Global organizations such as the United Nations and World Health Organization have viewed gender norms as a driver of worldwide inequities (e.g., United Nations, 2023). The pursuit of disrupting and dismantling gender norms has therefore been of interest for achieving global equity. While a person’s identified gender may align with any number of diverse identities, gender roles are typically assigned based on a binary status (male versus female) that corresponds with often rigid cultural expectations based on sex. Rigid gender norms and stereotypes have been long known to have a harmful effect on health and thus are considered a social determinant of health (Heise et al., Reference Heise, Greene, Opper, Stavropoulou, Harper, Nascimento and Zewdie2019). While gender norms have been of scientific interest for more than a half century, and particularly regarding psychological well-being and health inequities, much of this work has been concentrated on the earlier half of the lifespan from childhood to middle age. However, recent scientific work on gender norms and health has begun to focus on older adults. In this issue, Kanamori and colleagues (Reference Kanamori, Stickley, Takemura, Kobayshi, Oka, Ojima, Kondo and Kondo2023) focus on older adults’ perceptions of the gender norms in their communities as indicated by gendered statements, as well as their own gender role endorsement, and their associations with mental health and suicide risk. Such examinations are critical in understanding cultural and gendered impacts on suicide risk in late life, particularly as suicide deaths themselves follow distinct patterns with regards to sex and gender in late life – for example, rates of suicide in older men in many parts of the world far exceed those of women (Kiely et al., Reference Kiely, Brady and Byles2019; World Health Organization, 2014). However, applying such knowledge to suicide prevention efforts requires understanding the underlying basis of differences or changes in gender roles among different age groups.
In a sample of over 25,000 older adults in Japan, Kanamori and colleagues examined self-reported depression, self-reported lifetime history of suicidal ideation and attempts, and self-reported resistance to seeking help. They also examined participants’ responses regarding the extent to which they thought their community used language that was indicative of restrictive, distinct gender roles (e.g., statements that a person should or should not do a particular activity due to being a man or woman). They found that greater perception of restrictive gender roles within the community, as well as participants’ own endorsement of conventional gender roles, was associated with greater risk of depression and suicidal ideation/behavior. They also found higher levels of endorsement of conventional gender roles among the older-old in their sample compared with younger age groups. While perceiving community gender roles as restrictive was more greatly associated with suicidal behavior than with resistance to help-seeking, one’s own conventional gender role attitudes were more greatly associated with resistance to help-seeking than suicidal behavior. In men, those who did not strongly endorse conventional gender roles themselves but did perceive restrictive gender roles within the community were at greater risk of suicidal ideation; a similar trend appeared among women though it was not statistically significant. Overall, the findings suggest that more conventionally delineated gender roles are associated with worse mental health and suicide outcomes among older adults.
These findings are consistent within the emerging research literature on gender and aging, where empirical support points to gender roles as key in accounting for psychological well-being. For example, in an issue of this journal themed around risk factors against and protective factors for well-being, a population-based cross-sectional study of 1,201 Spanish older adults reported how traditionally masculine and feminine traits were associated with components of psychological well-being (Matud et al., Reference Matud, Bethencourt, Ibáñez and Fortes2020). Findings indicated that older men self-reported greater psychological well-being compared to older women. In addition, though masculine and feminine traits were statistically associated with psychological well-being for both men and women, the strongest effect was in the association of masculine traits with well-being among men. The study also highlighted the importance of self-esteem and social support for older men and women. The authors expressed that these findings supported the importance of both instrumental masculine traits (e.g., self-confidence, independence/autonomy) and expressive feminine traits (e.g., sensitivity/empathy, affiliation) in fostering well-being. This conclusion corresponds with Kanamori and colleagues, in that strict emphasis on one-sided gender roles may be less conducive to well-being and put older adults at greater risk for poor mental health outcomes. In response to the Matud and colleagues study, Dumas (Reference Dumas2020) further outlined past research showing that masculine traits are often related to greater psychological well-being among both men and women and called for continued attention to gender roles in research on late-life well-being. Additionally, research has shown that gender inequality or disparities within a society help to explain differential risk for negative mental health outcomes in older adults, i.e., higher rates of mental health disorders in women (Kiely et al., Reference Kiely, Brady and Byles2019). It is plausible that there may be correspondence between societies that hold more restrictive gender norms and those in which there exists greater gender inequality.
