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A Systematic Review of Adolescent Masculinities and Associations with Internalizing Behavior Problems and Social Support


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Interest in the connection between masculinities and mental health continues to grow. However, no previous systematic review has explored this association for adolescents. We present the systematic review of 29 articles that explore the connection between adherence to stereotypical male gender role norms (e.g., emotional restriction), attributes (e.g., “ambitious”), and identity (most commonly, gender “typicality”) and internalizing behavior problems and social support. A total of 24,795 adolescent boys (6th‐12th grade) were included in the reviewed studies from 1997–2017. In the quantitative articles (n = 20), associations varied by aspect of masculinity assessed. Specifically, we found that greater endorsement of “masculine” traits (e.g., ambitious, assertive) was generally associated with fewer internalizing behavior problems and greater social support. However, lower gender “typicality” and higher adherence to stereotypical gender role norms were generally associated with more internalizing behavior problems and lower social support. In the qualitative articles (n = 9), the most predominant theme was emotional restriction (i.e., a gender role norm) and consequences for mental health. While research in this area is newer for community psychologists, the connection between masculinities and mental health is directly relevant to the field. Given the focus on individual‐level conceptions of masculinity and mental health found in our review, we describe key future directions for masculinities research in community psychology.
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A Systematic Review of Adolescent Masculinities and Associations with
Internalizing Behavior Problems and Social Support
Deinera Exner-Cortens,
Alysia Wright,
Caroline Claussen,
and Emma Truscott
Comprehensive review of masculinities and internalizing problems/social support in adolescence.
Stereotypical masculine attributes were generally associated with better mental health.
Adherence to stereotypical male gender role norms was generally associated with worse mental health.
Lower gender typicalitywas generally associated with worse mental health.
Results suggest pathways to mental health inequities for men may rst emerge in adolescence.
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are made.
Abstract Interest in the connection between masculinities
and mental health continues to grow. However, no previous
systematic review has explored this association for
adolescents. We present the systematic review of 29 articles
that explore the connection between adherence to
stereotypical male gender role norms (e.g., emotional
restriction), attributes (e.g., ambitious), and identity (most
commonly, gender typicality) and internalizing behavior
problems and social support. A total of 24,795 adolescent
boys (6th-12th grade) were included in the reviewed studies
from 19972017. In the quantitative articles (n =20),
associations varied by aspect of masculinity assessed.
Specically, we found that greater endorsement of
masculinetraits (e.g., ambitious, assertive) was generally
associated with fewer internalizing behavior problems and
greater social support. However, lower gender typicality
and higher adherence to stereotypical gender role norms
were generally associated with more internalizing behavior
problems and lower social support. In the qualitative
articles (n =9), the most predominant theme was emotional
restriction (i.e., a gender role norm) and consequences for
mental health. While research in this area is newer for
community psychologists, the connection between
masculinities and mental health is directly relevant to the
eld. Given the focus on individual-level conceptions of
masculinity and mental health found in our review, we
describe key future directions for masculinities research in
community psychology.
Keywords Systematic review Adolescent Masculinity
Mental health Internalizing behavior problems Social
Poor mental health among adolescents is a pressing com-
munity health problem. In the United States, 22.2% of
adolescents experience a mental health disorder, and many
adult disorders start during the adolescent period
(Merikangas et al., 2010). Beyond specic disorders, a
substantial minority of adolescents report poor mental
health generally; for example, a national survey of Cana-
dian adolescents found that 3544% of girls and 2729%
of boys in grades 610 report that they experienced a high
level of emotional problems (e.g., feeling low) in the past
six months (Freeman & Luu, 2010). While a substantial
body of literature focuses on individual-level correlates of
Deinera Exner-Cortens
Department of Psychology, Faculty of Arts, University of Cal-
gary, Calgary, AB, Canada
Faculty of Social Work, University of Calgary, Calgary, AB,
Am J Community Psychol (2021) 0:117
DOI 10.1002/ajcp.12492
mental health problems among adolescents, research in
community psychology highlights the importance of con-
sidering individuals within their broader context when
addressing mental health and well-being (Trickett, 2009).
As it pertains to health outcomes, this approach of under-
standing people in context can be grounded in the applica-
tion of a social determinants of health framework, where
mental health is seen as intrinsically related to things like
poverty (instead of individual income level) and racism
(as opposed to individual race/ethnicity; Government of
Canada, 2019; World Health Organization, 2019). As dis-
parities in mental health status by gender are well-docu-
mented (e.g., Centers for Disease Control, 2017; Freeman
& Luu, 2010; Merikangas et al., 2010), this framework is
also used to understand these differences, both between-
and within-genders (Lohan, 2007).
For men, a growing body of research now indicates
connections between aspects of societal expectations for
male-identied individuals and poor mental health (Addis
& Cohane, 2005; Courtenay, 2000; Evans, Frank, Oliffe,
& Gregory, 2010; Mankowski & Maton, 2010; Wong,
Ho, Wang, & Miller, 2017). In this literature, gender is
understood as being socially constructed; that is, men act
in the ways they do not because of biological traits, but
because of the concepts of masculinity that are adopted
from their culture (Courtenay, 2000). Specically, within
a framework of social construction, masculinities are not
viewed as the biological essence of an individual, but
rather, as a set of practices put into action by individuals
interacting with others in their environment (e.g., practices
such as how one is expected to react to emotional situa-
tions; Addis & Cohane, 2005; West & Zimmerman,
1987). In other words, there is no one way of being a
man,but rather, multiple ways depending on an individ-
uals given context (Connell, 2005).
The assumption that multiple versions of masculinity
exist also corresponds with the view that some masculini-
ties are more powerful than others (Connell, 2005; Con-
nell & Messerschmidt, 2005). At the top of this
masculinity hierarchy is a concept referred to as hege-
monic masculinity, or the most socially sanctioned form
of masculinity in a given time and place (Connell, 2005;
Connell & Messerschmidt, 2005). In many Western coun-
triesincluding the United States and Canadathis form
of masculinity is associated with being White, heterosex-
ual and middle-class, and possessing stereotypical mascu-
line traits of assertiveness, dominance, control, physical
strength and emotional restraint(Evans et al., 2010, p.
8). Given its association with social power and control,
many men may strive for this form of masculinity, though
few, if any, will fully achieve it (Connell & Messer-
schmidt, 2005; Mankowski & Maton, 2010). However, it
is in the striving for the hegemonic ideal that pathways to
downstream health inequities likely emerge. For example,
because of its focus on power, control, and strength, men
may avoid seeking help for medical issues, given the per-
ception that help-seeking is a sign of weakness or loss of
control over the body (Addis & Mahalik, 2003). The
restricted emotionality that accompanies this idealized
form of masculinity is highly detrimental to mental health
in particular (Addis & Cohane, 2005; MacLean, Sweeting,
& Hunt, 2010).
Masculinities and Mental Health
While research on masculinities has primarily been con-
ducted outside of community psychology (Bond &
Wasco, 2017; Mankowski & Maton, 2010), masculinities
are connected to a number of mental health outcomes that
are of interest to community psychologists (e.g., depres-
sion, suicide, psychological distress), and masculinities
represent a critical aspect of understanding lived realities
within sociocultural context (Trickett, 1996). Thus,
research connecting mental health outcomes and masculin-
ities is of direct applicability to the interests of community
psychologists. However, given the substantial research
that explores connections between masculinities and men-
tal health, systematically reviewing this literature is an
important task. Recent reviews in this area tend to be nar-
rowly focused, making a holistic assessment of connec-
tions between gender and health difcult. For example,
Wong et al. (2017) reviewed 78 samples of both female-
and male-identied individuals (though the majority were
male-identied, 91%), specically focusing on associa-
tions between conformity to dominant masculine norms
(as measured by one scale, the Conformity to Masculine
Norms Inventory) and negative mental health (e.g.,
depression), positive mental health (e.g., life satisfaction),
and psychological help-seeking. Among the 19,453 partic-
ipants in this meta-analysis, Wong et al. (2017) found that
higher conformity to masculine norms was associated with
poorer mental health and less help-seeking. In another
comprehensive review, ONeil (2008) explored the use of
the Gender Role Conict Scale (GRCS) to understand
mens experience of mental health, nding that higher
gender role conict (i.e., a psychological state in which
socialized gender roles have negative consequences for
the person or others(p. 362)) was associated with poorer
mental health.
In terms of types of mental health outcomes, past
reviews have primarily focused on internalizing behavior
problems (i.e., the propensity to experience distress
inwards; Carragher, Krueger, Eaton, & Slade, 2015, p.
340). Internalizing behavior problems include issues
related to distress (depression, anxiety) and fear (phobias,
panic disorder), while externalizing behavior problems
2 Am J Community Psychol (2021) 0:117
(i.e., the tendency to express stress outwards; p. 340)
include drug and alcohol dependence and antisocial
behaviors (Carragher et al., 2015). In the Wong et al.
