The Intersection of Gender and Mental Well-Being among Adolescents in Pakistan: Challenges, Strategies, and Future Recommendations

Abstract

This chapter delves into the nexus of mental well-being, gender dynamics, and contextual intricacies in Pakistan. Acknowledging mental health’s foundational role in human development, particularly during the post-COVID-19 landscape, immense need of comprehensive mental health action plans, with a focus on late adolescents and young adults is highlighted. The narrative unfolds the complex web of adolescent mental health challenges, woven by individual attributes, behaviors, and socioeconomic conditions. Adolescence emerges as a pivotal phase for identity exploration, marked by activities challenging established gender norms. Gender, viewed as a sociocultural construct and a dynamic continuum, is explored in its role in shaping behaviors and expectations. The chapter underscores the early imprinting of gender roles through familial, peer, and cultural channels. With a commitment to understanding these dynamics deeply, the chapter aims to offer nuanced insights. The overarching objective is to inform future research, influence policies, and guide interventions fostering mental well-being in Pakistan’s diverse and globalized society.

1. Introduction

The fortification of mental well-being is a key pillar in the panorama of human development, shaping our minds and how we interact with the world, our skills in managing interpersonal relationships, and our resilience in facing adversities. The significance of this facet of human experience cannot be overstated, as the repercussions of inadequate mental health reverberate throughout society.

In recent years, post-COVID-19 mental health has received a lot of limelight in public health policy. In 2013, a resolution was passed by the World Health Organization (WHO) that called for a comprehensive mental health action plan for the next years to be followed in each country [1]. The population that was targeted to receive more attention was late adolescents and young adults. It is considered that half of all mental health issues may exhibit in adulthood, but the seeds are usually sown by age 14 [2]. Worldwide, approximately 14% of individuals, aged 10–19, have an experience with a mental disorder, contributing to 13% of the overall disease burden in this age bracket. Primary contributors to illness and disability in adolescents are depression, anxiety, and behavioral disorders. Furthermore, suicide stands as the fourth most prevalent cause of mortality among those aged 15–29 [3]. It is an enigma to see that mental health concerns are the most common ones and yet are the most taboo topic to be discussed [4, 5].

Adolescent mental health challenges arise from the intricate and dynamic interplay of individual attributes and behaviors, such as genetic elements, emotional and social intelligence, and so on. More factors such as social and economic conditions, including social support, financial dependency and paucity, and educational opportunities, further drag toward the compromised mental health pitfall. The larger sociocultural environment, influenced by factors such as national-level social and economic policies, further impacts mental well-being [5]. The interactions could be turbulent or self-motivated resulting in either safeguarding or posing risks to mental health.

Adolescence is a period of curiosity, experimentation, and learning about their identity. In this age period, boys and girls indulge in activities, which might not conform with socially constructed gender behaviors. Gender is a sociocultural construct that presets characteristics that are considered suitable and acceptable by society to be exhibited by men and women, such as norms, demeanor, and forethought [6, 7]. Gender is considered as a continuum; it is a self-concept that everyone develops during their personal development, and therefore, it is subject to change [8]. Gender roles are ingrained from an early age through socialization and education received by boys and girls. This cultural upbringing and learning occurs within the family setting, among friends and peers and are also influenced by cultural representations in the arts, media, and religion [9, 10, 11]. A study on school-going adolescents aged 15–18 years in Pakistan reported that 53.2% of the 400 students suffered from depression and anxiety [12].

This chapter seeks to navigate the multifaceted terrain of gender, mental health, and the unique contextual realities of Pakistan with a deep commitment to understanding these intricate links. By offering this comprehensive exploration, we aspire to provide a deeper and more nuanced understanding of the complexities inherent to this intersection. We aim to shed light on these complexities and offer insights that can inform future research, shape policies, and guide interventions aimed at promoting mental well-being in a diverse and globalized society.

2. Cultural aspect and mental health

In Pakistan, the relationship between gender and the mental health of adolescents is a complicated and multidimensional topic [13]. This section will examine the cultural aspects contributing to adolescents’ mental health in the Pakistani context, covering the “what,” “how,” “when,” and “why” of these realities. This analysis will lay the groundwork for comprehending the opportunities and difficulties in tackling this important problem in the Pakistani context. The prevalent gender preferences and role expectations are a crucial cultural aspect that has a major impact on the mental wellness of adolescents in Pakistan [14]. Pakistan’s cultural customs and conventions frequently impose strict gender roles with distinct expectations for men and women. These demands place a great deal of strain on teenagers, who may experience disorientation and identity crises as they explore their own identities and go through sexual transitions. For example, in Pakistan, conventional gender roles typically require men to earn the family’s living, while women should concentrate on taking care of the home. Young boys and girls who might not fit into these roles are under tremendous strain due to this inflexible gender split, which can cause stress and mental health problems. Furthermore, adolescents, particularly girls, are subjected to harsh expectations due to the strongly rooted concept of “honor” in Pakistani society. If they feel that their acts would bring dishonor to their families, they may experience great emotional pain. Depression and anxiety may arise from this.