Studies such as Kanamori and colleagues (Reference Kanamori, Stickley, Takemura, Kobayshi, Oka, Ojima, Kondo and Kondo2023) and others discussed here provide support for the importance of gender roles in late-life suicide risk. However, due to the cross-sectional nature of this and other studies on the topic, it is difficult to parse out how changes in adherence to or perceptions of gender norms as one ages, compared with differences in these norms across generations, may impact changes in suicide risk trajectories moving into the future. Longitudinal data following several age cohorts over time are necessary to determine how shifts in gender norms may lead to shifts in their association with suicide risk at various age stages, into later life. Designs such as these would allow the separate examination of differences between age cohorts or generations at similar ages, as well as changes across age within each generation (e.g., Joiner et al., Reference Joiner, Bergeman and Wang2018). For example, a cross-sectional study of adults’ views showed that gender roles were more weakly prescribed to older adults by others, compared to younger age groups (Koenig, Reference Koenig2018). This finding may suggest that the extent to which one is expected to adhere to gender norms lessens as one ages into later life. Yet, given the cross-sectional nature of the study, it is unknown whether this effect may also differ among subsequent generations of older adults. Notably, in both Kanamori and colleagues and Matud and colleagues, participant ages spanned two to three decades (65–94 years old in Matud et al., 65 to over 80 in Kanamori et al.). Thus, for context, these samples represent multiple cohorts that may have experienced different early life experiences and may demonstrate different patterns of change and risk as they age. For instance, Kanamori and colleagues reported greater endorsement of conventional gender roles among the older-old in their sample.
The importance of distinguishing between cohort or generational effects and aging effects is highly recognized within developmental and aging research. For example, within a recent issue of this journal, Meyer and colleagues (Reference Meyer, Eng, Ko, Chan, Ngo, Gilsanz, Glymour, Mayeda, Mungas and Whitmer2023) acknowledged and examined the effects of both age and generation on the association between immigration and later life cognitive outcomes; they found distinct effects related to both generation and age at immigration. Expanding upon that work, Brown and García (Reference Brown and García2023) argued for a lifespan perspective examining both life course and generations to account for heterogeneity among sociodemographic groups, including older adults. This type of lifespan developmental approach, though rarely attended to in late-life suicide research, could clarify modifiable targets for the prevention of suicide among older adults (Conwell and Lutz, Reference Conwell and Lutz2021).
Finally, it is worth noting that Kanamori and colleagues’ findings are based on a gender binary (male and female). Future research should examine the relationships between gender norms and suicide risk using more nuanced gender identities rather than binary gender/sex, given the particular vulnerability found among those with non-conventional gender role attitudes and with high perceived community adherence to restrictive gender norms. It is widely recognized that older adults with non-binary gender identities have not been represented in research on gender effects on mental health (Kiely et al., Reference Kiely, Brady and Byles2019). There may be generational effects of lifelong stereotypes and stigma on older adults with non-binary gender identities, as well as aging effects regarding health and social vulnerabilities in late life that are highly relevant to this discussion and essential to understand to provide adequate care (Kiely et al., Reference Kiely, Brady and Byles2019). Additionally, the interplay between gender role attitudes and community gender norms may be particularly complex for gender minority older adults. For example, transgender individuals who identify with primarily male or female gender identities often feel that adherence to gender stereotypes is necessary to receive gender identity recognition (Morgenroth et al., Reference Morgenroth, van der Toorn, Pliskin and McMahon2024). Meanwhile, it is unclear to what extent gender minority individuals whose identities fall outside the gender binary (e.g., non-binary, agender, gender fluid) feel compelled to adhere to particular gender norms. As such, it may be especially informative to compare the effects of gender norms on well-being and suicide among older adults with cisgender, transgender, and/or non-binary gender identities.
As researchers are just beginning to explore gender roles in later life and their association with mental health and suicide risk, it will be critical to examine differences between older cohorts (as well as cohorts that will soon be aging into later life), as well as how development shapes changes in gender roles throughout the life. This knowledge can then inform effective targets for interventions to reduce suicide risk in late life.