(2017) review, outcomes included negative mental health
(depression, psychological distress/stress, substance use,
body image problems, other psychological problems, neg-
ative social functioning) and positive mental health (life
satisfaction, self-esteem, psychological well-being, social
well-being). Except for substance use, all of these issues
are related to internalizing behaviors. Similarly, ONeil
(2008) reviewed literature using the GRCS from 1987 to
2007, nding that most studies had focused on internaliz-
ing behavior problems (depression, anxiety, stress). The
only externalizing behavior problem included was again
substance use and was the focus of far fewer studies than
internalizing behavior problems.
In terms of pathways from masculinities to poor mental
health, Addis and Mahalik (2003) suggest that help-seek-
ing may be an important mediator, as help-seeking is an
important step toward resolving numerous problems in
living(p. 5), but many steps in the help-seeking process
(e.g., seeking support, asking for help) conict with Wes-
tern hegemonic masculine standards. Past researchin-
cluding the reviews mentioned previouslyhas
demonstrated connections between adherence to masculine
norms and both formal (e.g., professional counseling) and
informal (e.g., friends) help-seeking (Addis & Mahalik,
2003; Blazina & Watkins, 1996; ONeil, 2008; Wong
et al., 2017). Beyond help-seeking specically, social sup-
port generally is also a potential mediator between mas-
culinities and mental health problems. For example,
Houle, Mishara, and Chagnon (2008) found that both
seeking help from a friend/family member and perceived
social support (e.g., having people to depend on, having
close relationships) mediated the pathway between adher-
ence to male gender role norms and suicidal behavior
(such that having support/seeking help was protective
against suicidal behavior) in a sample of men with and
without a history of suicide attempts.
Assessing Masculinity
Both the Conformity to Masculine Norms Inventory and
Gender Role Conict Scale assess one aspect of gender,
particularly around adherence to (and consequences of
adherence to) male gender role norms in Western society.
Smiler (2004) refers to measures tapping such adherence as
the ideology perspective, which sees gender as related to a
broad variety of personality attributes, attitudes, behaviors,
and activities (vocation and leisure), as well as abstract
properties(p. 22). Broadly, then, measures of male gender
role norm adherence include a mixture of behaviors (e.g.,
I do not let it show to my friends when my feelings are
hurt; Gupta et al., 2013), beliefs (e.g., Guys should
always be able to gure out what they should do; Levant
et al., 2012), and attitudes (I can respect a guy who backs
down from a ght; Chu, Porche, & Tolman, 2005). Such
behaviors, beliefs, and attitudes converge into commonly
recognized features of stereotypical masculinity, including
restricted emotionality, dominance, and power-seeking
(ONeil, 2008). These features of stereotypical masculinity
exist along a continuum, such that many men and boys may
endorse a lower level of these behaviors, some may endorse
a moderate level, and a smaller group may endorse a high
level. In addition, levels of adherence can change over time
and in different contexts.
While measures tapping adherence to male gender role
norms have been a primary focus within counseling psy-
chology, the psychology of men and masculinities, and the
limited literature in community psychology (likely because
of their clear connection to social context and culture), gen-
der role socialization is not the only way masculinity is
understood and assessed (Mankowski & Manon, 2010;
Smiler, 2004). To more fully understand connections
between masculinities and mental health, then, other mas-
culinity-related constructs are important to consider. For
example, there is a body of literature exploring the set of
masculineand feminineattributes considered desir-
ablefor men and women. Masculine attributes included
on a common measure used in this areathe Bem Sex
Role Inventoryinclude things like self-reliant,”“makes
decisions easily,”“independent,”“ambitious,”“assertive,
and competitive.Unlike adherence to role norms, attri-
butes are seen as residing within the individual and do not
consider social context (Smiler, 2004).
Attribute-based research arose separately (and before)
research on adherence to gender role norms (Smiler,
2004), and thus, attributes are a distinct conceptualization
of masculinity. However, expectations of appropriate
attributes for males likely also intersect with socialization
into the masculine role. In terms of overlap with gender
role norm adherence scales, Parent, Moradi, Rummell,
and Tokar (2011) found that higher endorsement of mas-
culineattributes on the Bem Sex Role Inventory had
moderate to large correlations with the winning, risk-tak-
ing, violence, and primacy of work sub-scales of the Con-
formity to Masculine Norms Inventory, as well as with
the total score, in a university sample. Conversely, in a
sample of 10- to 14-year-old boys, Chu et al. (2005)
found a negligible correlation between scores on the Bem
Sex Role Inventory (masculine attributes) and scores on
the Adolescent Masculinity Ideology in Relationships
scale (a measure tapping gender role norm adherence).
Related, adolescents are actively developing a sense of
identity (Erikson, 1968), including in the domain of gen-
der (Rogers, Scott, & Way, 2015). When exploring
Am J Community Psychol (2021) 0:117 3
identity, both the individuals evaluation of their own
identity group (known as private regard) and the impor-
tance of being a member of that group to an individuals
self (known as centrality) can be assessed (Rogers et al.,
2015). However, identity can also be explored in terms of
what researchers in this area call gender typicality(Egan
& Perry, 2001), or how well one feels they align (glob-
ally) with their socially perceived gender category. For
example, Jewell and Brown (2014) assessed peer and self-
report gender typicality, based on how much peers/the
individual felt they were typicalfor their gender (e.g.,
I feel I am a good example of being a boy).
Typicality measures are seen as distinct from measures
focused on gender role socialization (Thompson, Pleck, &
Ferrera, 1992); however, as beliefs about typicality
undoubtedly arise in connection with larger cultural
expectations for gender roles, there is likely some overlap.
For example, a study with 342 college men by Leaper
and Van (2008) found a moderate, negative correlation
between perceived gender typicality and adherence to
masculine gender role norms (assessed using the Male
Role Norms Inventory). Similarly, while both perceived
attributes and perceived typicality are likely connected
(as, e.g., holding a high level of a perceived masculine
attribute like dominantmay be related to ones self-
assessment of their typicality), these two concepts also
appear to be distinct. For example, looking at the associa-
tion between gender-typed attributes and typicality, Tate,
Bettergarcia, and Brent (2015) found a small, positive cor-
relation between the Bem Sex Role InventoryAgency
(i.e., masculinity) sub-scale and self-assessed gender typi-
cality among heterosexual, cisgender adult males, but no
association among cisgender GBQIA +males, while
Dinella, Fulcher, and Weisgram (2014) found a small,
positive correlation between Bem Sex Role Inventory
masculine attributes and felt gender typicality among 185
male college students. In their study of 4
children and youth, Egan and Perry (2001) also found a
small, positive correlation between gender typicality and
amount of male-typed activities for boys.
In sum, past research indicates that at least three
related, yet distinct, assessments of masculinity can be
considered when examining connections with mental
health: gender role norm adherence, gender-typed attri-
butes, and identity (Smiler, 2004; Thompson et al., 1992).
Current Study
In addition to being narrowly focused on one way of
assessing masculinity, past reviews have not focused on
adolescents specically (while the most recent Wong
et al. (2017) review did include six adolescent samples,
results were not separated by age group, and the majority
of samples were from adults). Given the developments in
gendered identity, beliefs, attitudes, behaviors, and attri-
butes that occur during adolescence (Galambos, 2004), as
well as the onset of many mental health problems
(Merikangas et al., 2010), a review of connections
between aspects of masculinity and mental health in ado-
lescence is warranted. Thus, the purpose of this systematic
review is to explore associations between multiple facets
of masculinity (role norm adherence, attributes, and iden-
tity) and mental health among adolescent boys.
As a primary focus in empirical and theoretical litera-
ture to date has been the connection between masculinities
and internalizing behavior problems, and masculinities
and help-seeking/social support, we chose to focus our
review on internalizing behavior problems and social sup-
port, so that we could systematically review this body of
literature specically for adolescents. By social support,
we mean willingness to seek and ability to access help
and/or support from both informal (e.g., friend) and for-
mal (e.g., therapist) sources. We do note that although not
the focus of this review, connections between masculini-
ties and externalizing behavior problems, including sub-
stance use and aggression, are also important to a holistic
understanding of mental health, and a topic worthy of
future review. Findings from this review will be used to
highlight research gaps in the eld, and promising direc-
tions for future research in community psychology.
Materials and Methods
Search Strategy
To locate relevant publications, we searched six online
databases (MEDLINE, PsycINFO, SocINDEX, ERIC,
Social Work Abstracts, and CINAHL) on September 10,
2017. Search terms were combinations of boy*or male*
or men*AND masculin*or gender or "role norm*"AND
teen*or adolescen*or youth*AND help*or support*or
loneliness or connect*or isolation or friend*or peer*or
"mental health" or depress*or anxi*or well-being.We
also reviewed the reference lists of eight relevant system-
atic reviews found during our larger search (i.e., the
ancestry approach; Johnson & Eagly, 2000), and hand-
searched three relevant journals that were not picked up
as part of the larger database search (American Journal of
Mens Health, Journal of Mens Studies, and Thymos:
Journal of Boyhood Studies).