The secrecy and stigma that surround conversations regarding gender-related concerns and mental health in Pakistani families and communities is another important factor [15]. Many adolescents find it challenging to open up about their mental health concerns due to the prevailing social stigma. This silence, combined with the absence of mental health and role transition education in the curriculum, exacerbates the problem. Adolescents are left to seek informal and often inappropriate resources for information, which can lead to the spread of incorrect and harmful beliefs about mental health and gender roles. For example, discussing openly mental health issues and challenges in adopting the gender-specific role expected by society, is considered taboo in many Pakistani families. Adolescents who experience depression or anxiety may fear seeking help and prefer to suffer in silence. Moreover, the topic of sexual education is often completely avoided, leading adolescents to rely on unreliable sources, like peers or the internet, for information. This can result in misconceptions and anxiety about sexual health.

In addition, adolescents in Pakistan often turn to the internet for information about mental health and gender-related topics. Unfortunately, they can encounter misleading and harmful content, which may worsen their mental health. Peer pressure is also a significant concern. Adolescents may receive advice and information from friends who may not be well-informed, leading to harmful decisions or behaviors. These pressures and misleading information can negatively impact their mental well-being.

These examples illustrate the real-world implications of gender and cultural dynamics, emphasizing the pressing need for sensitive and context-specific strategies to address the challenges of gender and mental well-being among adolescents in Pakistan [13, 14, 15]. By acknowledging these challenges and understanding the local context, researchers and mental health practitioners can develop more effective interventions and support systems tailored to the unique cultural landscape of Pakistan. This approach holds the potential to significantly contribute to the enhancement of mental health outcomes for young individuals in the country.

3. Socioeconomic aspect and mental health

Following the discussion on the cultural aspects and their relationship to mental health, exploring the relationship between socioeconomic variables and adolescence mental health is critical, because it leads to a greater understanding of the complicated difficulties that young adults experience. As individuals negotiate cultural standards and socioeconomic status, the development and maintenance of social interactions are crucial in forming their identity and frequently result in internal and external conflicts. Peers from higher socioeconomic status may have an influence on their friends and this could lead to copying and risk-taking behaviors such as substance abuse and thrill-seeking.

Additionally, there is a common assumption that lower socioeconomic status (SES) correlates with increased mental health problems in adolescence. In countries like Pakistan, where adolescence is typically at school or college, financial dependence on family can contribute to feelings of helplessness and depression affecting self-esteem. A supportive family environment, however, can mitigate mental health challenges, irrespective of socioeconomic status. A longitudinal study included 426 adolescents revealed that self-efficacy exhibited a modest protective effect against mental health problems in those belonging to low-income homes, while social support showed a similar effect for adolescents from higher-income families [16]. Additionally, a positive family environment emerged as a factor associated with lower mental health problems in adolescence, irrespective of socioeconomic status.

Moreover, in Pakistani culture, adolescence are considered as minors and they are not being involved in decision-making, if they try to speak and express their viewpoint, then they are being shunned. A qualitative study was done in 19 adolescents aged 11–17 years, highlighting their strong desire for decision-making, self-expression, decision-making autonomy, emphasizing the importance of achieving dreams for good mental health [17]. Conversely, in low-income eastern cultures, male teenagers may take on a paternal role, especially in situations when there is a lack of financial support for the family. This position and obligation frequently result in early school dropout, low-paying employment, and the abandonment of personal goals, all of which exacerbate mental health issues.

The above examples convey complex interplay between socioeconomic factors and adolescent mental health is essential for devising targeted interventions.

4. Recommendations and way forward

Gender and mental health realities in Pakistan call for thoughtful interventions that need to be interweaved at various levels such as individual, society, and government. It is crucial to prioritize mental well-being and use gender-sensitive approaches to tackle challenges faced by adolescents in Pakistan and nurture them as resilient individuals.