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Global organizations such as the United Nations and World Health Organization have viewed gender norms as a driver of worldwide inequities (e.g., United Nations, 2023). The pursuit of disrupting and dismantling gender norms has therefore been of interest for achieving global equity. While a person’s identified gender may align with any number of diverse identities, gender roles are typically assigned based on a binary status (male versus female) that corresponds with often rigid cultural expectations based on sex. Rigid gender norms and stereotypes have been long known to have a harmful effect on health and thus are considered a social determinant of health (Heise et al., Reference Heise, Greene, Opper, Stavropoulou, Harper, Nascimento and Zewdie2019). While gender norms have been of scientific interest for more than a half century, and particularly regarding psychological well-being and health inequities, much of this work has been concentrated on the earlier half of the lifespan from childhood to middle age. However, recent scientific work on gender norms and health has begun to focus on older adults. In this issue, Kanamori and colleagues (Reference Kanamori, Stickley, Takemura, Kobayshi, Oka, Ojima, Kondo and Kondo2023) focus on older adults’ perceptions of the gender norms in their communities as indicated by gendered statements, as well as their own gender role endorsement, and their associations with mental health and suicide risk. Such examinations are critical in understanding cultural and gendered impacts on suicide risk in late life, particularly as suicide deaths themselves follow distinct patterns with regards to sex and gender in late life – for example, rates of suicide in older men in many parts of the world far exceed those of women (Kiely et al., Reference Kiely, Brady and Byles2019; World Health Organization, 2014). However, applying such knowledge to suicide prevention efforts requires understanding the underlying basis of differences or changes in gender roles among different age groups.
In a sample of over 25,000 older adults in Japan, Kanamori and colleagues examined self-reported depression, self-reported lifetime history of suicidal ideation and attempts, and self-reported resistance to seeking help. They also examined participants’ responses regarding the extent to which they thought their community used language that was indicative of restrictive, distinct gender roles (e.g., statements that a person should or should not do a particular activity due to being a man or woman). They found that greater perception of restrictive gender roles within the community, as well as participants’ own endorsement of conventional gender roles, was associated with greater risk of depression and suicidal ideation/behavior. They also found higher levels of endorsement of conventional gender roles among the older-old in their sample compared with younger age groups. While perceiving community gender roles as restrictive was more greatly associated with suicidal behavior than with resistance to help-seeking, one’s own conventional gender role attitudes were more greatly associated with resistance to help-seeking than suicidal behavior. In men, those who did not strongly endorse conventional gender roles themselves but did perceive restrictive gender roles within the community were at greater risk of suicidal ideation; a similar trend appeared among women though it was not statistically significant. Overall, the findings suggest that more conventionally delineated gender roles are associated with worse mental health and suicide outcomes among older adults.
These findings are consistent within the emerging research literature on gender and aging, where empirical support points to gender roles as key in accounting for psychological well-being. For example, in an issue of this journal themed around risk factors against and protective factors for well-being, a population-based cross-sectional study of 1,201 Spanish older adults reported how traditionally masculine and feminine traits were associated with components of psychological well-being (Matud et al., Reference Matud, Bethencourt, Ibáñez and Fortes2020). Findings indicated that older men self-reported greater psychological well-being compared to older women. In addition, though masculine and feminine traits were statistically associated with psychological well-being for both men and women, the strongest effect was in the association of masculine traits with well-being among men. The study also highlighted the importance of self-esteem and social support for older men and women. The authors expressed that these findings supported the importance of both instrumental masculine traits (e.g., self-confidence, independence/autonomy) and expressive feminine traits (e.g., sensitivity/empathy, affiliation) in fostering well-being. This conclusion corresponds with Kanamori and colleagues, in that strict emphasis on one-sided gender roles may be less conducive to well-being and put older adults at greater risk for poor mental health outcomes. In response to the Matud and colleagues study, Dumas (Reference Dumas2020) further outlined past research showing that masculine traits are often related to greater psychological well-being among both men and women and called for continued attention to gender roles in research on late-life well-being. Additionally, research has shown that gender inequality or disparities within a society help to explain differential risk for negative mental health outcomes in older adults, i.e., higher rates of mental health disorders in women (Kiely et al., Reference Kiely, Brady and Byles2019). It is plausible that there may be correspondence between societies that hold more restrictive gender norms and those in which there exists greater gender inequality.