Inclusion/Exclusion Criteria
Searches were restricted to quantitative and qualitative
peer-reviewed articles published in English between 1997
4 Am J Community Psychol (2021) 0:117
and 2017 (i.e., in the prior 20 years). We chose this
search range as we felt this would offer a thorough snap-
shot of contemporary masculinities research, including
understandings of masculinities as socially constructed
(Smiler, 2004). Searches were not restricted by geographic
region. To be included, articles had to focus on adolescent
boys (age 1018 years, or those in middle/high school;
Steinberg, 2001) and assess a masculinity construct (i.e.,
role norm adherence, attributes, and/or identity), as well
as a mental health outcome (i.e., internalizing behavior
problems and/or social support). Articles were excluded if
they focused on a college or adult sample. We also
excluded articles where gender was included as a covari-
ate in analyses only; when results were not stratied by
gender; on gender non-conformity if exclusively a sexual
minority sample (as this seemed like a different goal than
the purpose of our study); as well as review, measure
development and program evaluation articles (unless the
article included baseline associations). We excluded four
articles because full text was not available (Figure 1).
Review Procedures
Screening was completed using Covidence, an online sys-
tematic review management software (www.covidence.
org). To determine whether articles should be included, a
team of six research assistants (primarily masters and
doctoral-level students) rst did three rounds of title and
abstract test screens along with the rst author, to ensure
consistency in screening decisions. Following these test
screens, research assistants reviewed the title and abstract
of each of the 7,487 eligible articles in teams of two (Fig-
ure 1), to determine whether these articles met inclusion
criteria. Screening of titles and abstracts followed the stan-
dard Cochrane process (Higgins et al., 2019). Following
independent review of their assigned titles and abstracts,
the team of two met to discuss decisions and come to
consensus on any discrepancies. If the team could not
come to consensus, a nal decision on inclusion was
made by the rst author. Results were also reviewed dur-
ing weekly team meetings. After initial screening of titles
Records identified through database
(n = 14,201)
Records screened after duplicates removed
(n = 7,487)
Records excluded
(n = 7,186)
Full-text articles assessed
for eligibility
(n = 301)
Full-text articles excluded,
with reasons
(n = 272)
78 Wrong outcomes
76 Doesn't explore masculinity
62 Duplicate
22 Adult population
21 Wrong study design
5 Child population
4 No full text available
2 Not for boys only/not stratified
2 Same sample
Studies included in
(n = 29)
Additional records identified through other sources
(n = 10 in prior systematic reviews, n=11 in peer-
reviewed journals not otherwise picked up)
Fig. 1 PRISMA diagram
Am J Community Psychol (2021) 0:117 5
and abstracts, 301 articles remained for full-text review
(Figure 1). Full text was again reviewed by a team of
two, following the same procedure as for screening of
titles and abstracts; 272 articles were excluded because
they did not meet inclusion criteria (Figure 1). Following
full-text review, 27 articles (19 quantitative and 8 qualita-
tive) from the database searches remained in the sample.
From the ancestry and journal hand search, we included
an additional two articles, bringing our nal total to 29
articles (20 quantitative and 9 qualitative). Of these arti-
cles, one (Gupta et al., 2017) reports on two samples (one
from the United States, one from China), for a total of 30
samples in the 29 articles.
Data Abstraction and Quality Assessment
Data from the 29 articles were extracted using a standard-
ized template in Covidence. Extracted information
included details on the study (e.g., country; setting; spon-
sorship information); study methods (e.g., study design,
population density, analysis used, study setting, study time
period); study population (e.g., inclusion criteria, exclu-
sion criteria, mean age of sample); measures for both mas-
culinity and mental health outcomes; and a description of
analysis and outcomes. Following test abstractions with
the rst author, one doctoral-level and one undergraduate
research assistant (the second and fourth authors, respec-
tively) abstracted information for all articles separately,
and then met to come to consensus. Abstractions were all
reviewed by the rst author. To assess data quality for
quantitative articles, we reviewed articles for missingness/
attrition for primary outcomes; bias in measurement; sam-
pling frame (representative or non-representative);
response rate (>30%); and other quality issues, using a
standard Covidence template. For qualitative articles, we
used the RATS checklist (Equator Network, 2016). Fol-
lowing test assessments with the rst author, one doctoral-
level and one undergraduate research assistant completed
quality assessments for all articles, which were then
reviewed and discussed with the rst author. For clarity,
we present quantitative and qualitative ndings separately
in the Results section and discuss their overlap in the
Conclusions section.
Types of Articles
Of the 29 articles that met our inclusion criteria, 69.0%
(n =20) were quantitative, and 31.0% (n =9) were quali-
tative (Table 1). Most studies (82.8%) were published
between 2007 and 2017; at least one study has been
published every year since 2007. Of the 20 quantitative
articles, most (n =17, 85.0%; Table 1) used non-repre-
sentative samples, and the majority (n =16, 80.0%) were
cross-sectional. Samples were, however, drawn from
across the globe; overall, 48.3% of articles used a United
States-based sample, and 37.9% used a sample from
somewhere other than North America (South Africa,
South Korea, China, India, Malaysia, England, The
Netherlands, Norway, Scotland, Sweden). Samples were
also fairly racially/ethnically diverse (Table 1). Ages in
the 29 included articles ranged from 9 to 20 (6
grade; Table 1).
Summary of Quantitative Findings
In terms of assessing associations with masculinity con-
structs, the included quantitative articles fell fairly evenly
into three broad categories: associations with masculine
gender role norm adherence; associations with masculine
attributes; and associations with masculine identity (pri-
marily, gender "typicality). We describe ndings for each
broad category and associations with mental health below.
A summary of mental health outcomes assessed is pre-
sented in Table 2, and a summary of ndings is presented
in Table 3 (full study ndings are described in Supple-
mental Tables S1 and S2).
Associations With Gender Role Norm Adherence
Nine (45.0%) of the quantitative articles assessed associa-
tions between masculine gender role norm adherence (i.e.,
adherence to ideologies and norms associated with being
male) and mental health; the majority of these articles
(n =7) assessed associations with depression, with others
assessing self-esteem, anxiety, other internalizing behavior
problems, stress, perceived social support, and help-seek-
ing intentions (Table 2). Scales used to assess beliefs
included the Traditional Masculinity Ideology Scale, the
Gender Role Conict Scale for Adolescents (GRCS-A)
scale, the Adolescent Masculinity Ideology in Relation-
ships Scale (AMIRS), the Conformity to Masculine
Norms Inventory, the Male Role Norms Inventory-Ado-
lescent scale (MRNI-A), and the Gender-Typed Behavior
in Relationships Scale (Table S1). All seven articles
assessed gender role norm adherence and mental health
outcomes at the individual level (Table S1).
Of articles focusing on gender role norm adherence,
two did not nd an association with any internalizing
behavior problems. The rst explored depression using a
sample of South African youth from public high schools
(Bastereld, Reardon, & Govender, 2014), and the second
explored depression, anxiety, stress, and self-esteem with
a small sample of male youth from a summer enrichment
6 Am J Community Psychol (2021) 0:117
Table 1 Summary of included articles (n =29)
Author and year of
publication N Sampling Location
male Racial/ethnic distribution Age range
Quantitative (n =20)
Bastereld et al.
568 Two public high schools South Africa 100% 51% White, 19% Black,
19% Indian
Choi et al. (2010) 454
Four urban high schools South Korea 100% n/a 14-18
Gupta et al. (2013)
872 Middle schools United States
and China
100% US: 27.7% White; 20.6%
African American; 19.5%
Chinese American;
15.2% Dominican; China:
not specied
grade (US); 7
grade (China) at
initial assessment
Jewell and Brown
84 Health class in a suburban
middle school
United States 40.5% 71.4% White, non-Hispanic 11-15
Kulis et al. (2010) 151 Community settings in
Arizona and North Carolina
United States 39.7% 100% Latinx 13-18
Lapointe and
Marcotte (2000)
339 Urban high schools in Quebec Quebec,
50.1% n/a 13-18
Mahalingam and
Balan (2008)
233 Communities in districts with
historically reported male-
biased sex ratio
India 100% n/a 14-16
Mansor et al.
282 6 secondary schools Malaysia 100% Malay (100%) 13-17
Marcotte et al.
306 French-speaking upper middle-
class high school
46.4% White (French-speaking) 14-17
Marcotte et al.
547 French-speaking public
elementary and high school
49.0% White (French-speaking) 11-18
Menon (2011)
357 An urban secondary school England 50.4% Primarily White (86%) 11-13
Rogers et al. (2015)
183 All male charter urban high
United States
100% African American (100%) 9
grade (initial
Santos et al. (2013)
226 Co-educational public junior
high school
United States
100% 44% White, 43% Latinx,
7% Black
grade (initial
Sears et al. (2009) 171 Rural high schools Eastern Canada 100% Predominately White 14-18
Shepard et al.
