• Highlights

• 3.8% of school girls and 4.2% of school boys reported not having close friends.
• The matters of mental health show that 29.6% of the girls reported feeling like life is not worth living; for the boys, the indicator is 13%.
• Self-perception of negative metal health among the girls was 27%, more than three times of boys’ (8%).
• 66.5% of the students felt satisfied or very satisfied with their own bodies, 49.8% considered their weight normal and 42.4% claimed not to take any steps for changing.
• By sex, satisfied or very satisfied students with their bodies are 75.5% of the boys, against just 57.8% of the girls.
• 20.1% of the girls have already suffered sexual violence (boys, 9%).
• 26.5% of the girls declared having been bullied (boys, 19.5%). Physical appearance was declared to be the reason for bullying by 16.5% of the students in Brazil.

Girls, most of the time, have been feeling sadder than boys. And also more worried or feeling that nobody cares for them, or yet that life is not worth living. It is what the National Survey of School Health (PeNSE) tells us. It was released today (September 10) by the IBGE and reveals a quite worrisome mental health picture of the 11.8 million students aged 13 to 17 interviewed in 2019. Especially for girls, whose share was 50.7% of the total.

The questions on mental health sought to capture the way adolescents felt in the 30 days prior to the survey. Except for the question about having close friends, in which both sexes had a low percentage of negative answers (girls 3.8% and boys, 4.2%), all indicators were worse for girls. The feeling that life was not worth living, for instance, reached 29.6% of the female teenagers, more than twice as much as the 13% for boys. Combining the answers of five questions, PeNSE showed that neagtive self-perceived mental health was much higher among girls: 27%, against 8% for boys -  which means that the female indicator was more than three times worse.

The analyst of this topic in the survey, Ms. Thaís Mothé comments that  specialized literature has been warning about this phenomenon. “It is an international pattern in mental health research, both for general population and for adolescents, as it is the case of PeNSE”, she says. “However, besides the unfortunate gender inequality, the big numbers call the attention for the female group as well. They represent very high figures for mental health results.”

A portrait of pre-pandemic teenagers

PeNSE, carried out throughout 2019, is the health picture of a population living a crucial life phase: adolescence. What the survey could not anticipate was the fact that the picture would be taken right before the pandemic period. “In general, mental health articles and studies indicate that isolation, fear, intense worries, stress are risk factors for mental health. In a pandemic all that comes in a very intensively”, says Ms. Mothé. “For the group of teenagers, in terms of age, social isolation seems to be more worrisome because it is the phase in which getting apart from family is a fact, in order to allow for peer proximity. The experience of pandemic isolation seems to go the other way around”.

WHO has already indicated as a pandemic effect a greater exposure to danger, as  domestic violence and child abuse, less physical activities and increase of the consumption of ultra-processed foods, tobacco, alcohol and other drugs. In this sense, mental health data interact with a series of data collected by PeNSE: dissatisfaction with one's own body, bullying, self-harm and physical, sexual or psychological violence background, for instance, which helps to outline the risk protection or exposure scenario for students, with a special look to girls’ results.

“There are very intricate connections among body image, violence and mental health. The matter of gender is quite evident”, says Ms. Alessandra Pinto, PeNSE analyst. She is referring to the dictatorship of the ideal body, from which not even toys escape. “There is a body pattern and girls are exposed to that. Studies in psychology approach the issue of toys. What is the doll’s image? Skinny. There is a very well-defined pattern”, she highlights.

The picture of satisfaction with one’s own body among the teenagers of PeNSE, in general, seems positive: 66.5% of the students were satisfied or very satisfied in relation to their own bodies, 49.8% considered their weight normal and 42.4% claimed not to take any steps for changing. But when data are viewed separately by sex, there comes female disadvantage again. Satisfied or very satisfied students with their bodies are 75.5% of the boys (against just 57.8% of the girls).

“The graph shows how the intake of sweet treats is very related to gender facts. It gives lots of hints that there is really a very specific female behavior”, says Ms. Pinto, highlighting initiatives to lose or avoid gaining weight, as the use of laxatives or self-induced vomiting. “Women resort to those practices, it is known for a fact in studies of that matter. Anorexia, bulimia, models’ images, all that affects girls very much. For boys, [the actions for a change] are more related to gaining weight and muscles.

Bullying cases and sexual violence are also more common for girls than for boys. PeNSE showed that 20.1% of the girls have suffered sexual violence (boys, 9%) and that 26.5% of the girls have reported having been bullied (19.5%, for boys). Physical appearance was declared the bullying reason by 16.5% of the students in Brazil.

“Studies in the area reveal that there is a strong association between mental health and bullying. It can be either a risk factor or a symptom of mental health issues, that is why it is difficult to establish which causes which. But they are surely related. It does not come as a surprise that gender inequality is so sharp in those three areas”, claims Ms. Mothé.

Another alarming issue, calling the attention of researchers in and out of the country, is the self-harm phenomenon. Of the 18.2% teenagers that were involved in an accident or aggression, 5.2% reported self-harm. Among them, in more than 60% of the cases, there were connections with typical characteristics of depression, anxiety and difficult relationships at home and at school. Once again, the female population is the most affected one: 85% of the adolescents who reported self-harm felt sad always of most of the time (among boys, 54.2%); 71.3% of the girls felt always or most of times that life was not worth living (boys, 50.5%) and 67% answered having been bullied (boys, 62%).

“PeNSE results give a hint. Here there is a picture, with numerous nuances, we need to dive deeper into those data”, says Ms. Pinto. “You cannot separate sociological, anthropological and psychological aspects from violence. It is like patchwork.”