Recent data in England show rising levels of mental health difficulties among young women, as compared to young men. Thus, the aim of this study was to explore the lived experiences of young women and girls (across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community) in the UK about their mental health and associated support.

Narrative interviews were conducted with 29 young women and girls aged 14 to 24 years. Using ideal-type analysis, a method for identifying broad patterns or ‘types’ within qualitative datasets, two typologies were developed to explore similarities and differences between participants’ stories and delineate overarching narratives across stories.

The first typology was titled: ‘What is my mental health story?’ Three overarching types or narratives within the dataset were identified in terms of participants’ mental health stories: ‘Traumatic and impactful experiences’; ‘Body-mind-society interaction’; and ‘Prolonged distress and disruption’. The second typology was titled: ‘How would I like to be supported in relation to my mental health?’ Three overarching types or narratives were also identified in relation to participants’ stories about how they would like to be supported with their mental health: ‘Empathy, understanding, and connection’; ‘Support from/for intersecting (overlapping) identities’; and ‘Heard, seen, and accepted’.

Hearing from young women and girls, in their own words, about their mental health stories is crucial to optimise prevention and treatment efforts. Our findings show that a positive therapeutic relationship, supportive social relationships, feeling heard and accepted, and consideration of the multiple overlapping facets of one’s identity are key mechanisms influencing the utility of support. Ultimately, mental health support should be individualised, consistent, and available.

Recent data in England show rising levels of mental health difficulties among young women, as compared to young men [33, 57], suggesting that this is a key factor driving the increased incidence of youth mental health difficulties in general [27]. This trend holds across cultures, with international data showing that compared with young men, young women have poorer average mental health at age 15 years [6]. Mental health difficulties (such as anxiety, depression, or eating disorders) can be associated with a range of challenges for individuals including distress, impaired functioning, and risk of self-harm [55]. Biological factors (e.g., hormones or genes), psychological factors (e.g., coping styles or body image perceptions), micro-level environment factors (e.g., adverse or stressful life events), and macro-level environment factors (e.g., gender inequity in society) may all contribute to gender differences in rates of mental health difficulties [22]. We need to better understand the challenges faced by young women and girls to determine how we can best support them to prevent and manage mental health difficulties.

A relatively small number of qualitative studies to date have examined young women and girls’ lived experiences of mental health difficulties and support. These studies have tended to focus on their experiences of specific mental disorders or symptoms, including depression (e.g., [8, 45]), eating disorders (e.g., [15, 24, 42]), suicidality and self-harm (e.g., [16, 52]), and psychosis [7]. For example, in a qualitative study of young women’s perceptions of their university experience with an eating disorder, participants indicated that their symptoms worsened due to such factors as being away from family and treatment teams and trying to handle the stress and pressure of university [15]. In another qualitative study of young women experiencing body image or weight concerns, participants referenced social media and viewing idealised pictures of women, in the context of having a ‘drive for thinness’ [42]. Young women and girls experiencing depression have described hiding their feelings from others, finding ways to self-manage their depression, and having mixed experiences of professional support, with some finding medication and therapy helpful, and others less so, such as due to side effects of medication or dislike of their therapist and their approach [8, 45]. Moreover, while parents and peers are perceived to be key sources of social support for self-harm, young women and girls also describe not always finding their responses helpful, such as when they are dismissive [52].

While these studies illuminate young women and girls’ experiences of specific mental disorders or symptoms and associated support, there is a gap in existing literature for a qualitative study exploring their experiences of mental health difficulties in general, alongside their experiences of professional and social support and self-help. Due to the high rates of comorbidity of different mental disorders [29], focusing on specific disorders or symptoms may not be able to capture the whole picture of young women and girls’ mental health experiences. Moreover, research indicates that the rate of unmet need for mental health care among young people is 54% [14], suggesting that not all mental health needs are identified, diagnosed, and treated. Thus, by focusing on the experiences of individuals with diagnosed mental disorders or who have received professional mental health care, we may be less likely to hear the voices of many who have not been diagnosed or who do not present to mental health services.

In this context, consideration of young women and girls’ intersectional identities is also important given that, for example, sexual minority individuals are also more likely to experience mental health problems [36]. Levels of mental health service use are also lower among minoritised ethnic groups [26], and Autistic women report high levels of unmet mental health service need [50]. In a qualitative study in Scotland of young women’s experiences of discrimination and its impact on mental health, cross-interview themes illuminated the intersectionality of their experiences [49]. For instance, participants from minoritised ethnic groups voiced their experiences of the impact of discrimination on their stress levels and in turn on their mental health difficulties [49]. Thus, hearing from young women and girls from diverse backgrounds about the broad range of their lived experiences of mental health difficulties (diagnosed and undiagnosed), and associated professional, social, and self support, is crucial to inform prevention and treatment efforts for this population.

