the most feminine is similar to how certain mental illnesses are 
seen as masculine or feminine (Boysen Ebersole Casner and Coston 2014:546). This does 
not mean that these stereotypes are accurate, but rather that they have implications for 
!  1
1
Fusco: How Gender Differences Affect Mental Health Outcomes
Published by University of New Hampshire Scholars' Repository, 2017
society as a whole and how gender affects mental health. The differences between 
genders account for who is at risk, as well as who recovers. 
The literature I examined looks at a variety of ages with a focus on adolescents. 
Much of the research examined elementary through high school-aged people, including 
research on how school nurses affect mental health outcomes. Much of the literature 
points out the gender divide regarding internalizing versus externalizing behaviors. 
According to Boysen et al, (2014) “Generally speaking, externalizing symptoms involve 
disturbance in conduct and internalizing symptoms involve disturbances in feelings”. 
Women are more likely to experience mental illnesses with internalizing symptoms, such 
as low self esteem and anxiety, than men, while men are more likely to experience 
externalizing symptoms and the mental illnesses that go along with them (Pattyn, 
Verhaeghe and Bracke 2015:1089). This is how the gendering of mental illnesses begins, 
and thus helps to predict who is at risk and who recovers. 
The importance of this topic in the field of sociology is substantial. Mental health 
directly affects many people, and in order for it to be fully understood, a sociological 
approach must be taken. To examine mental health with regard to gender differences 
provides context on the unique experiences of each gender, and with this understanding 
can help to explain mental illnesses as well as provide insight on how to treat them 
accordingly. 
Gendered Mental Illness  
 The gendering of mental illness refers to the ways in which feminine or masculine 
qualities are assigned to different mental illnesses and mental illness symptoms. 
!  2
2
Perspectives, Vol. 9 [2017], Iss. 1, Art. 6
https://scholars.unh.edu/perspectives/vol9/iss1/6
Stereotypes about men and women are what lead to this. For example women are thought 
of as overly emotional, and therefore emotional illnesses such as depression and anxiety 
are thought to be more feminine (Boysen et al. 2014:547; Holtberg, Olson and Brown-
Rice 2016:225). This has real-world implications, as Boysen and colleagues point out that 
mental illnesses with a masculine stereotype, such as substance abuse or anger 
management problems, are actually more prevalent amongst men, and the same findings 
were found for women and “feminine” mental illnesses (2014:561). The question this 
raises though, is are these disorders actually more prevalent amongst their corresponding 
gender stereotype, or do men and women simply get diagnosed with the respective 
stereotypical illnesses more often (Eriksen and Kress 2008:153)? Eriksen and Kress 
(2008) point out that “mental health professionals have been found to label people 
disturbed if their behavior does not fit the professional’s gender ideals” (2008:154).  
In a study done by Rosvall and Nilsson in 2016, school nurses were interviewed 
regarding mental health and the students they serve. The qualitative study showed that the 
nurses believed girls were more likely to have mental health problems than boys, and that 
the boys were harder to get to open up about mental health (2016:5). Despite the nurses’ 
assumptions that girls were more likely to have mental health problems, it has been found 
that both boys and girls are equally affected, though girls are more likely to report it. 
Some of the nurses attributed this to hegemonic masculinity, which is the overarching 
societal ideal that being hyper-masculine is important. In a culture where asking for help 
and appearing weak is considered to be feminine, adolescent hyper-masculine boys will 
not risk their manliness, even when it puts their mental health in danger (Rosvall and 
!  3
3
Fusco: How Gender Differences Affect Mental Health Outcomes
Published by University of New Hampshire Scholars' Repository, 2017
Nilsson 2016:4-7). This can have implications for who gets treatment and when, which 
can have implications for mental illnesses in adulthood.  
Gendered mental illnesses may be based in the simple reality that women are 
more likely to experience internalizing mental illnesses such as depression and anxiety 
whereas men are more likely to experience externalizing mental illnesses such as 
substance abuse and conduct disorders (Boysen et al. 2014:561; Holtberg et al. 
