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What is happening with the mental health of older female students? The figures paint a stark picture.

The - which tracks around 19,000 young people born across England, Scotland, Wales and Northern Ireland in 2000 to 2002 - found that at age 14, some 23 per cent of young women had self-harmed (compared with 9 per cent of young men). By the age of 17, that figure had risen to 28 per cent (and 20 per cent for young men).

And across all demographics, post-traumatic stress disorder is now .

Meanwhile, from the NSPCC for suicidal thoughts are girls, and suicide is the (and the fifth most common for boys).

Women of all ages are known to experience higher rates of depression and anxiety: some estimate that , while a reported that young women were three times more likely than young men to experience common mental health problems.

And these challenges can have multiple long-term consequences, from poorer educational outcomes to midlife health, and even early mortality.

Girls’ mental health: a new problem?

Despite many assuming otherwise, this gender imbalance is not new. Praveetha Patalay is an adolescent mental health researcher based at the MRC Unit for Lifelong Health and Ageing and the Centre for Longitudinal Studies at University College London, and she says that, while the overall prevalence of mental health challenges has increased in the youth population across the board in recent years, the gender gap has remained.

And as Tamsin Ford, professor of child and adolescent psychiatry at the University of Cambridge, states: “As long as there’s been psychiatric epidemiological data, teenage girls have been doing worse than teenage boys.”

So, why is this the case? It’s an area that is frustratingly under-researched, Patalay explains.

“There’s an inherent assumption that it must be a biological thing,” she says. “But people have tried to find clear biological markers, and there is very little good evidence for that. There’s evidence that suggests it can’t be purely biological, for example, looking at the gender gap in adolescent mental health across many countries.”

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Patalay was part of of more than 550,000 adolescents across 73 countries, which found that girls do consistently have worse average mental health than boys across four key measures (psychological distress, life satisfaction, eudaemonia and hedonia).

However, if biology were the key factor, she explains, the gender gap would be similar across the world. And it isn’t.

“The gap is actually really different across countries,” she says. “There are some countries in which the gap is tiny [such as those in the Eastern Mediterranean], and some where it is very big, like in the UK. If it was a purely biological phenomenon, you would expect it to be more globally consistent.”

Interestingly, the gap is often larger in countries that are more gender equal - that is, where the rights and opportunities of men and women are more aligned. There are various sociological factors that could be feeding into this, Patalay explains.

“There is some evidence that girls in more gender-equal countries compare themselves to everyone, whereas in less gender-equal countries, girls compare themselves to girls and boys to boys.”

This could also be a question of expectation versus reality, she continues, where it may be “potentially worse to expect the world to not be patriarchal, sexist, and then find that the world constantly is, rather than growing up not expecting it”. But, she adds, “we don’t have any perfectly gender-equal countries where we can actually test these hypotheses”.

The diagnosis difference

In addition to these sociological factors, there are also potential differences in how we diagnose behaviours in boys and girls that could affect the perceived prevalence of mental health challenges in each gender.

The received wisdom is that neurodevelopmental conditions (such as ADHD and autism) are more likely to affect boys, while emotional disorders (such as anxiety, depression and eating disorders) are more common in young women, explains Ford.

But this can bring disparity in mental health diagnosis, she continues, whereby we “underdiagnose and undertreat” young women, especially in primary school.

She points to , also using the MCS data, in which ADHD symptoms between boys and girls in the UK were matched, but girls were found to be “less likely to be referred for treatment, and if they were seen for treatment, they were less likely to be given medication”.

“There’s no clinical reason for that, because they were matching on the symptoms,” she continues. “But the ratio in the population is about three boys to one girl with ADHD diagnoses and it’s similar for autism. By the time you get to clinics, it’s nine to one.

“We know that boys are more vulnerable to neurodevelopmental conditions, but we don’t seem to recognise girls with those difficulties.”

This means that at primary age, boys and girls are roughly “equally affected” in terms of mental health diagnosis, she continues, which is “probably about the balance of emotional disorders to neurodevelopmental disorders in the preschool and primary age”.

“But by the time you get to early teens, the girls start taking off,” she says. “When I was a trainee, you could see it because we had different colour folders, green for boys and buff for girls. The clinics that focused on primary school kids were nearly all green folders, and the other side of the shelf, which was dealing with adolescents, were nearly all buff folders.”

The after-effects of the pandemic

How did the Covid pandemic - so often cited as a significant cause of mental health challenges in young people - affect this pre-existing gender split? The lockdowns appear to have “amplified” an existing trend, Ford says.

The incidence of eating disorders saw a particular spike, with one study finding that than would be expected for girls aged 13-16 in the two years after the pandemic began, and 32 per cent higher for girls aged 17-19. Diagnoses in boys, however, remained broadly as expected.

Meanwhile, found the likelihood of girls “hiding poor mental health or distress” had risen from 60 per cent to 80 per cent since the start of the pandemic. The same report also highlights “unhealthy perfectionism” and “extreme self-control” having increased from 20 per cent to 80 per cent.

“It’s not that it’s a novel pattern: it’s an accentuated pattern,” Ford explains. “As we went into the pandemic, we’d already had a deterioration from the beginning of the century in terms of the numbers of youngsters with anxiety and depression, and that was affecting girls more.

“But in the follow-up surveys over Covid, the increase in the prevalence of mental health conditions is in all age groups and both genders, but it’s accentuated in teenage girls. And those conditions are often self-harm, anxiety, depression and eating disorders.”