58 A summer enrichment
program at a university-
based center for gifted
United States 100% Primarily White (90%) 12-18
Smith et al. (2018)
5412 26 urban middle schools California,
United States
48.2% 31% Latinx; 20% White;
13% Asian American;
12% African American
Grade 6 (initial
Steinfeldt and
Steinfeldt (2010)
179 Football players enrolled in
participating high schools
United States
100% Primarily White (81%) 9
van Beusekom et al.
1026 Secondary schools The
50.4% Dutch/Western ethnicity
Wichstrøm (1999)
10,839 Public junior and senior high
Norway n/a n/a 12-20 (grades 7-12)
Young and
Sweeting (2004)
2194 School-based sample of
Scotland 50.8% n/a 15
Qualitative (n =9)
Heinrich (2013) 4 High school English class in a
small Midwestern town
United States
100% Primarily White 11
Mac An Ghaill and
Haywood (2012)
28 An urban middle school in
northeast England
England 42.9% n/a 9-13
Maclean et al.
90 One primary and one
secondary school
Scotland n/a White Scottish students 10-15
Randell et al. (2016) 33 Schools in a mid-sized
suburban town in central
Sweden 100% Primarily Swedish 16-17
Reigeluth and Addis
30 Boys from several settings (a
small university, an all-boys
private school and an urban
youth mentoring program)
United States
100% 50% White, 23% Hispanic,
10% Black, 10% other,
7% Asian/Pacic Islander
Am J Community Psychol (2021) 0:117 7
program within a university-based center for gifted educa-
tion (Shepard, Nicpon, Haley, Lind, & Liu, 2011). Five
articles found negative associations (i.e., higher adherence
to gender role norms emphasizing things like emotional
restriction and dominance predicted poorer mental health;
Choi, Kim, Hwang, & Heppner, 2010; Gupta et al., 2013;
Mansor, Othman, Yasin, Husain, & Yaacob, 2014; Santos,
Galligan, Pahlke, & Fabes, 2013; Sears, Graham, &
Campbell, 2009). These studies were all school-based,
used established measures of male gender role norm
adherence, and were conducted across the globe (South
Korea, United States, China, Malaysia, and Canada). Out-
comes in these ve studies included depression (n =3),
self-esteem (n =3), anxiety (n =1), and stress (n =1).
Finally, one study found a positive association (i.e., higher
adherence to gender role norms emphasizing things like
emotional restriction and dominance predicted better men-
tal health; Mahalingam & Balan, 2008). This study was
conducted in India (Mahalingam & Balan, 2008), looked
at depression as an outcome, and drew its study popula-
tion from a somewhat specialized community-based sam-
ple of youth (Table 1). As noted below, this study was
also assessed as at higher risk of bias. A summary of
associations by type of internalizing behavior problem is
shown in Table 3, and full study details are in Table S1.
In terms of social support seeking, of the four studies
that looked at this outcome, one found no association
between gender role norm adherence and social support
(Shepard et al., 2011), while the other three found nega-
tive associations (i.e., higher adherence to gender role
norms like emotional restriction and dominance predicted
less social support seeking; Gupta et al., 2013; Sears
et al., 2009; Steinfeldt & Steinfeldt, 2010; Table 3). Two
of these studies (Gupta et al., 2013 and Sears et al., 2009)
used the same outcome measure to assess perceived social
support (Table S2). Sears et al. (2009) and Steinfeldt and
Steinfeldt (2010) assessed help-seeking intentions and atti-
tudes toward help-seeking, respectively, and in both cases
found that higher adherence to male gender role norms
was associated with less potential help-seeking
(Table S2).
Table 1 Continued
Author and year of
publication N Sampling Location
male Racial/ethnic distribution Age range
Reigeluth et al.
40 Boys in a public high school Northeast
United States
100% Racially/ethnically diverse
(30% White, 37% Latinx,
17% African American,
13% Asian/Asian
Spencer (2007) 12 Boys in a mentoring program Northeast
United States
100% Racially/ethnically diverse
(75% non-White)
Way et al. (2014)
55 Ethnically diverse middle
school boys
New York
City, United
100% 20.8% Black; 32.7%
White; 23.6% Chinese
American; 14.5%
Dominican American;
9.1% Puerto Rican
6th grade at
Wisdom et al.
22 Adolescents at an urban health
center with a history of
United States
40.9% Primarily White, non-
Longitudinal study.
Abstract states n =464 and Method section states n =454, so we report n =454 here.
Representative (probability) sample. All other samples non-representative.
These did not appear to be the same sample, and so both are included here.
Presents nearly identical results to Menon, Schellhorn, and Lowe (2013). As such, only Menon (2011) is presented in this review.
Uses same sample as Smith and Juvonen (2017) but presents more robust outcome analysis and additional outcomes, and so Smith et al.
(2018) is presented here.
Table 2 Summary of quantitative articles (n=20)
Mental health
Masculinity measure, % (n))
Adherence Attributes Identity All
Depression 35.0 (7) 30.0 (6) 25.0 (5) 90.0 (18)
Self-esteem 20.0 (4) 15.0 (3) 20.0 (4) 55.0 (11)
Perceived social
15.0 (3) 10.0 (2) 5.0 (1) 30.0 (6)
Other internalizing
5.0 (1) 10.0 (2) 15.0 (3) 30.0 (6)
Anxiety 10.0 (2) 0.0 (0) 15.0 (3) 25.0 (5)
Stress 10.0 (2) 0.0 (0) 0.0 (0) 10.0 (2)
10.0 (2) 0.0 (0) 0.0 (0) 10.0 (2)
TOTAL 45.0 (9) 35.0 (7) 30.0 (6) 100.0 (20)
Numbers do not add to 100% because some studies reported multi-
ple outcomes.
Other internalizing behaviors included internalized shame, personal
strength, general internalizing behaviors, psychological distress, and
loneliness. See Tables S1 and S2 for details.
8 Am J Community Psychol (2021) 0:117
Associations With Attributes
Seven (35.0%) of the quantitative articles assessed asso-
ciations between masculine attributes and mental health.
As with gender role norm adherence, the majority of arti-
cles focusing on masculine attributes assessed associa-
tions with depression (n =6), but half also assessed
associations with self-esteem (n =3; Table 2). Additional
mental health variables assessed were perceived social
support and other internalizing behavior problems
(Table 2). All but one article used versions of the Bem
Sex Role Inventory to assess masculine (instrumental)
attributes (Table S1); the other article used an investiga-
tor-created scale (Kulis, Marsiglia, & Nagoshi, 2010). All
seven articles assessed masculine (instrumental) attributes
and mental health outcomes at the individual level
(Table S1).
Of these articles, four found a positive association (i.e.,
greater identication with masculine attributes, such as
ambitiousand assertive,was associated with better
mental health; Choi et al., 2010; Marcotte, Alain, & Gos-
selin, 1999; Marcotte, Fortin, Potvin, & Papillon, 2002;
Young & Sweeting, 2004). These articles were all school-
based and included samples from South Korea, French-
Table 3 Summary of quantitative associations
Internalizing behavior problem Social support
Depression Anxiety Stress Self-esteem Other Help-seeking intentions Perceived support
Adherence (n =9)
Bastereld et al. (2014) No ––– – –
Choi et al. (2010) Yes ()––Yes ()–– –
Gupta et al. (2013)
Yes ()––Yes ()–– Yes (-)-
Mahalingam and Balan (2008) Yes (+)––– Yes (+)
Mansor et al. (2014) No Yes () Yes ()––– –
Santos et al. (2013)
-Yes ()–– –
Sears et al. (2009) Yes ()–– Yes () Yes ()
Shepard et al. (2011) No No No No –– No
Steinfeldt and Steinfeldt (2010) Yes (-)
Attributes (n =7)
Choi et al. (2010) Yes (+)––Yes (+)–– –
Kulis et al. (2010) ––Yes ()
Lapointe and Marcotte (2000) No ––– – – No
Marcotte et al. (1999) Yes (+)––– – –
Marcotte et al. (2002) Yes (+)––Yes (+)–– –
Wichstrøm (1999) No ––– – –
Young and Sweeting (2004)
Yes (+)––Yes (+) Yes (+)
Yes (+)
Identity (n =6)
Jewell and Brown (2014) No Yes ()Yes (-) –– –
Menon (2011) Yes ()––Yes ()–– –
Rogers et al. (2015)
Yes (+)––Yes (+)–– –
Smith et al. (2018)
No Yes ()–– Yes ()
van Beusekom et al. (2016) Yes ()–– Yes ()
Young and Sweeting (2004)
Yes ()––No Yes ()
For full details on study ndings, see Tables S1 and S2.