4.1 Addressing as a fundamental fabric of society

The societal pressures and gender-specific roles imposed on adolescents can lead to disparities and psychological stress [18]. Addressing those might require a complete societal shift, however, a few steps can serve as a whistle-blower and sensitize Pakistani society to thoughtfully invest in the mental health of future generations. Indeed, in Pakistan, there is a need to establish an inclusive society that is adolescents-centered and actively supports and promotes gender equality. As a first step, we need to instill equality and mutual respect in the next generation to embrace connectedness and positive values. Additionally, it requires settling their bewilderment regarding the understanding of gender norms, roles, and relationships. It is also critical to implement public awareness campaigns which challenge gender stereotypes and encourage gender sensitivity. By challenging negative attitudes and advocating fair treatment for everyone, regardless of gender, such activities can help to promote a more inclusive society and empowerment.

4.2 Promoting a gender-inclusive environment

Family environment and early years of education make an important contribution to how gender-inclusive society is shaped. The family has a significant role in normalizing the alteration of gender roles prescribed by society [19]. A helping hand from a male member of the family in home tasks, for example, and an economic contribution from a female member of the family should be acceptable. Also, it is equally important to create a gender-inclusive educational environment that teaches the significance of being flexible in relationships. The positive role demonstration with such examples will have a profound effect on creating an optimistic approach and unconditional acceptance of the sex individual is born. Educators play a critical role, particularly those who teach at primary schools. Their persistent guidance and mentorship will assist individuals in how social and personal relationships should be managed respectfully. This will promote the mental well-being of adolescents and allow them to enjoy freedom as an individual and reciprocate the same for others, without connecting roles imposed by society that are a possible obstacle to enjoying the freedom of living respectfully. However, one needs to be vigilant about how much freedom is internalized and practiced without breaching the ethical and moral values that are ingrained as a part of Eastern (Pakistani) culture. Equal opportunity to be part of entrepreneurship programs for financial independence can be a positive approach.

4.3 Positive use of media

The increased usage of digital media can play an important part in supporting a positive attitude shift by providing diverse and positive depictions of men and women while confronting stereotypes. By generating appropriate debate and relaying examples of empowerment, the media may influence public opinion and increase understanding of how gender equality can enhance teenage mental health in Pakistan. Additionally, films, drama series, and other social media platforms can depict inclusive debates and good effects of gender equality. Highlighting this important agenda through the media will reach the entire society.

4.4 Building resilience

Building a gender-inclusive society in Pakistan that has a promising effect on the mental health of adolescents will be a long journey. However, building resilience in children can enhance adolescent mental health and empower them to avoid gender biases and promote equality [18]. Moreover, it empowers individuals to handle and overcome stressors related to gender, as well as helps them navigate through these situations. We should also be mindful of an increasing trend of internal migration among adolescents in Pakistan to attain higher education or for climate reasons [20]. Therefore, self-care, communication, and life skills building are a few examples that need to be integral components in such training to strengthen adolescents’ emotional well-being and help them cope with uncertainties in daily living. Creating accessible safe spaces for adolescents where they can openly discuss gender-related issues can be helpful.

4.5 Research and policy implications

Pakistan is moving forward in terms of integrating various policy-level measures to create gender quality in Pakistan. This includes the development of the National Gender Policy Framework [21] and creating better representation of women in the national assembly and leadership at the federal level. However, integration at ground level is yet to be considered with the fact that gender discrimination is deeply rooted in our society, like in decision-making dynamics, shared inheritance, and power structures within households and communities [18]. Youth in the country can be whistle-blowers to bring a slow and progressive transition that is grounded within societies and serves as a “bottom-up” approach. Future research needs to consider this important agenda to understand how these measures and policies have influenced the mental health of adolescents. Those insights will be instrumental in informing future research and interventions to promote resilience and mental well-being among adolescents.

5. Conclusions

In conclusion, the intricate meshwork of culture, socioeconomic factors, gender dynamics, adolescence, and their intersectionality provides a comprehensive lens through which we understand the complex landscape of mental health. As adolescents navigate the subtle balance between societal expectations and personal aspirations, cultural influences, economic circumstances, and gender norms interweave into the fabric of their mental well-being. Recognizing the interconnectedness of these elements is crucial for developing thorough strategies that foster mental health resilience in adolescents. Embracing diversity and acknowledging the unique challenges faced by individuals at the intersection of these factors is essential for promoting a more inclusive and detailed understanding of mental health in the context of adolescence. This comprehensive approach not only aids in cultivating a supportive environment but also lays the foundation for informed interventions that consider the diverse needs of this pivotal stage in human development.

Conflict of interest

The authors declare no conflict of interest.