‘I don’t think we’re going to put the social media genie back in the box’

What about the impact of social media? Phones, and what young people do on them, have been widely cited as a trigger and accelerator of mental health issues, particularly among girls.

However, this is in need of more research, Ford argues.

“Some research finds that young people with poor mental health spend more time on social media and feel more negatively about their experiences while using it but nearly all this work is cross-sectional,” she explains.

“If young people reported their social media use and mental health at the same time, we don’t know if poor mental health is the cause or result - so this suggested link doesn’t necessarily mean causality.

“If you’re anxious and depressed, you might be going online more because of that. We need longitudinal studies that follow young people’s mental health and social media use over time, and we don’t have very many of them.”

She adds that there is “no doubt that for anorexia and self-harm, for example, there are some absolutely awful sites that you don’t need any kind of research to demonstrate that they really ought to be blocked or taken down as they’re promoting both conditions as an acceptable lifestyle choice, and many are very, very graphic”.

“But I don’t think we’re going to put the social media genie back in the box,” she adds. “It’s going to be like cars: we’re going to have to help people to negotiate using them safely, as far as we can.”

‘A linear relationship’

Others, though, are more convinced of a negative directional link. John Gallacher is professor of cognitive health at the University of Oxford and is leading on , a 10-year research project that is looking to recruit 50,000 young people across the UK.

The project is still in its infancy, but already hit the headlines in October with an early finding that young people are spending as many as eight hours a day on their phones, and that there is a “a linear relationship between higher rates of anxiety and depression and time spent networking on social media sites”.

“It may not be directly causal because these things are complex, but nevertheless, it would be very surprising to me if you stopped using your phone and your mental health did not improve,” Gallacher says. “We are setting up trials to explore that because otherwise there will always be the debate over the direction of causation.”

The Australian government, too, seems convinced, recently announcing under the age of 16.

Does social media affect girls more than boys, though? While the negative effects will hit all young people, research suggests that from social media use than boys, particularly in relation to sexualised pictures and self-image.

“It’s not that boys are immune,” Gallacher continues. “Our data shows that social media use is correlated with higher anxiety in boys as well. But if you have an overall lower level of anxiety, as boys do, the impact isn’t as great.

“I think it’s really, really hard to be a young girl these days. The pressures on you in terms of your look and your social prestige are enormous, and often entirely unrealistic.

“And a thing about social media is that whatever is considered perfect at the time gets promoted, whereas in one’s smaller real-world ecosystem there’s a much better sense of perspective, not just in terms of the breadth of data that you have but the depth of data.”

Aside from social media, sociological forces and diagnosis issues, what other forces that affect mental health may be affecting girls more acutely?

There are myriad other well-known risk factors for poor mental health in all young people, explains Patalay, including “genetic predisposition, poverty, violence and behaviours like being sedentary, smoking and taking drugs”, but it’s as yet unknown exactly how these affect young women and men differently.

“We’re doing a big multi-country project at the moment to look at risk factors for mental ill-health, but women might experience more of them so they’re disproportionately affected.”

She offers the example of sexual violence, which is five times more likely to be experienced by young women than young men: a 2022 analysis of the MCS found that in the previous 12 months.

“Essentially, sexual violence in adolescence is bad for mental health for both girls and boys but girls experience it far, far more. So on the population level, it’s worse for girls because more women experience this risk factor.”

‘It’s really, really hard to be a young girl these days. The pressures on you are enormous’

Alongside all this complexity you have education. What role are schools playing in the mental health of girls? Can they help reduce the imbalance in their female students, or do they accelerate it?

Patalay says that while more research is needed into protective factors for young people’s mental health, found the significant impact that schools can have.

It found that a “more positive school climate” meant almost 25 per cent less chance of having “high levels of difficulties” with “emotional and behavioural symptoms”.

“What we found is probably what you’d expect: in schools where children feel connected and safe, and where they can speak to an adult in the school, young people’s mental health was better,” she explains.

“But we also found what we call an interaction with gender, where the effect of a better climate was stronger for girls than boys.

“Again, it’s good for everyone, but it’s possible that it’s more protective for girls because they are more vulnerable to emotional symptoms and distress at that age.

“Increasing those protective factors is good for everyone’s mental health, but it’s possible that some of them will disproportionately end up being better for girls.

“But that’s OK, because many, many more girls are struggling with their mental health.”

The importance of referrals

Ford likewise highlights the importance of good relationships for good mental health (for girls and boys), particularly around “school connectedness and being actively engaged”.

And where staff are seeing issues, she continues, it’s important to refer to experts, even while waiting lists are long (a 2024 report found that to be seen by Camhs).

Ford points to the many excellent resources of support available - including the , and a new self-harm support resource developed by members of her team, entitled - but says referrals should still be made.

“I would still be referring because we can’t just pretend it’s not there,” she says. “We wouldn’t if it was diabetes or cancer, so we shouldn’t for mental health either. Camhs is seeing more people, but the problem is that the number of people needing seeing has increased faster.

“If a school doesn’t have a mental health support team, they should be thinking about getting some kind of mental health intervention on site, because poor mental health gets in the way of how people can access education.”

Ultimately, the reasons for the mental health struggles experienced by teenage girls are complex and firm conclusions about their drivers are, as yet, elusive. Popular wisdom suggests that social media may be playing a role, but it would be an oversimplification to believe it’s the sole culprit.

Amid the intricate interplay of societal pressures, biological factors and individual experiences, more research is needed, along with greater awareness of what life is really like for these young women. It seems there will be no easy fixes; instead, it will require investment in comprehensive support systems, including accessible mental health services, and a focus on fostering genuine connections within communities.