We need a sophisticated international approach to understanding the mental health needs of boys and girls

Oct 10

Every year around 67,000 adolescents die by suicide worldwide. Although most completed suicides are male, most attempted suicides are female. Not surprisingly, depression is linked to both attempted and completed suicide. However there is evidence that physical activity decreases depression, a risk factor for suicidal behaviour, possibly due to the exercise increasing self-esteem and serotonin levels.

A study published last year, measured the impact of physical activity on suicide attempts in 48 countries. It was described by the authors as possibly “the most globally representative study on this topic to date”. It included nearly 137,000 male and female adolescents, all of whom were schoolchildren aged 12–15 years old.

Intriguingly, they found that although high levels of physical activity - such as brisk walking, dancing, swimming, and soccer - were associated with a lower risk of suicide attempts in boys, higher levels of physical activity were associated with a higher risk of suicide attempts in girls.

How can the findings of this multinational study be explained? Some research shows that, in general, men and women tend to utilise different coping strategies. For example, men might prefer to fix the problem causing their distress rather than talking about their feelings about the problem. One coping strategy men tend to like is physical exercise, such as going to the gym or playing football.

Some research has found that boys tend to enjoy playing and watching team sports more than girls do, possibly due to the social support found in teams sports. Thus how much boys and girls played team sports is an important variable in assessing the impact of physical exercise in mental health. Unfortunately, the multinational study asked only very broad questions about activity which didn’t allow for analysis of the different types of activity that might have been chosen by the participants.

A further limitation of the multinational study is that it was ‘cross-sectional’, making it difficult to say whether activity levels had an impact on suicide attempts, or whether girls who were vulnerable to suicide attempts were inclined to engage in more physical activity, perhaps due to body image dissatisfaction or related to eating disorders.

Although the survey consisted of countries from a variety of income levels and claimed to be globally representative, most of these were low- and middle-income countries, and none of the countries were in Europe, North America and the survey didn’t include Westernised countries like Australia.

We should note that the data used in this multinational study had previously been collected in research supported by the World Health Organization (WHO) and the United States Centers for Disease Control (CDC), so the authors of the present multinational study were limited in the sophistication they could bring to addressing their research questions.

Although improved research is needed to identify the reasons the multinational study found that girls and boys benefitted differently from physical activity, this study reminds us that we should always be sensitive to the subtle ways in which men and women are different in relation to their mental health. Above all, we should avoid the temptation to apply a ‘one-size-fits-all’ approach to mental health either to boys and girls or across different cultures.

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