For beliefs, Yes ()means higher adherence to stereotypical gender role norms was associated with worse mental health; Yes (+)means
higher adherence to stereotypical gender role norms was associated with better mental health; Nomeans an association was explored but not
found; and -means an association was not explored.
Longitudinal study.
Other behaviors measured were shame and personal strength.
For traits, Yes ()means more identication with masculineattributes was associated with worse mental health; Yes (+)means more
identication with masculineattributes was associated with better mental health; Nomeans an association was explored but not found;
and -means an association was not explored.
Other behavior measured was general internalizing behaviors, using the Achenbach Youth Self-Report.
This is a longitudinal study, but only data from the age 15 wave are included in the paper; thus, it is considered cross-sectional for the pur-
poses of this paper.
Other behavior measured was loneliness.
All identity studies measure gender typicalityexcept Rogers et al. (2015). For Rogers et al. (2015), Yes (+)means higher gender private
regard was associated with better mental health; -means an association was not explored. For typicality, Yes (-)means higher gender
atypicalitywas associated with worse mental health; Yes (+)means higher gender atypicalitywas associated with better mental health;
Nomeans an association was explored but not found; and -means an association was not explored.
Other behavior measured was psychological distress (generally).
Am J Community Psychol (2021) 0:117 9
speaking Canada, and Scotland (Table 1). Outcomes in
these four articles were depression (n =4), self-esteem
(n =3), and loneliness (n =1). However, two other arti-
cles also using school-based samples to assess masculine
attributes found no association with depression (Lapointe
& Marcotte, 2000; Wichstrøm, 1999). These samples were
drawn from French-speaking Canada and Norway, and
were considered to be at higher and very low risk of bias,
respectively (see below). Finally, one included article
found a negative association with general internalizing
behaviors (i.e., greater identication with masculine attri-
butes was associated with poorer mental health; Kulis
et al., 2010; Table 3); however, it is important to note that
this is the only article to use an investigator-created scale,
and not the Bem Sex Role Inventory, and was rated as
having a high risk of bias.
Two articles assessed associations between masculine
attributes and social support. Lapointe and Marcotte
(2000) assessed social support seeking and did not nd an
association in a school-based French Canadian sample,
while Young and Sweeting (2004) found a positive asso-
ciation between greater endorsement of masculine attri-
butes and number of friends (Table S2).
Associations With Identity
Seven (33.3%) of the quantitative articles assessed associ-
ations with masculine identity, primarily by measuring
gender typicality(or, how well one feels they align
(globally) with their socially perceived gender category;
n=6). A majority of these articles assessed associations
with depression (n =5), self-esteem (n =4), and anxiety
(n =3), and the remainder assessed associations with
other internalizing behavior problems (loneliness, general
psychological distress). To assess gender typicality, four
articles used Egan and Perrys (2001) measure, one used
the Childhood Gender Non-conformity Scale, and one
assessed gender diagnosticity (i.e., the degree of male-
nessan individual possesses, and used in this study to
categorize participants as gender atypical, extremely gen-
der-typed, or gender typical; Young & Sweeting, 2004;
Table S1). The remaining identity article from Rogers
et al. (2015) assessed gender private regard and gender
centrality. Six articles assessed identity and mental health
outcomes at the individual level; however, one article
(Smith, Schacter, Enders, & Juvonen, 2018) also consid-
ered a school-level measure of gender norm salience, and
associations with individual-level loneliness, depressed
mood, and social anxiety (Table S1).
All six articles exploring gender typicality found nega-
tive associations with the internalizing behavior problems
described above (i.e., higher gender atypicality was asso-
ciated with poorer mental health; van Beusekom, Baams,
Bos, Overbeek, & Sandfort, 2016; Jewell & Brown, 2014;
Menon, 2011; Smith & Juvonen, 2017; Smith et al.,
2018; Young & Sweeting, 2004; Table 3). All of these
articles used school-based samples; half of these studies
were with United States-based samples, and the other
three included youth from England, The Netherlands, and
Scotland (Table 1). Examining a different aspect of iden-
tity, Rogers et al. (2015) found a positive association
between gender private regard and depression and self-es-
teem in a school-based sample of African American youth
(i.e., a more positive assessment of the identity group was
associated with better mental health). Only one article also
assessed associations with perceived social support
(Young & Sweeting, 2004), but did not nd an associa-
tion (Table 3).
Article Quality
We used four criteria to assess the quality of quantitative
articles: (a) missingness/attrition, (b) measures used, (c)
sampling frame, and (d) response rate. We then evaluated
risk of bias for each criterion: (a) high, (b) low, or (c)
unclear. We also had a category for other quality issues,
where the team could highlight general concerns, issues,
or questions for consensus. Quality was then determined
through consensus between the rst, second, and fourth
authors. Three (15.0%) studies were found to be at low
risk of bias (Mansor et al., 2014; Wichstrøm, 1999;
Young & Sweeting, 2004), due to minimal attrition, use
of standardized measures, probability sampling, and high
response rates. As noted above, nearly all of the studies
included in this review used a convenience sample as the
sampling frame, which increased the risk of bias. Eight
(40.0%) studies were found to be at fairly low risk of bias
(van Beusekom et al., 2016; Gupta et al., 2013; Marcotte
et al., 2002; Rogers et al., 2015; Santos et al., 2013; Sears
et al., 2009; Smith et al., 2018; Steinfeldt & Steinfeldt,
2010). Each of these studies used standardized measures,
employed convenience sampling, and reported high
response rates, though Sears et al. (2009) and van Beuse-
kom et al. (2016) did not report on missingness/attrition,
and missingness/attrition in Santos et al. (2013) was
unclear. Nine (45.0%) studies were found to be at higher
risk of bias (Bastereld et al., 2014; Choi et al., 2010;
Jewell & Brown, 2014; Kulis et al., 2010; Lapointe &
Marcotte, 2000; Mahalingam & Balan, 2008; Marcotte
et al., 1999; Menon, 2011; Shepard et al., 2011). Though
all these studies except Kulis et al. (2010) used standard-
ized measures, most did not report on missingness/attrition
or response rates, and all used a convenience sample.
Though Jewell and Brown (2014) did report on missing-
ness/attrition, the consent and response rate in this study
was quite low (49.1%).
10 Am J Community Psychol (2021) 0:117
Summary of Qualitative Findings
In terms of assessing associations with masculinity, the
nine included qualitative articles focused on the inuence
of male gender role norm adherence, primarily exploring
emotional connection/restriction and mental health (n =6;
66.7%). Other less prominent themes included policing of
masculinity (n =3; 33.3%) and institutional expectations
for masculinity (n =2; 22.2%). A summary of key nd-
ings by article is presented in Table S3.
Emotional Connection
Six (66.7%) of the included qualitative studies discussed
emotional connection, including closeness, expression, con-
sequences of, and restriction. Randell, Jerden, Ohman, Star-
rin, and Flacking (2016) and Reigeluth, Pollastri, Cardemil,
and Addis (2016) explored emotional expression related to
masculinity and friendships. Reigeluth and Addis (2016)
examined the emotional consequences of policing mas-
culinity, and Spencer (2007) examined emotional closeness
in healthy male adultyouth relationships. Way et al.
(2014) found that the ability to maintain close friendships
through adolescence was linked to the ability to resist con-
forming to stereotypical masculine norms; specically,
emotional connection was directly related to the ability to
establish and maintain close friendships, which in turn sup-
ported resistance to adopting stereotypical male gender role
norms. Finally, Wisdom, Rees, Riley, and Weis (2007)
found that adherence to stereotypical gender role norms
resulted in emotional restriction and created a barrier to
seeking help for depression. In this study, boys were more
likely than girls to ignore, repress, or distract themselves
from negative emotions and feelings.
Overall, all six articles found that emotional connec-
tion, expression, and closeness with friends were affected
by adherence to stereotypical male gender role norms.
Specically, boys who adhered more strongly to gender-
normative masculinity were more likely to exhibit emo-
tional restriction than their less adherent peers, and tended
to police other boysperformances of masculinity in order
to diminish expressivity and maintain a perceived mascu-
line ideal. Emotional connection was also found to be
contextually dependent upon boysadherence to or rejec-
tion of stereotypical gender role norms.
Policing of Masculinity
One study discussed policing of masculinity specically
(Reigeluth & Addis, 2016), although there were two other
studies focused on emotional connection that also high-
lighted the issue of policing masculinity (MacLean et al.,
2010; Reigeluth et al., 2016). The themes of policing
masculinity and emotional connection overlapped in the
Reigeluth et al. (2016) and Reigeluth and Addis (2016)
studies, in which some boys were found to engage in the
policing of masculinity among their peers. In these stud-
ies, policing of masculinity was used to minimize emo-
tional expressivity and uphold stereotypical gender role
norms of stoicism, toughness, and emotional restriction.