Consequently, the present study took a narrative inquiry approach, aiming to explore the lived experiences of young women and girls in the UK about their mental health and associated support. We specifically sought to hear from young women and girls across different ethnic groups, who are neurodivergent, and/or who identify with the lesbian, gay, bisexual, trans, queer/questioning, intersex, asexual, and other (LGBTQIA +) community. To address our study aim, we sought to answer the following research questions:

This study was part of a wider research project called ‘My Story and Me’, a response to a Public Health Research call from the National Institute for Health Research (NIHR) for researchers to develop and examine interventions to promote good mental health and wellbeing among young women and girls aged 12 to 24. The present study reports on findings from the first stage of this wider research project. The core research team consisted of early career, peer, and senior researchers working within the field of child and adolescent mental health, aged between 22 and 38 years, from mixed-race, White Polish American, and White British ethnic backgrounds. Four members of the research team identified as women, and one identified as a man. At the outset of the study, a Young Person Advisory Group (YPAG) was recruited to review the study materials, advertise the study to relevant networks, provide feedback on qualitative data analyses and findings, and advise on dissemination. The involvement of the YPAG was crucial to ensure that our study met the needs of our target population. We have taken an inclusive approach in this study to defining the terms ‘young women and girls’. We use the terms women, girls, and females interchangeably, referring to cis- and trans-women, -girls, and -females.

Ethical Considerations.

Ethical approval for this study was granted by the University College London (UCL) Research Ethics Committee (ID number: 14037/008). Written informed consent to take part was obtained from all participants. When participants were under the age of 16, written informed consent was sought from their parents or carers and written assent was sought from participants themselves. It was made clear in study information sheets that participation was voluntary, participants could withdraw at any time without consequence, and all interviews were confidential. To protect participant confidentiality, interviews were anonymised at the point of transcription (e.g., with names of people and places removed). The research team were trained in the study’s safeguarding protocol and participants were signposted to sources of support before and after their interview. Participants received a £20 voucher after their interview as reimbursement for their time.

Purposive criterion sampling was used to recruit young women and girls currently living in the UK, aged 12 to 24 years old, across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community, with lived experience of mental health difficulties. Recruitment ran from February to July 2022. The study advertisement and expression of interest form were distributed through the research team’s networks (e.g., via relevant organisations’ social media pages and newsletters). Interested participants were emailed information sheets and consent forms and had a pre-interview call with a researcher to answer any questions, check whether they had any accessibility needs, and schedule the interview.

The final sample consisted of 29 young women and girls aged 14 to 24 years old (M = 20.00, SD = 3.25) who met the study sampling criteria. Demographic data were collected qualitatively by asking participants to start their interview by telling us the story of ‘Who am I?’. The rationale behind this data collection strategy was to empower participants to share what they considered to be salient aspects to their identity, rather than those imposed by researchers. Participants talked about their (or their parents’) ethnicity, nationality, and cultural upbringing, such as being Black British,’mixed-race’, South Asian, or White British. Some participants described themselves as being neurodivergent, Autistic, and/or as having attention deficit hyperactivity disorder (ADHD), whether medically or self-diagnosed. Gender identity and sexual orientation were often talked about together by participants, sometimes being described as a ‘journey’ or something that they were ‘exploring’. Gender identity was described in different ways, including: cisgendered woman, fluid, queer, and trans. Sexual orientation was sometimes described (e.g., bisexual, pansexual) or discussed implicitly when a participant talked about a relationship with someone of the same or a different gender.

Two members of the research team conducted each interview. One led the interview and the other supported the process, including noting any safeguarding issues that could require follow-up action. All interviewers received training in conducting narrative interviews by the first author (the team’s Qualitative Research Lead). The interview schedule was developed for this study (please see supplementary materials). It was informed by the free association narrative interview method [17] and the biographic-narrative-interpretive method [53]. The interview consisted of three narrative or ‘story’ questions asked by the lead researcher: ‘Who am I?’,‘What is My Mental Health Story?’; and ‘How Would I Like to be Supported?’. At the end of each story, both researchers asked follow-up questions to clarify or elaborate on details as necessary, for example: ‘Can you tell me more about that?’.

In response to feedback from the YPAG, a document containing the three narrative questions and possible topics that each story could cover was made available to participants prior to their interview to provide guidance for preparing their stories if they wanted it. We also developed a set of more structured prompts (see Table 1 for examples and see supplementary materials for the full list) to use in the interview itself if participants were not comfortable with an open storytelling approach. These were reviewed and refined by the YPAG, but were ultimately only used in a minority of the interviews.