Studies such as Kanamori and colleagues (Reference Kanamori, Stickley, Takemura, Kobayshi, Oka, Ojima, Kondo and Kondo2023) and others discussed here provide support for the importance of gender roles in late-life suicide risk. However, due to the cross-sectional nature of this and other studies on the topic, it is difficult to parse out how changes in adherence to or perceptions of gender norms as one ages, compared with differences in these norms across generations, may impact changes in suicide risk trajectories moving into the future. Longitudinal data following several age cohorts over time are necessary to determine how shifts in gender norms may lead to shifts in their association with suicide risk at various age stages, into later life. Designs such as these would allow the separate examination of differences between age cohorts or generations at similar ages, as well as changes across age within each generation (e.g., Joiner et al., Reference Joiner, Bergeman and Wang2018). For example, a cross-sectional study of adults’ views showed that gender roles were more weakly prescribed to older adults by others, compared to younger age groups (Koenig, Reference Koenig2018). This finding may suggest that the extent to which one is expected to adhere to gender norms lessens as one ages into later life. Yet, given the cross-sectional nature of the study, it is unknown whether this effect may also differ among subsequent generations of older adults. Notably, in both Kanamori and colleagues and Matud and colleagues, participant ages spanned two to three decades (65–94 years old in Matud et al., 65 to over 80 in Kanamori et al.). Thus, for context, these samples represent multiple cohorts that may have experienced different early life experiences and may demonstrate different patterns of change and risk as they age. For instance, Kanamori and colleagues reported greater endorsement of conventional gender roles among the older-old in their sample.
The importance of distinguishing between cohort or generational effects and aging effects is highly recognized within developmental and aging research. For example, within a recent issue of this journal, Meyer and colleagues (Reference Meyer, Eng, Ko, Chan, Ngo, Gilsanz, Glymour, Mayeda, Mungas and Whitmer2023) acknowledged and examined the effects of both age and generation on the association between immigration and later life cognitive outcomes; they found distinct effects related to both generation and age at immigration. Expanding upon that work, Brown and García (Reference Brown and García2023) argued for a lifespan perspective examining both life course and generations to account for heterogeneity among sociodemographic groups, including older adults. This type of lifespan developmental approach, though rarely attended to in late-life suicide research, could clarify modifiable targets for the prevention of suicide among older adults (Conwell and Lutz, Reference Conwell and Lutz2021).
Finally, it is worth noting that Kanamori and colleagues’ findings are based on a gender binary (male and female). Future research should examine the relationships between gender norms and suicide risk using more nuanced gender identities rather than binary gender/sex, given the particular vulnerability found among those with non-conventional gender role attitudes and with high perceived community adherence to restrictive gender norms. It is widely recognized that older adults with non-binary gender identities have not been represented in research on gender effects on mental health (Kiely et al., Reference Kiely, Brady and Byles2019). There may be generational effects of lifelong stereotypes and stigma on older adults with non-binary gender identities, as well as aging effects regarding health and social vulnerabilities in late life that are highly relevant to this discussion and essential to understand to provide adequate care (Kiely et al., Reference Kiely, Brady and Byles2019). Additionally, the interplay between gender role attitudes and community gender norms may be particularly complex for gender minority older adults. For example, transgender individuals who identify with primarily male or female gender identities often feel that adherence to gender stereotypes is necessary to receive gender identity recognition (Morgenroth et al., Reference Morgenroth, van der Toorn, Pliskin and McMahon2024). Meanwhile, it is unclear to what extent gender minority individuals whose identities fall outside the gender binary (e.g., non-binary, agender, gender fluid) feel compelled to adhere to particular gender norms. As such, it may be especially informative to compare the effects of gender norms on well-being and suicide among older adults with cisgender, transgender, and/or non-binary gender identities.
As researchers are just beginning to explore gender roles in later life and their association with mental health and suicide risk, it will be critical to examine differences between older cohorts (as well as cohorts that will soon be aging into later life), as well as how development shapes changes in gender roles throughout the life. This knowledge can then inform effective targets for interventions to reduce suicide risk in late life.
Conflict of interest
The authors have no conflicts of interest to report.
Acknowledgements
JL and SAB were supported by the Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System. EAR was supported by the VA Advanced Fellowship Program in Mental Illness Research and Treatment, Office of Academic Affiliations.