MacLean et al. (2010) also found that boys demonstrated
awareness of and adherence to expectations of gender role
norms, including stoicism, strength, control, and indepen-
dence, such that these norms become strict rulesfor
behavior policed by peers. For both physical and psycho-
logical symptoms, boys said that they would conceal,
downplay, or ignore symptoms in order to better conform
to masculine norms in front of their peers.
Institutional Expectations for Masculinity
There were two (22%) studies that focused on institutional
modeling and expectations for masculinity (Mac an Ghaill
and Haywood, 2012, describe institutional masculinity as
gendered expectations within school systems and other
institutions that determine acceptable behaviors). Heinrich
(2013) focused on the production of masculinity and vul-
nerability, and found that institutional masculinity rein-
forced hierarchy, hegemony, and power structures,
ultimately privileging some performances of masculinity
over others. Emotional connection and expression were
consequently restricted by these institutional expectations,
resulting in performances of masculinity that adhered to
male gender role norms such as stoicism and toughness.
Mac an Ghaill and Haywood (2012) examined normative
models of masculinity and suicide, nding that assump-
tions of gendered behaviors developed at the institutional
(school) level rather than the individual level; specically,
characteristics and norms of behaviors were determined
by institutional assumptions (e.g., around showing fear),
rather than individualized traits. Based on their ndings,
the authors conclude that institutional masculinity results
in a production and regulation of boyhood(p. 485) and
that failure to conform to institutional expectations of boy-
hood led to anxiety and emotional distress among their
participants. The institutional expectations of gendered
norms also affected boysability to emotionally disclose,
demonstrate emotion, or seek help. Institutional expecta-
tions for masculinity thus created structural processes and
barriers to help-seeking, especially in cases where boys
were expected to be stoic and independent.
Article Quality
We assessed the quality of the qualitative studies using
the RATS Checklist (Equator Network, 2016). This
Am J Community Psychol (2021) 0:117 11
checklist assesses the: (a) relevance of the study ques-
tions; (b) appropriateness of the qualitative method used;
(c) transparency of the sampling, recruitment, roles, and
ethical procedures; and (d) soundness of the approach.
The majority of the qualitative articles (n =8, 88.9%) had
low to mostly low risk of bias (Mac an Ghaill & Hay-
wood, 2012; Maclean & Sweeting, 2010; Randell et al.,
2016; Reigeluth & Addis, 2016; Reigeluth et al., 2016;
Spencer, 2007; Way et al., 2014; Wisdom et al., 2007).
We considered Randell et al. (2016), Spencer (2007), and
Wisdom et al. (2007) to be at low risk of bias as these
studies accounted for all of the RATS Checklist criteria
and provided clear explanations of the study design, ethi-
cal considerations, analysis, and ndings. For the others,
we consider them to be at mostly low risk of bias as they
did not clearly report some of their procedures per RATS
guidelines, but were generally transparent (Mac an Ghaill
& Haywood, 2012; Maclean & Sweeting., 2010; Reige-
luth & Addis, 2016; Reigeluth et al., 2016, Way et al.,
2014). We found only one study to have a higher risk of
bias. The analysis in Heinrich (2013) was not clearly
specied, ethics approval was not discussed in the article
and it was unclear how the researcher accounted for their
relationship with participants.
In this article, we present the most comprehensive review
to date of connections between masculinities and internal-
izing behavior problems and social support in adolescent
boys. Generally, we found that greater identication with
stereotypical masculine attributes (e.g., ambitious) was
associated with better mental health (i.e., fewer internaliz-
ing behavior problems, greater social support), while
greater adherence to stereotypical male gender role norms,
such as restricted emotionality and dominance, as well as
lower gender typicality(a measure of identity), was
associated with poorer mental health (i.e., more internaliz-
ing behavior problems, less social support). Qualitative
articles exclusively focused on understanding the conse-
quences of emotional restriction (a stereotypical male gen-
der role norm) for mental health. In the included
qualitative articles, emotional restriction contributed to
boys being less likely to discuss or seek help for mental
health problems. However, qualitative articles also demon-
strated that when boys were more aware of stereotypical
male norms, or had more supportive peer and adult rela-
tionships, they felt less of a need to police masculinity or
uphold idealized expectations for masculinity, suggesting
the need to intervene on interpersonal and institutional set-
tings (in addition to individual-level beliefs and attitudes)
to improve mental health outcomes for adolescent boys.
In terms of masculine gender role norms, in quantita-
tive articles, we primarily found that as adherence to these
norms increased, mental well-being decreased (i.e., higher
depression, anxiety and stress, lower self-esteem and per-
ceived social support); these ndings were also supported
and expanded upon by included qualitative articles. These
ndings also align with theory that links adherence to
these masculine norms with poor mental health (e.g.,
Courtenay, 2000; Evans et al., 2010), and indicate that
pathways to downstream internalizing behavior problems
for men may rst emerge in adolescence. This nding
also aligns with Wong et al.s (2017) meta-analysis,
which found that conformity to stereotypical masculine
norms had moderate correlations with both poor mental
health and less psychological help-seeking in samples of
primarily adult men.
The three studies in our review which demonstrated a
positive association/no association between gender role
norm adherence and mental health were all rated as at
higher risk of bias, which may be one reason for this dif-
ference. However, we also note that the one article that
found a positive association (i.e., that greater adherence to
male gender role norms was associated with lower depres-
sion and shame and greater personal strength) was in a
community-based sample, while the articles that found
negative associations were all in school-based samples.
The two articles that found no association were in a spe-
cialized (a summer enrichment program; Shepard et al.,
2011) and a non-North American (South African youth;
Bastereld et al., 2014) sample. Given that masculinities
are locally constructed (Ward et al., 2017), it is thus pos-
sible that in some contexts, adhering to certain masculine
ideologies may be adaptive for mental health (Heller
et al., 2015). This highlights the role of domain-specic
contexts in shaping behavior (Trickett, 2009), and the
need for future research in community psychology to
more deeply explore the role of differential contexts in
shaping connections between masculinities and mental
Of the six studies that examined identication with
gender-typed attributes as assessed by the Bem Sex Role
Inventory, all but two found that endorsement of mascu-
lineattributes was associated with fewer internalizing
behavior problems and better social support. In other
words, male adolescents who more strongly identied
with attributes such as ambitiousand assertive
reported less depression, better self-esteem, and more per-
ceived social support (the one study that found a negative
association did not use a standardized measure and was
rated as having high risk of bias). As Gupta et al. (2013)
suggest, ndings such as these should not be surprising,
as qualities that are often perceived as positive (such as
being ambitious and assertive) are associated with
12 Am J Community Psychol (2021) 0:117
masculinity (instrumentality) on the Bem Sex Role Inven-
tory. However, although this scale interprets these attri-
butes as masculine, adolescents themselves may no longer
view them this way. Specically, research by Auster and
Ohm (2000) compared the validity of the Bem Sex Role
Inventory from 1972 to 1999 in college samples, nding
that in 1999, only 8 of the original 20 masculineattri-
butes were still interpreted as masculine, likely since con-
structions of masculinity have changed over time
(Bastereld et al., 2014). Thus, future research on these
attributes should likely be disentangledfrom the con-
cept of masculinity (Spence & Helmreich, 1980, p. 147).
We also note that adherence to gender role norms (e.g.,
around toughness, stoicism) was generally associated with
poorer mental health, while endorsement of masculine
attributes (e.g., self-reliance, ambitious, assertive) was gen-
erally associated with better mental health. This nding
aligns with past research with male adolescents, which did
not nd a signicant correlation between gender role norm
adherence and attributes (Chu et al., 2005), and thus, it fol-
lows that these two constructs may be differentially related
to mental health outcomes. Specically, as noted by Gupta
et al. (2013), masculine attributes typically refer to traits
that are viewed positively by individuals and interpersonal
others (e.g., in Western culture, it is a good thing to be
viewed as an independent, assertive leader who is willing
to take risks). Conversely, gender role norms assess behav-
iors likely to cause internal distress (e.g., hiding emotions,
feeling like you have to appear in control at all times). In
addition to differential interpretations, these ndings may
also reect issues in measurement and conceptualization.
Specically, and as mentioned above, the masculine
traits presented in gender-typed attribute studies are likely
not the best way to explore associations between masculin-
ities and mental health in contemporary contexts, as
respondents themselves may no longer interpret these traits
as masculine(Bastereld et al., 2014). However, gender
role adherence behaviors are still very much interpreted as
comprising what it means to be a manin many contexts
(e.g., Way et al., 2014). These differential interpretations
and measurement issues may thus underlie the divergent
association of these two constructs with internalizing
behavior problems and social support in the articles
reviewed in our study.