2016:226). Holtberg and colleagues hypothesized this in 2016, looking at male and 
female adolescent patients in both outpatient and residential care facilities. With the 
outpatient care, the hypothesis was supported for both males and females. The girls in 
residential mental health treatment were found to exhibit externalizing behaviors over 
internalizing; furthermore, they were more likely than the boys in the residential care to 
exhibit these behaviors, which contradicts the rest of the literature I looked at (Holtberg et 
al. 2016:227). This raises the question of the effect residential care has on patients and 
concerns the issues of how mental illness is treated. 
Consequences 
 Mental illness can affect anyone, regardless of demographics. Yet it is undeniable 
that demographics can influence mental health in a serious way, whether it is class, race, 
geographic location, or gender. This section will primarily focus on how sexism and the 
oppression of women play a role in mental health outcomes. 
 Entity theory is the belief that personal traits and abilities are unchangeable 
(Schleider and Wisez, 2016:131). Schleider and Wisez hypothesized that girls were more 
likely to believe that their personal traits are static because of how they are treated by 
!  4
4
Perspectives, Vol. 9 [2017], Iss. 1, Art. 6
https://scholars.unh.edu/perspectives/vol9/iss1/6
adults. “Dweck and colleagues (1978) tested this possibility through several classroom-
based studies, finding that teachers verbally attributed failures to insufficient effort more 
often for boys than girls (Schleider and Wisez 2016:131)”. Therefore, the girls believe 
that their failures are simply because they are inherently less adequate. This belief that 
they are lesser than beginning so early in life has an impact on overall mental health and 
self-esteem. The sociological theory developed by Charles Cooley called the Looking 
Glass Self states that people will act in the ways that society expects them to act. When 
these adults imply that the girls are perceived as unable to change, they will act 
accordingly. This leads to girls experiencing more stress and therefore more mental 
illness, and can help be explained by both entity and ‘looking glass self’ theory (Shleider 
and Wisez 2016:144). 
 Women are more likely than men to experience stress and trauma in their lifetime 
(Klonoff, Landrine and Campbell 2000:93). Klonoff, Landrine and Campbell (2000) 
hypothesized that if they looked at women who experienced sexist-based stressors and 
women who did not, they would find that the women who did not experience theses 
stressors would not differ from men in terms of mental health symptoms. These stressors 
were things like being treated unfairly in work settings due to being a woman, hearing 
sexist jokes, and street harassment. This study did not include traumatic experiences such 
as rape or battery, which women are far more likely to experience these things than men. 
Once they began the study, with a sample of 180 women and in a prior study of over 
1,000 women, they could not find any who had never experienced these stressors, which 
in itself speaks volumes about the risk women are at for mental health problems. 
!  5
5
Fusco: How Gender Differences Affect Mental Health Outcomes
Published by University of New Hampshire Scholars' Repository, 2017
However, they did find that women who experienced these stressors less frequently did 
not differ from men in number of symptoms, whereas the women who did experience 
more stressors showed higher rates of symptoms for things like depression and anxiety 
(Klonoff, Landrine and Campbell 2016:98).  
 Two studies I looked at showed how the difference in men and women’s 
substance usage affected their mental health. This impacts consequences because when 
someone is abusing drugs it is typically intimately tied to mental illness (Drapalski, 
Bennett and Bellack 2011:812). Both studies pointed out that there was no difference in 
severity or number of substance abuse users by gender, but there was a difference in other 
factors (Drapalski, Bennett and Bellack 2011:813; Thamotharan and Conrad 2015:4) 
Drapalski and colleagues looked at substance abusers with existing mental illnesses, and 
concluded that the reasons men and women abuse drugs are different, as well as how they 
are introduced to them. They found that women with serious mental illness and substance 
use were likely to have been sexually abused (2011:814). The study also found that these 
women were more likely to be associating drugs with friends and significant others, as 
those are the people that they purchase from and use drugs with (2011:814). Similarly, 
Thamotharan and Conrad found that women’s ties to the substance abuse stems from 
close interpersonal relationships (2015: 5). Another similarity between studies is the 
finding that most girls who are substance abusers are survivors of trauma (2015:5). This 
ties back to women being more likely to experience trauma regardless of substance use. 
