Gender Norms, Mental Health, and School Engagement Among Adolescent Girls In Southern Uganda

Background and Purpose: Adolescent girls in sub-Saharan Africa navigate developmental transitions within social contexts shaped by restrictive gender norms, poverty, and limited psychosocial resources. While prior research links gender norms to adverse mental health and educational outcomes, empirical evidence disentangling these relationships remains limited. This study examines the associations between gender norms, mental health, and school absenteeism among adolescent girls in Southern Uganda.

Methods: Baseline data were drawn from the Suubi4Her study, a longitudinal cluster-randomized clinical trial conducted across 47 secondary schools. The analytic sample included 903 school-going adolescent girls aged 14–17 years. Gender norms were assessed using a 10-item gender attitude scale. Mental health outcomes included depressive symptom severity measured with the Child Depression Inventory, while educational outcomes were captured through self-reported general and fee-related school absenteeism. Ordered logistic regression was used to model depression severity, and logistic and negative binomial regression models were applied to absenteeism outcomes, adjusting for demographic, psychosocial, and household covariates. Interaction effects between hopelessness and gender norms were examined.

Results: Gender norms were not independently associated with depressive symptom severity (OR = 0.98; 95% CI: 0.90–1.06; p = 0.611) or school absenteeism (OR = 0.96; 95% CI: 0.86–1.07; p = 0.444). However, higher levels of hopelessness were strongly associated with greater depression severity (OR = 1.34; 95% CI: 1.11–1.62; p = 0.002), while parental support (OR = 0.95; p = 0.008), friend support (OR = 0.98; p = 0.038), self-esteem (OR = 0.95; p = 0.002), and self-concept (OR = 0.94; p < 0.001) were protective factors. A significant interaction revealed that the association between hopelessness and severe depressive symptoms was stronger among girls with less traditional gender norm beliefs. Depressive symptoms were significantly associated with increased general school absenteeism (OR = 2.33; p = 0.001), while fee-related absenteeism was primarily driven by economic resources and teacher support.

Conclusions and Implications: Findings suggest that psychosocial factors and structural constraints play a more immediate role in shaping mental health and educational engagement than gender norms alone. However, gender norms may indirectly shape vulnerability by modifying how adolescent girls experience psychological distress. Interventions should integrate mental health support, strengthen psychosocial resources, and equip girls to navigate normative environments while addressing structural barriers to schooling.