Finally, all of the articles that assessed gender typical-
ity(an aspect of identity) found that boys who reported
higher scores on measures of gender atypicality reported
more depression, anxiety, loneliness, general psychologi-
cal distress, and lower self-esteem than their more gender-
typical peers. This nding likely speaks to the marginal-
ization and violence experienced by gender non-conform-
ing boys (Brooks, 2000; DAugelli, Grossman, & Starks,
2006); to make this connection to larger structural
marginalization clearer, we encourage future research to
take a critical lens on social exclusion of individuals who
are not perceived as conforming to the typicalgender
binary, as opposed to a focus which roots causality at the
level of the individual. To this end, we encourage future
research on this topic to move away from terms that cen-
ter the problem within individuals (such as gender typical
or atypical), and that instead locate the problem within
environments that are gender rigid or gender accepting.
This structural understanding is also critical when inter-
preting this nding (i.e., the issue is not helping boys to
be more typical,but rather creating communities where
these boys are accepted for who they are). Only one of
the seven gender typicalityarticles assessed any form of
social support, and the one article that did investigate this
support only looked at number of friends (Young &
Sweeting, 2004). Given the adverse mental health out-
comes reported by boys who scored high in gender atypi-
cality in our review, additional research exploring social
support among this group is critically needed.
Implications for Community Psychology
As Mankowski and Manon (2010) note, the analysis of
mens gender largely is missing from community psychol-
ogys efforts to understand wellness, oppression and social
systems change(p. 74). Yet, understandings of masculini-
ties and mental health in context are clearly relevant to the
work of community psychologists. Thus, community psy-
chology can specically play a role in addressing gaps
identied by this review. First, despite an acknowledge-
ment among researchers that masculinity is socially con-
structed and context-dependent (Connell, 2005; Connell &
Messerschmidt, 2005; Smiler, 2004), most articles in our
review still focused on an individual-level of analysis (i.e.,
analysis that explored individual adherence to beliefs or
endorsement of attributes, independent of their broader
social context). More specically, while beliefs about mas-
culine role norms, attributes, and identity are of course
shaped by the larger culture (Bond & Wasco, 2017), the
majority of included quantitative articles did not explore
this larger context, focusing instead on how individual-
level beliefs, behaviors, and attitudes were related to indi-
vidual-level internalizing behavior problems/social support
(this may reect the discipline of study authors; only three
articles were published in journals relevant to community
; two-thirds of articles were published in
developmental psychology or gender/masculinity journals).
Conversely, only three articles in this review included an
explicit focus on contexts other than the interpersonal
Am J Community Psychol (2021) 0:117 13
setting (one quantitativeSmith et al., 2018; two qualita-
tiveHeinrich, 2013; Mac an Ghaill & Haywood, 2012),
with all demonstrating how the school context shapes
expectations for appropriate masculine behavior and pre-
sentation, and the detrimental impact of these expectations
for mental well-being. Thus, community psychology
research exploring the contextual nature of gendered quali-
ties, and the role of settings in shaping gender norms,
expectations, and processes (Bond & Wasco, 2017; Man-
kowski & Maton, 2010), is warranted. While the call to
consider connections between masculinities, context, and
mental health is not new (e.g., Connell, 2005), our review
demonstrates that these connections have still not been
adequately explored, and thus, community psychologists
can make a much needed and valuable addition to this lit-
Second, we feel the ndings of our review further Smi-
lers (2004) point that there is no problematic form of mas-
culinity itself, but rather that problems arise as a result of
overly rigid adoption/adherence to masculine norms [that]
can be problematic(i.e., a lack of behavioral exibility; p.
20). Since this is the case (i.e., masculinity in and of itself is
not something problematic residing within individuals),
sociocultural context, and implications of this context for
outcomes, is critical to understand. However, despite the
importance of cultural and contextual norms and beliefs, the
eld to date has largely focused on individualistic
approaches to understanding masculinities (Smiler, 2004), a
nding further bolstered by our review. Thus, we believe
community psychology researchers can signicantly
advance the eld by plac[ing] boysidentities within insti-
tutional contexts in order to explore what gender means and
how gender is lived out(Mac An Ghaill & Haywood,
2012, pp. 485486), and implications of such living out for
mental health. To this end, Bond and Wasco (2017) present
a three-part conceptual model on understanding gendered
nature of settings that can guide this work.
Finally, cross-cultural work suggests that while there
may be dimensions of gender-typed behavior that is simi-
lar across cultures (Arciniega, Anderson, Tovar-Blank, &
Tracey, 2008; Way, 2011; Yim & Mahalingam, 2006),
the degree to which individuals adhere to masculine
expectations and their mental health adjustment may vary
depending on the meaning of the behavior within cultures
(Gupta et al., 2013). For example, in our review, one of
the articles using a school-based sample of South African
youth did not nd an association between adherence to
male gender role norms and internalizing behavior prob-
lems (depression; Bastereld et al., 2014), while another
study using a community-based sample of Indian youth
found positive associations (i.e., stronger adherence to
male gender role norms was associated with less depres-
sion and shame, and greater personal strength;
Mahalingam & Balan, 2008). These ndings point to the
possible inuence of local and regional constructions of
masculinity on mental health outcomes, and as such, more
research exploring the cultural aspects of the impacts of
gender-typed ideologies on mental health is warranted
(Connell, 2012). Community psychologists can contribute
to this work by exploring cross-cultural differences in
masculinity and mental health (Trickett, 2009), illuminat-
ing both the contexts of [masculine] diversity and the
diversity of [masculine] contexts(Trickett, 1996, p. 218).
Further, only one of the included articles (Rogers et al.,
2015) specically explored intersections of race and gen-
der identity. Thus, an explicit focus on intersections
between race, gender, and class (and other identity mark-
ers) is another critical area for future community psychol-
ogy research on masculinities in context.
Several limitations should be noted. First, while we had
originally planned to conduct additional searches for other
mental health outcomes (particularly externalizing behavior
problems, including substance use and antisocial behavior),
the large number of returns on our internalizing behavior
problems/social support search meant we were not able to
address additional outcomes, due to resource constraints.
Thus, a review of connections between masculinities and
externalizing behavior problems in adolescence is a needed
contribution to the literature. We also did not include per-
sonality disorders. These are all important outcomes for
future reviews. Second, because of the lack of consistency
in reporting of effects, as well as the lower quality of a
number of our quantitative articles, we made the decision
not to perform a meta-analysis on these data. Finally, all
quantitative studies but three used non-representative sam-
ples, and all but four used a cross-sectional design. Thus,
ndings should be interpreted with caution.
Future Directions
Attention to the mental health of men and boys, and the asso-
ciation of masculinities with mental health, continues to
grow. Indeed, the recently released American Psychological
Association (APA) Guidelines for Psychological Practice
with Men and Boys (2018) specically draw attention to the
role of gender role conict and masculinity ideology in shap-
ing mental health, including through restricting willingness
to seek help. Given the importance of the adolescent period
for understanding the development of masculinities in con-
text, as well as for promoting mental health, it is critical to
continue to explore connections between aspects of mas-
culinity and mental health in this age group. Our review
highlights several key gaps in the adolescent literature,
14 Am J Community Psychol (2021) 0:117
including a failure to assess interactions between context,
masculinities, and mental health, and areas where community
psychology can address these gaps.
In addition to implications for research, our review also
has key implications for practice. Specically, we believe
our review highlights the critical need to focus on gender-
transformative health promotion approaches with adoles-
cent boys (Brush & Miller, 2019), in order to help them
deconstruct and explore gendered expectations for their atti-
tudes, beliefs, behaviors, attributes, and identity. To be
effective, it is critical this work focuses on the larger cul-
tural context that shapes masculine norms, attributes, and
identity (e.g., by working to change school culture), and not
just individual-level behavior (Trickett, 2009; Trickett &
Rowe, 2012). The APA (2018) practice guidelines also
specically highlight the need for experiential groups to
promote friendships and support among boys while helping
them critically examine dysfunctional boy codes and
restrictive notions of masculinity(p. 14). The ndings of
this review demonstrate the critical nature of such pro-
grams, and their potential for addressing life course health
Acknowledgments This research was supported in part by a Seed
Grant from PolicyWise. The authors thank Chelsea Stone, Tasmia
Hai, Madelyn Worth, and Marisa Van Bavel for their support with
manuscript preparation and also to Angelique Jenney, PhD, for her
input on earlier versions of this paper.
Conicts of Interest
The authors have no conicts of interest to declare.
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Supporting Information
Additional supporting information may be found online in
the Supporting Information section at the end of the arti-
Am J Community Psychol (2021) 0:117 17
... When emotion was displayed, boys who endorsed highly hegemonic masculine ideas tend to feel that anger was the only acceptable emotion, leading such boys to be less likely to back down from a physical fight when challenged. Research on hegemonic masculinity in young children is limited, but does find the beginnings of similar attitudes and patterns displayed by adults, such as increased internalizing problems (Exner-Cortens, Wright, Claussen, & Truscott, 2021). For example, one study of middleschool-aged children (seventh and eighth grade) found that children who prescribed more masculine norms (especially emotional stoicism) decreased both school liking and engagement (Rogers, Updegraff, Santos, & Martin, 2017). ...
