Advancing measurement of gender and sexual dimensions of adolescent mental health and wellbeing: Addressing a missing link

Why we are doing this project: Mental health problems are increasing among young people. There is lots of research being done to understand why this is happening, and to explore the factors that protect young people from poor mental health and support their wellbeing. This research usually focuses on things like school pressures, family and friendships, social media use and sleep, but rarely explores issues relating to gender/sexual identity and sexual feelings and experiences. The lack of attention to these issues in mental health research is worrying because young people say they are important. As they develop, young people explore new sexual feelings and curiosities about sex (or worry about their absence of feelings and experiences); they consider their own sense of having a particular gender and sexuality; and they learn to express sexual feelings and form intimate relationships. Sexuality development is normal and healthy but can also involve difficult and harmful experiences, thoughts and feelings including shame and stigma. So far, research has mainly focused on understanding how risky and difficult experiences (such as forced sex) can lead to problems like depression and anxiety. Much less is known about how anxiety and depression affects sexual feelings and behaviour, or how healthy and positive sexual experiences contribute to feelings of wellbeing. Reluctance to ask about sex in mental health research may be based on concerns about getting funding to do the research; worries about backlash from parents and the media; fears that such questions might upset young people; and lack of confidence about which questions to ask and how. A lack of research into sexual matters in mental wellbeing research influences the support that is given to young people, which means that young people can feel their sexual concerns are not being acknowledged or addressed. This needs to change.

What we will do: We create tools and resources to help mental health researchers and those who provide mental health services to ask the right questions to understand links between mental health hand sexual wellbeing, and to ensure that young people's concerns are properly understood.

How we will do it: We will begin by holding workshops with young people, parents, researchers, policy makers and practitioners to understand priorities and challenges of researching gender and sexual issues in mental health. Next, we will add to those understandings by reviewing existing research on the topic. We will then collect existing survey questions that cover these priority topics and review those questions so that we can recommend the most trustworthy ones to researchers and give advice on how to use them. It is very likely that some priority topics are not covered by existing questions, so we will fill the most important gaps by creating and testing some new questions. One gap we have already identified is for a set of questions on adolescent sexual wellbeing. We will fill that gap by designing a new set of questions (known as a measure) using group discussion and interviews with young people. We will check how well the measure works by testing it in an online survey of 1500 young people aged 14-19. We will bring all our work together into a website of resources for researchers, ethics committees (who review and approve research plans), and schools. We will train these stakeholders on research on young people's gender and sexual development, and we will share our findings with researchers, policy makers, mental health practitioners, and young people.

What we hope to achieve: We aim for better understanding of the links between sexuality and mental health in adolescence by bringing greater attention to the issues and producing excellent research tools and guidance focused on young people's priorities.

Background: Mental health problems are increasing among adolescents. Research to understand causes and protective factors has largely overlooked issues related to gender identity and sexual development, despite their importance to young people. Sexuality development in adolescence is normal and healthy but can also involve difficulties including shame and stigma. Research has focused on the causal link between sexual risk behaviour and poor mental health. In contrast, little is known about how poor mental health affects sexual behaviour, and how healthy adolescent sexuality development links to wellbeing. These gaps reflect lack of valid and reliable measures, lack of cross-speciality collaboration, and discomfort with sexual expression in youth. Gaps in research limit the evidence-base and can mean that interventions fail to address issues of concern to young people.
Aim: To advance understanding of links between adolescent gender identities, sexuality, sexual wellbeing and mental health/wellbeing to support mechanistically informed research.
Methods: (1) 6 engagement workshops with stakeholders (including young people) to set research agenda; (2) Systematic review of validated measures of gender identity and sexual development constructs important to mental health/wellbeing; (3) Qualitative fieldwork and web-based survey (n=1,500) to design and validate a new measure of sexual wellbeing in mid/late adolescence and test associations with mental health/wellbeing (4) Capacity building via: agenda-setting paper to facilitate cross-speciality dialogue; development of web-based methods resource, combining outputs from (2/3); pilot training for end-users of measures; translation and dissemination of findings to policy/practice audiences and young people.
Outcomes: Stronger methodological foundations to support descriptive, theoretical and hypothesis testing research on mechanistic links between adolescent gender and sexual development and mental health/wellbeing.