Since the findings show that women who experience trauma are more likely to abuse 
substances, this adds another stressor to their life, and more stressors means more 
!  6
6
Perspectives, Vol. 9 [2017], Iss. 1, Art. 6
https://scholars.unh.edu/perspectives/vol9/iss1/6
likelihood of mental illness. The effects of trauma and substance abuse have considerable 
implications for negative mental health outcomes.  
Recovery 
 Not only does gender influence mental health in terms of symptoms, but also in 
terms of recovery. Much of the literature found that men are far less likely to seek 
treatment for mental health problems, and this spanned across all ages, from middle 
school into adulthood. As previously mentioned, the middle school boys in the Rosvall 
and Nislon (2016) study would only go to the nurse for things regarding height measuring 
or physical pains, despite having interpersonal stress and potential mental health concerns 
(2016:6). Untreated stress and mental illness causes mental health to decline, and the 
stigma around men and boys expressing their feelings could be a reason why men tend to 
exhibit externalizing disorders.  
 Hjorth and colleagues (2016) conducted a study to see how mental health affected 
school dropout rates across genders, over a five year time span to include follow up 
studies. The results of the study were that while females were more likely to have poor 
mental health, men were more likely to drop out of school due to their mental health. The 
women were coping with their mental health challenges better, they cited this as being 
due to women getting more treatment, and therefore staying in school despite poor mental 
health (Hjorth et al. 2016:7). Education level is a significant factor in the path of one’s 
life course, and therefore the boys having higher dropout rates because of not being 
treated for their mental health has a severe impact on them and their future success as a 
whole. 
!  7
7
Fusco: How Gender Differences Affect Mental Health Outcomes
Published by University of New Hampshire Scholars' Repository, 2017
 According to one study done by Pattyn, Verhaeghe and Bracke (2015) “doing 
health is a form of doing gender”. Men are taught that it would be too feminine to ask for 
help, and therefore to keep their ideal of hegemonic masculinity intact, they do not seek 
help. This study by Pattyn and colleagues states that even when men do seek treatment, 
they prefer ones that are either just medication or not too time consuming (2015:1092). 
This indicates people do not get the help they need to treat their mental illness, they are 
less likely to recover or cope with it in helpful ways.  
Conclusion 
 Mental health and gender have an undeniable correlation, as found in the 
literature examined. Overall, the literature revealed that women are more likely to 
experience more mental health problems, internalizing disorders, and be more likely to 
recover. On the other hand, men are less susceptible to poor mental health, yet when they 
are mentally ill they mostly experience externalizing disorders, and they are less likely to 
recover. Much of the reasoning for phenomena things can be linked to socialization, 
hegemonic masculinity, stereotypes, and stigma.  
 The literature that was reviewed did make valid cases for their arguments, yet 
there were limitations as well. All of the literature was based on the gender binary, the 
idea that there are only two genders; man and woman, which provides a lot of insight into 
the majority of the population but leaves gaps in research for those who do not fit within 
the binary. Another gap would be race, and how race by gender is affected; much but not 
all of the literature focused on predominately white samples.  
!  8
8
Perspectives, Vol. 9 [2017], Iss. 1, Art. 6
https://scholars.unh.edu/perspectives/vol9/iss1/6
 This research is important to the field of sociology because it can help us to 
understand both gender and mental health better, as well as look into how socialization of 
children affects adults and overall populations. In the future, studies encompassing all 
genders should be done. Furthermore, studies on whether women and men actually 
experience internalizing and externalizing disorders more than the other, respectively, or 
if they are just diagnosed with them more because of gender stereotypes, should be done.  
