What about the boys? A study finds stigma around mental health influences how parents seek support for sons vs. daughters

There’s an established difference between how and if adult men and women seek help for their mental health. A Santa Clara public health professor wants to know if those differences are imposed by parents.

Little Boys Nursery Rhyme. Courtesy Victoria and Albert Museum.
Whereas little girls are made of sugar and spice and everything nice, little boys are reportedly made of snips, snails, and puppy-dog tails. Do the discrepancies laid out in the old English nursery rhyme hold up today when it comes to mental health stigma? Image courtesy Victoria and Albert Museum.

Are the kids actually alright? For all the societal talk of children’s resilience, there’s an equal amount of concern about the state of their mental health. According to the U.S. Department of Health and Human Services, an estimated one in five U.S. children ages 3-17 has a mental, emotional, developmental, or behavioral disorder. And yet, the Centers for Disease Control and Prevention says that less than a quarter of these children receive help addressing their issues.

In her research, Santa Clara University public health Assistant Professor Alice P. Villatoro is interested in identifying—and discussing ways to eliminate—the various obstacles blocking access to adequate mental health care. “One of the biggest barriers happens to be stigma,” Villatoro says, referring to the negative attitudes, beliefs, and stereotypes people may hold regarding those who experience mental health conditions. In considering how this affects young people’s mental health in particular, Villatoro wants to know how stigma influences parents in seeking help for their children.

Partnering with researchers from UC Riverside and Columbia University, where she did her postdoctoral training, Villatoro studied data collected from a school district in Texas that followed 11 to 13-year-old students over the course of a few years. Both the students and their parents responded to various surveys about their conceptions of mental health and access to care. 

“We were interested in understanding how parents were involved in the process, and the question of how stigma influences their behaviors around getting care for their children,” Villatoro says. “And then I started wondering, well, if stigma affects help-seeking, how is gender unfolding there?” The findings were recently published in the journal Stigma and Health.

Among adults, Villatoro explains, there’s a very clear, established difference in help-seeking patterns between women and men. Women, on average, are much more likely to seek mental health care—whether informally, such as support from friends, family, or religious leaders, or formally, through a physician or therapist. “So the question was, do these patterns emerge early in life, and are they imposed by parents?” Villatoro asks.

Middle school students in the study self-identified as boys or girls and were asked whether or not they perceived a problem within themselves, how much knowledge they had about mental health, and about their willingness to interact with peers who had established mental health issues. They then were randomly assigned to participate in one or more anti-stigma interventions. For example, a young person with a mental illness visited their classroom to share experiences, or their teacher presented a curriculum on mental illness and stigma, or they were exposed to anti-stigma written materials. Overwhelmingly, students reported improvements in their attitudes about getting help for mental health issues, especially if they participated in the curriculum intervention.

Among adults, there’s a very clear, established difference in help-seeking patterns between women and men. … “So the question becomes, do these patterns emerge early in life, and are they imposed by parents?”

Meanwhile, their parents—who did not receive such interventions—were asked if they could recognize different issues, whether they would seek help for their child if a mental health issue was detected, whether their child had ever taken medication for a mental health problem, and how willing they’d be to allow their child to engage with a peer who had known mental health issues.

In general, when looking at children with high self-reported mental health symptoms, “parents who had more knowledge about mental health or positive attitudes toward help-seeking were more likely to seek help for their children regardless of gender,” says Villatoro. However, there was a noted difference between the parents of boys and girls when parents recognized a mental health problem in their child. “It didn’t matter if a parent could label their son as having a mental health issue; they still didn’t seek services for him,” she says. “But it did matter for girls. So, if a parent labeled their daughter’s symptoms as a mental health issue, they were more likely to engage with healthcare providers.” Parents who labeled their girls as having a mental health problem were almost two-times more likely to engage in medical support than parents of boys who applied the same label. 

What’s up with the disparity? First, there are issues around labeling, which Villatoro says is a sort of double-edged sword. On one hand, labeling something as a mental health symptom can be useful for understanding how to respond to someone’s needs. On the other hand, it can lead to stigmatization and “othering.” Secondly, though parents weren’t asked why they were hesitant to seek mental health help for their sons, Villatoro says it could point to gender stereotyping and expectations of masculinity within the wider culture.

“Boys will be boys, and they have to toughen up, right?” she says. “Plus, when you look at patterns of mental illness among children, boys tend to have more externalizing problems such as aggressive behaviors or hyperactivity or attention problems, all of which could just be couched as ‘boy behavior.’ Whereas if a girl is experiencing some of those symptoms, that could be seen as more problematic.” 

To combat these inequalities, Villatoro says the fight has to happen on multiple levels. The original study found that classroom interventions that focused on increasing knowledge on mental health issues and building empathy toward those who struggle were hugely successful at improving students’ notions around mental health. “But the curriculum did not address gender patterns around help-seeking and stigma. Unfortunately, our society has created this narrative that men should not seek help, that it’s a sign of weakness,” Villatoro says. Early intervention combating such gender stereotypes is critical. 

Moreover, Villatoro says such interventions need to include greater gender diversity. “How do we incorporate multiple perspectives of gender? Because we do see nonbinary and transgender people struggle with mental health issues at higher rates [than their cisgender peers],” she says. Then, public health campaigns, via social and traditional media, and policy discussions must include a greater focus on mental health. “There’s a lot of work that needs to be done,” she says.

Finally, parents need to be involved in their kids’ mental health care education from the jump. They also need to be educated themselves since they play such an important role in finding mental health care for their children. And the earlier in a kid’s life that a parent can advocate for them, the better, Villatoro says. “Because when you start young, you’re helping to develop a society where, as adults, these children can access services, identify issues on their own, and be more empathetic toward peers who are struggling.” And what parent wouldn’t want their kid to live in a world like that?

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