Princess culture is criticized for contributing to gender stereotypes and poor body esteem, however, there is little longitudinal research examining these claims. This study examines associations between engagement with princess culture during early childhood and gender stereotypes, body esteem, and adherence to hegemonic masculinity in early adolescence. Participants included 307 children (51% female, Mage = 4.83 years, 87% White) who completed questionnaires at two time points, 5 years apart. The results indicated that early engagement with princess culture was not associated with later adherence to female gender stereotypes. However, princess engagement was associated with lower adherence to norms of hegemonic masculinity and higher body esteem. Socioeconomic status and gender moderated the results. Effect sizes were small to moderate. The changing nature of Disney princesses is discussed in the context of gender development across childhood.
... The role of toxic masculinity regarding mental health has been previously investigated. Toxic masculinity is associated with reduced mental well-being and less help-seeking behaviors [28], and are harmful to men and those around them [29]. However, research has shown that men's health improves when they participate in egalitarian groups that foster alternative masculinities and friendship relationships [24]. ...
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This study investigated the association between gender role attitudes, perceived friend support, and school bullying among male adolescents from 11 schools in two cities in China. A total of 3172 Chinese adolescents between 12 and 20 years of age (48.80% girls and 51.20% boys) completed questionnaires that included measures of bullying, gender role attitudes, and perceived social support. In terms of outcome measures, the Chinese version of the Illinois Bully Scale (IBS), Attitudes toward Women Scale for Adolescents (AWSA), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess bullying perpetration, gender role attitudes, and perceived friend support, respectively. Based on masculinity theories and the stress-buffering theory, the study found that male adolescents held more traditional gender role attitudes (t = 30.78, p < 0.001) and reported higher prevalence of bullying behaviors (36.02%) than girls (31.20%). In addition, boys’ bullying behaviors were significantly predicted by gender role attitudes through perceived friend support. That is, male youth with more conservative gender role attitudes reported less perceived friend support (adjusted OR = 1.055; SE = 0.013), which elevated their risks of bullying perpetration (adjusted OR = 2.082; SE = 0.302). These findings have critical implications for bullying intervention and prevention through gender equity education.
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Gender-transformative approaches (i.e., approaches that support male-identified individuals to critique and resist stereotypical male gender role norms that negatively affect health and well-being) are increasingly recognized as a key health promotion strategy. However, there is limited evidence to date on gender-transformative interventions for male-identified adolescents. In addition, given the dynamic and socially constructed nature of gender, methods beyond quantitative data collection are needed to gain a holistic understanding of promising gender-transformative health promotion approaches. One newer method to capture lived experiences with adolescents is photo-based evaluation, where youth program participants take pictures to represent their knowledge, attitudes, and/or behaviors before and after a program. The present study presents findings from the photo-based evaluation of a gender-transformative health promotion program called WiseGuyz. WiseGuyz is offered to mid-adolescent, male-identified youth in school and community settings, and is designed to promote mental and sexual health and prevent violence. Six youth photographers from a rural Canadian setting took part in this evaluation, taking photos to represent what being a guy in their world meant before and after WiseGuyz. Youth then participated in an individual visual storytelling interview and a group-based photovoice process. Key themes in relation to masculinities that emerged from these data were around changes to (1) social norms and (2) emotionality following program participation, and the need for a safe program space to support these changes. This study adds to literature demonstrating the promise of gender-transformative approaches with adolescents, with implications for future health promotion research and practice with male-identified youth.
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Youth who feel they do not fit with gender norms frequently experience peer victimization and socioemotional distress. To gauge differences between schools, the current study examined the longitudinal effects of school-level gender norm salience—a within-school association between gender typicality and peer victimization—on socioemotional distress across 26 ethnically diverse middle schools (nboys = 2607; ngirls = 2805). Boys (but not girls) reporting lower gender typicality experienced more loneliness and social anxiety in schools with more salient gender norms, even when accounting for both individual and school level victimization. Greater gender norm salience also predicted increased depressed mood among boys regardless of gender typicality. These findings suggest particular sensitivity among boys to environments in which low gender typicality is sanctioned.
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Observable anxieties have been developing about the position of boys and young men in contemporary society in recent years. This is expressed as a crisis of masculinity, in which place is often implicitly implicated, but is rarely considered for its role in the shaping of young men’s practices, trajectories and aspirations. Drawing on research conducted with young people who accessed a range of social care support services, this article argues that transition means different things for young men in different locales and that local definitions of masculinity are required to better understand young men’s lives and the opportunities available to them. The authors argue that home life, street life, individual neighbourhoods, regions and nations all shaped the young men’s identities and the practices they (and the staff working with them) drew on in order to create successful futures and ‘safe’ forms of masculinity. It is suggested that this place-based approach has the potential to re-shape the ‘crisis’ discourse surrounding masculinity and the anxieties associated with young men.
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Despite theoretical postulations that individuals' conformity to masculine norms is differentially related to mental health-related outcomes depending on a variety of contexts, there has not been any systematic synthesis of the empirical research on this topic. Therefore, the authors of this study conducted meta-analyses of the relationships between conformity to masculine norms (as measured by the Conformity to Masculine Norms Inventory-94 and other versions of this scale) and mental health-related outcomes using 78 samples and 19,453 participants. Conformity to masculine norms was modestly and unfavorably associated with mental health as well as moderately and unfavorably related to psychological help seeking. The authors also identified several moderation effects. Conformity to masculine norms was more strongly correlated with negative social functioning than with psychological indicators of negative mental health. Conformity to the specific masculine norms of self-reliance, power over women, and playboy were unfavorably, robustly, and consistently related to mental health-related outcomes, whereas conformity to the masculine norm of primacy of work was not significantly related to any mental health-related outcome. These findings highlight the need for researchers to disaggregate the generic construct of conformity to masculine norms and to focus instead on specific dimensions of masculine norms and their differential associations with other outcomes. (PsycINFO Database Record
The World Health Organization encourages a “gender transformative” paradigm for preventing violence against women and girls. Gender transformative interventions engage men and boys to reflect critically on—and then to challenge and change—gender-inequitable attitudes and behaviors. To interpret the mixed findings of research evaluating such programs, we review the “social norms” model that informs the paradigm. We bolster the paradigmatic conceptualization of social norms through insights about how exposure to trauma shapes gendered patterns of victimization and perpetration, about gendered violence from research on homophobic bullying, and about transforming local regimes of gender accountability.
The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review ? The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
The current longitudinal study was designed to examine one of the possible underlying mechanisms that can help account for why low gender typicality (i.e., not feeling like a typical boy or girl) is related to subsequent psychosocial adjustment problems: peer victimization. Relying on a large (N = 5,991, 52% female), ethnically diverse U.S. sample, the results suggested that peer victimization at 7th grade partially accounts for associations between 7th grade gender typicality and 8th grade social anxiety, somatic complaints, and externalizing behavior, when controlling for earlier (e.g., 6th grade) levels of adjustment. Associations were similar across ethnic groups. Peer victimization mediated associations for boys and girls across all outcomes; however, girls showed stronger associations with somatic complaints and boys showed stronger associations with externalizing behavior. These results suggest that attempts to improve adjustment for youth feeling low gender typicality should focus in part on reducing peer victimization.
We present the results of three large-scale randomized controlled trials (RCTs) carried out in Chicago, testing interventions to reduce crime and dropout by changing the decision-making of economically disadvantaged youth. We study a program called Becoming a Man (BAM), developed by the non-profit Youth Guidance, in two RCTs implemented in 2009–10 and 2013– 15. In the two studies participation in the program reduced total arrests during the intervention period by 28–35%, reduced violent-crime arrests by 45–50%, improved school engagement, and in the first study where we have follow-up data, increased graduation rates by 12–19%. The third RCT tested a program with partially overlapping components carried out in the Cook County Juvenile Temporary Detention Center (JTDC), which reduced readmission rates to the facility by 21%. These large behavioral responses combined with modest program costs imply benefit-cost ratios for these interventions from 5-to-1 up to 30-to-1 or more. Our data on mechanisms are not ideal, but we find no positive evidence that these effects are due to changes in emotional intelligence or social skills, self-control or “grit,” or a generic mentoring effect. We find suggestive support for the hypothesis that the programs work by helping youth slow down and reflect on whether their automatic thoughts and behaviors are well suited to the situation they are in, or whether the situation could be construed differently.
This study stems from a yearlong qualitative inquiry examining the influence that gender ideologies exercised in the lives of four young men in the high school setting. Utilizing a feminist, post-structuralist perspective (Davies, 1997, 1989; Connell, 1996, 1997, 1989; Martino, 1995), it analyzes how masculinity constructs itself through discursive practices. The study involves four adolescent boys, Michael, Peter, Aiden and Jack, all friends and classmates in a small, Midwestern high school comprised mainly of working class and farming families. This study examines each boy’s idiosyncratic positioning within dominant discourses of masculinity, specifically questioning its ability to shape, influence and possibly constrain posture and performance in the classroom setting.