Overall, gender socialization creates gender differences that in turn affect mental health 
outcomes.  
!  9
9
Fusco: How Gender Differences Affect Mental Health Outcomes
Published by University of New Hampshire Scholars' Repository, 2017
References  
Boysen, Guy, Ashley Ebersole, Robert Casner and Nykhala Coston. 2014. "Gendered 
Mental Disorders: Masculine and Feminine Stereotypes about Mental Disorders and 
their Relation to Stigma." Journal of Social Psychology 154(6):546-565 doi: 
10.1080/00224545.2014.953028.  
Drapalski, Amy, Melanie Bennett and Alan Bellack. 2011. "Gender Differences in 
Substance use, Consequences, Motivation to Change, and Treatment Seeking in 
People with Serious Mental Illness." Substance use & Misuse 46(6):808-818 doi: 
10.3109/10826084.2010.538460.  
Eriksen, Karen and Victoria E. Kress. 2008. "Gender and Diagnosis: Struggles and 
Suggestions for Counselors." Journal of Counseling & Development 86(2):152-162  
Hjorth, Cathrine F., Line Bilgrav, Louise S. Frandsen, Charlotte Overgaard, Christian 
Torp-Pedersen, Berit Nielsen and Henrik Bøggild. 2016. "Mental Health and School 
Dropout Across Educational Levels and Genders: A 4.8-Year Follow-Up Study." 
BMC Public Health 16:1-12. doi: 10.1186/s12889-016-3622-8.  
Holtberg, Tomas, Seth Olson and Kathleen Brown-Rice. 2016. "Adolescent Gender 
Differences in Residential Versus Outpatient Mental Health Treatment: A Meta-
Analysis." Journal of Mental Health Counseling 38(3):217-232. doi: 10.774/mehc.
38.3.03.  
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Perspectives, Vol. 9 [2017], Iss. 1, Art. 6
https://scholars.unh.edu/perspectives/vol9/iss1/6
Klonoff, Elizabeth A. and Hope Landrine. 2000. "Sexist Discrimination may Account for 
Well-Known Gender Differences in Psychiatric Symptoms." Psychology of Women 
Quarterly 24(1):93  
Pattyn, E., M. Verhaeghe and P. Bracke. 2015. "The Gender Gap in Mental Health 
Service use." Social Psychiatry & Psychiatric Epidemiology 50(7):1089-1095 doi: 
10.1007/s00127-015-1038-x.  
Rosvall, Per-Åke and Stefan Nilsson. 2016. "Gender-Based Generalisations in School 
Nurses' Appraisals of and Interventions Addressing Students' Mental Health." BMC 
Health Services Research 16:1-8  doi: 10.1186/s12913-016-1710-1.  
Schleider, Jessica L. and John R. Weisz. 2016. "Mental Health and Implicit Theories of 
Thoughts, Feelings, and Behavior in Early Adolescents: Are Girls at Greater Risk?" 
Journal of Social & Clinical Psychology 35(2):130-151  doi: 10.1521/jscp.
2016.35.2.130.  
Thamotharan, Sneha and Selby Conrad. 2015. "Gender-Responsive Considerations for 
Substance-using Adolescent Girls. (Cover Story)." Brown University Child & 
Adolescent Behavior Letter 31(12):1-6. doi: 10.1002/cbl.  
