Gender gaps in mental distress and help-seeking: testing convergence across 111 countries

Background

Gender differences in mental health follow a well-established pattern: women report more depressive symptoms, while men are less likely to seek professional help. The convergence hypothesis suggests these gaps should narrow as societal gender equality increases, but evidence is unlcear. We examine how country-level gender equality is associated with gender differences in self-reported mental health problems and mental health service use across 111 countries.

Methods

We analyse individual-level data from the Wellcome Global Monitor 2020, a cross-sectional survey covering 111 countries with nationally representative samples. Outcomes were self-reported lifetime mental health problems and use of professional mental health services. These data were linked to the UNDP Gender Inequality Index (GII), reverse-coded so higher values indicate greater gender equality. Multilevel logistic regression models with gender interaction terms were used, adjusting for individual and country-level covariates.

Findings

Across both genders, greater gender equality is associated with lower levels of reported mental health problems (OR = 0.78, 95% CI [0.63–0.98]). In interaction models, greater gender equality is associated with a widening gender gap in reported mental health problems (interaction OR = 0.88, 95% CI [0.85–0.90]), reflecting fewer problems among men in more gender-equal contexts, while no significant association is observed for women. Greater gender equality is also associated with higher levels of help-seeking, with a stronger increase among women (interaction OR = 0.88, 95% CI [0.83–0.94]).

Interpretation

Greater gender equality is associated with better mental health and higher use of mental health services overall. However, this does not support the convergence hypothesis, as improvements are stronger for men’s mental health and women’s help-seeking. Gender equality may improve population health without uniformly reducing inequalities between men and women.

Key messages

• Greater gender equality is associated with better mental health and higher use of mental health services across populations.

• These benefits are not evenly shared: men show larger mental health gains, while women show stronger increases in help-seeking, challenging the convergence hypothesis.