Author: Fiona Samuels

Setting the scene


We know that norms are part and parcel of everyday life, shaping attitudes and behaviours. We know that they are produced and reproduced both formally and informally through a range of mechanisms and institutions, including social interactions. We also know that many are gendered and discriminatory, with girls and women often feeling their constraints more keenly than boys and men. 

As a result, a girl who reaches puberty may well be forced into an early marriage, where she is expected to bear male offspring, drop-out of school and discouraged from – or completely barred from –seeing or talking to other males. The effects of such gendered norms are far-reaching, touching every aspect of her life, including her mental health and psychosocial well-being. The impact can leave girls and women facing isolation, depression, anxiety, fear and some even contemplate or commit suicide. 

Key concepts

Before exploring these issues, it is useful to have some background on the global prevalence of mental health problems and their causes, as conceptualised in the broader literature. According to IHME Global Burden of Disease study, in 2016 globally, around 1-in-6 people (15-20 percent) had one or more mental or substance use disorders. Similarly WHO (2018a) estimates that globally, an estimated 300 million people are affected by depression; and suicide, which has strong links to depression in high-income countries, claims the lives of over 800,000 people annually across the globe (WHO, 2018b). Whiteford et al. (2013) find that the burden of mental and substance abuse disorders increased by 37.6% between 1990 and 2010. 

Research by WHO (2001a) reveals that mental ill-health and psychosocial problems often start during adolescence with the common mental disorders (CMDs) of anxiety and depression being the most prevalent psychiatric illnesses among adolescents and young people worldwide. Other studies show that suicide rates among young people are increasing, often a result of un-diagnosed and untreated mental ill-health and psychosocial distress. Young people are now the highest-risk group for suicide in around 30% of all countries, and in China, India and South-East Asia, suicide is the leading cause of death among those aged 15 to 19 (see, for example, Patel et al., 2007; WHO, 2014; WHO, 2016; Samuels et al., 2016). 

A body of literature across various disciplines, though largely from psychology, has explored the causes of mental ill-health and psychosocial distress, confirming that it is driven by a wide range of biological, psychological and social and environmental factors (see, for example, Chesney et al., 2015; WHO, 2001; WHO and Calouste Gulbenkian Foundation, 2014). 

This guide:

  • examines social and environmental factors that contribute to mental ill-health and psychosocial distress.
  • focuses on the CMDs at the less severe end of the mental health disorder spectrum (including those defined internationally as internalising/emotional problems such as anxiety, depression, loneliness, sadness and somatic complaints), all of which can have a range of disastrous consequences, including suicide. 
  • focuses largely on the Global South, while recognising that such issues are just as pertinent to the Global North, as shown by growing media attention for mental ill-health in the UK, focused largely on CMDs as a result of social and environmental factors. An article in the Guardian, for example, notes that being lonely can be as bad for health as a long-term illness.

Box 1: Definitions 

According to WHO (2018a), mental disorders are ‘generally characterised by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others. Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia intellectual disabilities and developmental disorders including autism’. 

As well as the biologically based disorders described above, mental health can also be affected by psychosocial factors that cause distress. According to the Cape Town Principles developed by UNICEF (1997), ‘psychological effects are defined as those experiences that affect emotions, behaviour, thoughts, memory and learning ability and the perception and understanding of a given situation’.  These include social effects on well-being as a result of various factors such as poverty, war, migration, famine and climate change.

Samuels, F., 2017, The ‘social’ in ‘psychosocial’: how gender norms drive distress, ALIGN, London UK