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How Gender Differences Affect Mental Health Outcomes

UNH Scholars' Repository

Perspectives2017 Article 68-1-2017How Gender Differences Affect Mental HealthOutcomesJulianna FuscoUniversity of New Hampshire, DurhamFollow this and additional works at: https://scholars.unh.edu/perspectivesThis Article is brought to you for free and open access by the Student Journals and Publications at University of New Hampshire Scholars' Repository.It has been accepted for inclusion in Perspectives by an authorized editor of University of New Hampshire Scholars' Repository. For more information,please contact nicole.hentz@unh.edu.Recommended CitationFusco, Julianna (2017) "How Gender Differences Affect Mental Health Outcomes," Perspectives: Vol. 9 : Iss. 1 , Article 6.Available at: https://scholars.unh.edu/perspectives/vol9/iss1/6Julianna Fusco SOC 599 Professor van Gundy 10/20/2016 How Gender Differences Affect Mental Health Outcomes Abstract This literature review will examine how mental health can be influenced by differences in gender, while being viewed through a sociological lens.  The paper is organized by the themes of gendered mental illness, consequences, and recovery. Introduction  Mental illness is an important topic, particularly because of how pervasive the issue has become recently all over the world, particularly in American news and media topics. Mental illness is stigmatized worldwide in a variety of ways and therefore can be overlooked in terms of research. While mental health is an individualized topic, demographics can influence it in a number of ways. Socioeconomic class, race, geographic location, occupation, sexuality, and a variety of other factors impact on an individual’s mental health outcome. This paper will look specifically at how gender can affect mental health.  Gender differences are not innate; they are a result of socialization and gender-specific experiences. Mental illnesses and their symptoms can be gendered in a way similar to how race is gendered; the way that African Americans are seen as the most masculine and Asians as the most feminine is similar to how certain mental illnesses are seen as masculine or feminine (Boysen Ebersole Casner and Coston 2014:546). This does not mean that these stereotypes are accurate, but rather that they have implications for !  11Fusco: How Gender Differences Affect Mental Health OutcomesPublished by University of New Hampshire Scholars' Repository, 2017society as a whole and how gender affects mental health. The differences between genders account for who is at risk, as well as who recovers. The literature I examined looks at a variety of ages with a focus on adolescents. Much of the research examined elementary through high school-aged people, including research on how school nurses affect mental health outcomes. Much of the literature points out the gender divide regarding internalizing versus externalizing behaviors. According to Boysen et al, (2014) “Generally speaking, externalizing symptoms involve disturbance in conduct and internalizing symptoms involve disturbances in feelings”. Women are more likely to experience mental illnesses with internalizing symptoms, such as low self esteem and anxiety, than men, while men are more likely to experience externalizing symptoms and the mental illnesses that go along with them (Pattyn, Verhaeghe and Bracke 2015:1089). This is how the gendering of mental illnesses begins, and thus helps to predict who is at risk and who recovers. The importance of this topic in the field of sociology is substantial. Mental health directly affects many people, and in order for it to be fully understood, a sociological approach must be taken. To examine mental health with regard to gender differences provides context on the unique experiences of each gender, and with this understanding can help to explain mental illnesses as well as provide insight on how to treat them accordingly. Gendered Mental Illness   The gendering of mental illness refers to the ways in which feminine or masculine qualities are assigned to different mental illnesses and mental illness symptoms. !  22Perspectives, Vol. 9 [2017], Iss. 1, Art. 6https://scholars.unh.edu/perspectives/vol9/iss1/6Stereotypes about men and women are what lead to this. For example women are thought of as overly emotional, and therefore emotional illnesses such as depression and anxiety are thought to be more feminine (Boysen et al. 2014:547; Holtberg, Olson and Brown-Rice 2016:225). This has real-world implications, as Boysen and colleagues point out that mental illnesses with a masculine stereotype, such as substance abuse or anger management problems, are actually more prevalent amongst men, and the same findings were found for women and “feminine” mental illnesses (2014:561). The question this raises though, is are these disorders actually more prevalent amongst their corresponding gender stereotype, or do men and women simply get diagnosed with the respective stereotypical illnesses more often (Eriksen and Kress 2008:153)? Eriksen and Kress (2008) point out that “mental health professionals have been found to label people disturbed if their behavior does not fit the professional’s gender ideals” (2008:154).  