Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century – trends, causes, consequences
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Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self‐harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.
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There is evidence of a growing disparity in depression, anxiety, and internalizing symptoms between females and males in several high-income countries, including Canada.
“This is consistent with evidence of a growing disparity in depression, anxiety, and internalizing symptoms between females and males in several high-income countries, including Canada [1, 4].”
From Social inequalities in youth mental health in Canada, 2007–2022: a population-based repeated cross-sectional study (2025) · cites this paper as [1]
The sections on trends in depression, anxiety, and internalizing symptoms report widening differences between adolescent girls and boys, including evidence from studies spanning multiple countries. The copy does not specifically establish a growing disparity in Canada (searched: Canada), so that geographic detail is not supported by this source. (LLM, conf=0.84)
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- Authors
- Keyes, K. M., & Platt, J. M.
- Affiliations
- Columbia University (US)
- University of Iowa (US)
- Corresponding author
- Keyes, Katherine M.
- ORCID
- Keyes, Katherine M.
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2023-07-17
- Volume
- 65
- Issue
- 4
- Pages
- 384-407
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC12341061
- OpenAlex
- W4384492986
- Cited by
- 253
- References
- 207
- Citations by year
- 2026: 98 · 2025: 103 · 2024: 47 · 2023: 5
- FWCI
- 12.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01‐MH121410)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- adolescent depression, adolescent anxiety, psychological distress, suicidal ideation, self-harm, adolescent suicide, sex differences, gender differences, pubertal timing, life events, digital technologies, social media, non-binary youth, gender nonconforming youth, prevention and intervention
- MeSH terms
- Adolescent, Anxiety, Anxiety Disorders, Depression, Female, Gender Identity, Humans, Psychopathology, Risk Factors
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