Girls are at higher risk of internalizing problems than boys. This disparity has widened in recent decades, but the underlying mechanisms remain understudied. Here we analysed data from 3,171 adolescents (46.9% girls) within the Tokyo Teen Cohort, assessed at ages 12, 14 and 16 years.
At age 16, girls showed higher prevalence of internalizing problems than boys: depressive symptoms (15.9% versus 8.2%) and suicidal ideation (29.8% versus 18.1%). Coproduction with young people suggested loneliness and desire for thinness as candidate pathways. Using the mediational g-formula, we estimated that the effect through these factors at age 14 relative to the total effect of female sex was 34.7% for depressive symptoms and 46.3% for suicidal ideation at age 16.
These findings suggest that social intermediates may contribute to the higher prevalence of internalizing problems among girls in this cohort, highlighting potential targets for interventions and policies informed by young people. This is a preview of subscription content, access via your institution Access Nature and 54 other Nature Portfolio journals Get Nature+, our best-value online-access subscription Receive 12 digital issues and online access to articles Prices may be subject to local taxes which are calculated during checkout The data analysed in this study are not publicly available owing to usage restrictions and licensing agreements with the TTC. Certain variables are proprietary and cannot be shared openly.
De-identified data are available to researchers upon request to the co-corresponding authors, subject to approval by the TTC steering committee. Requests will normally be reviewed within 4 weeks. Access is subject to the TTC data-use conditions, and approved researchers may be required to enter into a data-use agreement.
Requests should be directed to Z.C.N. or S. Analyses were conducted using R version 4.5.1. The parametric mediational g-formula was implemented using custom code.
The code supporting the main analyses is available via GitHub at https://github.com/ZuiCNarita/Loneliness-thinness-sex-differences-mediation. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Bull. 143, 783–822 (2017).
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