In a study done by Rosvall and Nilsson in 2016, school nurses were interviewed regarding mental health and the students they serve. The qualitative study showed that the nurses believed girls were more likely to have mental health problems than boys, and that the boys were harder to get to open up about mental health (2016:5). Despite the nurses’ assumptions that girls were more likely to have mental health problems, it has been found that both boys and girls are equally affected, though girls are more likely to report it. Some of the nurses attributed this to hegemonic masculinity, which is the overarching societal ideal that being hyper-masculine is important. In a culture where asking for help and appearing weak is considered to be feminine, adolescent hyper-masculine boys will not risk their manliness, even when it puts their mental health in danger (Rosvall and !  33Fusco: How Gender Differences Affect Mental Health OutcomesPublished by University of New Hampshire Scholars' Repository, 2017Nilsson 2016:4-7). This can have implications for who gets treatment and when, which can have implications for mental illnesses in adulthood.  Gendered mental illnesses may be based in the simple reality that women are more likely to experience internalizing mental illnesses such as depression and anxiety whereas men are more likely to experience externalizing mental illnesses such as substance abuse and conduct disorders (Boysen et al. 2014:561; Holtberg et al. 2016:226). Holtberg and colleagues hypothesized this in 2016, looking at male and female adolescent patients in both outpatient and residential care facilities. With the outpatient care, the hypothesis was supported for both males and females. The girls in residential mental health treatment were found to exhibit externalizing behaviors over internalizing; furthermore, they were more likely than the boys in the residential care to exhibit these behaviors, which contradicts the rest of the literature I looked at (Holtberg et al. 2016:227). This raises the question of the effect residential care has on patients and concerns the issues of how mental illness is treated. Consequences  Mental illness can affect anyone, regardless of demographics. Yet it is undeniable that demographics can influence mental health in a serious way, whether it is class, race, geographic location, or gender. This section will primarily focus on how sexism and the oppression of women play a role in mental health outcomes.  Entity theory is the belief that personal traits and abilities are unchangeable (Schleider and Wisez, 2016:131). Schleider and Wisez hypothesized that girls were more likely to believe that their personal traits are static because of how they are treated by !  44Perspectives, Vol. 9 [2017], Iss. 1, Art. 6https://scholars.unh.edu/perspectives/vol9/iss1/6adults. “Dweck and colleagues (1978) tested this possibility through several classroom-based studies, finding that teachers verbally attributed failures to insufficient effort more often for boys than girls (Schleider and Wisez 2016:131)”. Therefore, the girls believe that their failures are simply because they are inherently less adequate. This belief that they are lesser than beginning so early in life has an impact on overall mental health and self-esteem. The sociological theory developed by Charles Cooley called the Looking Glass Self states that people will act in the ways that society expects them to act. When these adults imply that the girls are perceived as unable to change, they will act accordingly. This leads to girls experiencing more stress and therefore more mental illness, and can help be explained by both entity and ‘looking glass self’ theory (Shleider and Wisez 2016:144).  Women are more likely than men to experience stress and trauma in their lifetime (Klonoff, Landrine and Campbell 2000:93). Klonoff, Landrine and Campbell (2000) hypothesized that if they looked at women who experienced sexist-based stressors and women who did not, they would find that the women who did not experience theses stressors would not differ from men in terms of mental health symptoms. These stressors were things like being treated unfairly in work settings due to being a woman, hearing sexist jokes, and street harassment. This study did not include traumatic experiences such as rape or battery, which women are far more likely to experience these things than men. Once they began the study, with a sample of 180 women and in a prior study of over 1,000 women, they could not find any who had never experienced these stressors, which in itself speaks volumes about the risk women are at for mental health problems. !  55Fusco: How Gender Differences Affect Mental Health OutcomesPublished by University of New Hampshire Scholars' Repository, 2017However, they did find that women who experienced these stressors less frequently did not differ from men in number of symptoms, whereas the women who did experience more stressors showed higher rates of symptoms for things like depression and anxiety (Klonoff, Landrine and Campbell 2016:98).   Two studies I looked at showed how the difference in men and women’s substance usage affected their mental health. This impacts consequences because when someone is abusing drugs it is typically intimately tied to mental illness (Drapalski, Bennett and Bellack 2011:812). Both studies pointed out that there was no difference in severity or number of substance abuse users by gender, but there was a difference in other factors (Drapalski, Bennett and Bellack 2011:813; Thamotharan and Conrad 2015:4) Drapalski and colleagues looked at substance abusers with existing mental illnesses, and concluded that the reasons men and women abuse drugs are different, as well as how they are introduced to them. They found that women with serious mental illness and substance use were likely to have been sexually abused (2011:814). The study also found that these women were more likely to be associating drugs with friends and significant others, as those are the people that they purchase from and use drugs with (2011:814). Similarly, Thamotharan and Conrad found that women’s ties to the substance abuse stems from close interpersonal relationships (2015: 5). Another similarity between studies is the finding that most girls who are substance abusers are survivors of trauma (2015:5). This ties back to women being more likely to experience trauma regardless of substance use. Since the findings show that women who experience trauma are more likely to abuse substances, this adds another stressor to their life, and more stressors means more !  66Perspectives, Vol. 9 [2017], Iss. 1, Art. 6https://scholars.unh.edu/perspectives/vol9/iss1/6likelihood of mental illness. The effects of trauma and substance abuse have considerable implications for negative mental health outcomes.  Recovery  Not only does gender influence mental health in terms of symptoms, but also in terms of recovery. Much of the literature found that men are far less likely to seek treatment for mental health problems, and this spanned across all ages, from middle school into adulthood. As previously mentioned, the middle school boys in the Rosvall and Nislon (2016) study would only go to the nurse for things regarding height measuring or physical pains, despite having interpersonal stress and potential mental health concerns (2016:6). Untreated stress and mental illness causes mental health to decline, and the stigma around men and boys expressing their feelings could be a reason why men tend to exhibit externalizing disorders.   Hjorth and colleagues (2016) conducted a study to see how mental health affected school dropout rates across genders, over a five year time span to include follow up studies. The results of the study were that while females were more likely to have poor mental health, men were more likely to drop out of school due to their mental health. The women were coping with their mental health challenges better, they cited this as being due to women getting more treatment, and therefore staying in school despite poor mental health (Hjorth et al. 2016:7). Education level is a significant factor in the path of one’s life course, and therefore the boys having higher dropout rates because of not being treated for their mental health has a severe impact on them and their future success as a whole. !  77Fusco: How Gender Differences Affect Mental Health OutcomesPublished by University of New Hampshire Scholars' Repository, 2017 According to one study done by Pattyn, Verhaeghe and Bracke (2015) “doing health is a form of doing gender”. Men are taught that it would be too feminine to ask for help, and therefore to keep their ideal of hegemonic masculinity intact, they do not seek help. This study by Pattyn and colleagues states that even when men do seek treatment, they prefer ones that are either just medication or not too time consuming (2015:1092). This indicates people do not get the help they need to treat their mental illness, they are less likely to recover or cope with it in helpful ways.  Conclusion  Mental health and gender have an undeniable correlation, as found in the literature examined. Overall, the literature revealed that women are more likely to experience more mental health problems, internalizing disorders, and be more likely to recover. On the other hand, men are less susceptible to poor mental health, yet when they are mentally ill they mostly experience externalizing disorders, and they are less likely to recover. Much of the reasoning for phenomena things can be linked to socialization, hegemonic masculinity, stereotypes, and stigma.   The literature that was reviewed did make valid cases for their arguments, yet there were limitations as well. All of the literature was based on the gender binary, the idea that there are only two genders; man and woman, which provides a lot of insight into the majority of the population but leaves gaps in research for those who do not fit within the binary. Another gap would be race, and how race by gender is affected; much but not all of the literature focused on predominately white samples.  !  88Perspectives, Vol. 9 [2017], Iss. 1, Art. 6https://scholars.unh.edu/perspectives/vol9/iss1/6 This research is important to the field of sociology because it can help us to understand both gender and mental health better, as well as look into how socialization of children affects adults and overall populations. In the future, studies encompassing all genders should be done. Furthermore, studies on whether women and men actually experience internalizing and externalizing disorders more than the other, respectively, or if they are just diagnosed with them more because of gender stereotypes, should be done.  Overall, gender socialization creates gender differences that in turn affect mental health outcomes.  !  99Fusco: How Gender Differences Affect Mental Health OutcomesPublished by University of New Hampshire Scholars' Repository, 2017References  Boysen, Guy, Ashley Ebersole, Robert Casner and Nykhala Coston. 2014. "Gendered Mental Disorders: Masculine and Feminine Stereotypes about Mental Disorders and their Relation to Stigma." Journal of Social Psychology 154(6):546-565 doi: 10.1080/00224545.2014.953028.  Drapalski, Amy, Melanie Bennett and Alan Bellack. 2011. "Gender Differences in Substance use, Consequences, Motivation to Change, and Treatment Seeking in People with Serious Mental Illness." Substance use & Misuse 46(6):808-818 doi: 10.3109/10826084.2010.538460.  Eriksen, Karen and Victoria E. Kress. 2008. "Gender and Diagnosis: Struggles and Suggestions for Counselors." Journal of Counseling & Development 86(2):152-162  Hjorth, Cathrine F., Line Bilgrav, Louise S. Frandsen, Charlotte Overgaard, Christian Torp-Pedersen, Berit Nielsen and Henrik Bøggild. 2016. "Mental Health and School Dropout Across Educational Levels and Genders: A 4.8-Year Follow-Up Study." BMC Public Health 16:1-12. doi: 10.1186/s12889-016-3622-8.  Holtberg, Tomas, Seth Olson and Kathleen Brown-Rice. 2016. "Adolescent Gender Differences in Residential Versus Outpatient Mental Health Treatment: A Meta-Analysis." Journal of Mental Health Counseling 38(3):217-232. doi: 10.774/mehc.38.3.03.  !  1010Perspectives, Vol. 9 [2017], Iss. 1, Art. 6https://scholars.unh.edu/perspectives/vol9/iss1/6Klonoff, Elizabeth A. and Hope Landrine. 2000. "Sexist Discrimination may Account for Well-Known Gender Differences in Psychiatric Symptoms." Psychology of Women Quarterly 24(1):93  Pattyn, E., M. Verhaeghe and P. Bracke. 2015. "The Gender Gap in Mental Health Service use." Social Psychiatry & Psychiatric Epidemiology 50(7):1089-1095 doi: 10.1007/s00127-015-1038-x.  Rosvall, Per-Åke and Stefan Nilsson. 2016. "Gender-Based Generalisations in School Nurses' Appraisals of and Interventions Addressing Students' Mental Health." BMC Health Services Research 16:1-8  doi: 10.1186/s12913-016-1710-1.  Schleider, Jessica L. and John R. Weisz. 2016. "Mental Health and Implicit Theories of Thoughts, Feelings, and Behavior in Early Adolescents: Are Girls at Greater Risk?" Journal of Social & Clinical Psychology 35(2):130-151  doi: 10.1521/jscp.2016.35.2.130.  Thamotharan, Sneha and Selby Conrad. 2015. "Gender-Responsive Considerations for Substance-using Adolescent Girls. (Cover Story)." Brown University Child & Adolescent Behavior Letter 31(12):1-6. doi: 10.1002/cbl.  !  1111Fusco: How Gender Differences Affect Mental Health OutcomesPublished by University of New Hampshire Scholars' Repository, 2017

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How Gender Differences Affect Mental Health Outcomes

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