The interviews were conducted over Microsoft Teams or telephone and lasted between 38 and 97 min (M = 64 min, SD = 16 min). All interviews were audio-recorded with an encrypted Dictaphone and transcribed verbatim. A written option, whereby participants could answer the three narrative questions by typing their answers in Microsoft Forms, was also made available to participants who did not want to participate in a verbal interview. This option was used by one participant. In a minority of interviews, participants chose to have their parent or carer accompanying them for support. At the end of each interview, the researchers participated in a debrief with a senior team member, for example to discuss any safeguarding concerns.

Narrative inquiry is a qualitative method for collecting, analysing, and reporting on data captured in the form of narratives or stories [43]. Within narrative inquiry, participants’ stories are not considered to be neutral nor objective accounts of their experiences, and neither is the researcher’s analysis of participants’ stories [37, 43]. The construction of stories from both the participant’s and the researcher’s perspectives will inevitably be influenced by their own prior experiences, views, and interpretations, as well as by the interaction between the researcher and participant during data collection [37, 43]. Thus, narrative inquiry is underpinned by a constructivist epistemological perspective [43].

Approaches to narrative analysis within the published literature vary and there has been no standardised procedure set out for conducting narrative analysis [41]. Broadly, there can be considered two core approaches to conducting narrative analysis [37, 43]. ‘Story analysts’ focus on developing themes or typologies to examine commonalities across stories, whereas ‘storytellers’ focus on creating a new narrative or story to represent the data collected, resulting in the development, for example, of a case study or a biography [37, 43]. Interviews are a common data collection method for story analysts, whereas data for storytellers could come from a range of sources, such as interviews, documents, and observations [37]. Therefore, aligning with our data collection method (interviews) and our study aim to explore participants’ own stories of their lived experiences, a story analyst approach was taken in the present study, consisting of the development of typologies to examine the similarities and differences between participants’ stories and delineate overarching narratives across stories.

In developing a typology, the researcher seeks to explore how each participant’s story compares with those of other participants within the dataset [46]. Thus, a typology consists of distinct groupings of participants whose stories share similarities. We developed two typologies – one per research question – the first focused on participants’ mental health stories and the second focused on participants’ stories about how they would like to be supported in relation to their mental health. We drew on ideal-type analysis as a systematic method for developing typologies from qualitative data [47]. Ideal-type analysis has seven steps: becoming familiarised with the dataset,writing the case reconstructions; constructing the ideal types; identifying the optimal cases; forming the ideal-type descriptions; checking credibility; and making comparisons [46, 47].

The following process was initially conducted using 18 participants’ interviews, as data collection was still ongoing when the analysis began. First, the research team familiarised themselves with the dataset through conducting the interviews and writing case reconstructions of participants’ stories (Step 1). To develop the case reconstructions (Step 2), each participant’s verbatim interview transcript was rewritten as a detailed summary and description of their stories, using their own words as much as possible. To construct the ideal types (Step 3), the lead author systematically compared and contrasted the case reconstructions with each other to inductively identify overarching, shared narratives across participants’ stories. Participants whose stories shared fundamental similarities in terms of the content were grouped together. This resulted in the development of two typologies. The first typology consisted of three ‘ideal types’ or groups representing participants’ stories about their mental health. The second typology also consisted of three ‘ideal types’ or groups representing participants’ stories about how they would like to be supported in relation to their mental health. An ‘optimal case’ for each group in each typology was then selected (Step 4). This was a participant whose data particularly exemplified the overarching narrative of that group. The optimal cases guided the lead author’s initial development of the names and descriptions of the defining features of each group (Step 5). The second and last authors then reviewed the lead author’s names and descriptions of the groups, and the participants’ stories that had been classified within each group (Step 6). Refinements made as a result of this included changes to group names and descriptions for clarity, as well as reassignment of some participants to alternative groups that, on reflection, more closely represented their stories.

Once data collection was complete, the initial typologies were then used to classify the final 11 participants’ interviews, using the same process. No new groups were developed, but again refinements were made to the group names and descriptions as necessary to ensure that they adequately captured the key features of all of the participants’ stories classified within them. The YPAG also reviewed the names and descriptions of the groups to ensure that the language used was accessible to young people, given the focus of the study on young women and girls’ experiences. Similarities and differences between the groups in the typologies and between participants’ individual stories have been illuminated throughout the report of the findings (Step 7).

This section presents the names and descriptions of the groups in the typologies.

The first typology answers our first research question: What are the stories of young women and girls (across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community) about their mental health? It consisted of three groups. Each group represents an overarching narrative that was common across participants’ stories in that group. A summary of the key characteristics of each group within the typology is presented in Table 2.

Narrative 1: Traumatic and impactful experiences

The nine participants whose mental health stories reflected the overarching narrative of ‘Traumatic and impactful experiences’ tended to describe having a history of traumatic and impactful events which they associated with their mental health difficulties, as causal influences and/or perpetuating factors. Participants referenced multiple different events, multiple instances of the same event, or described one experience that was particularly impactful for their mental health.

Descriptions of traumatic incidents, fear, or risks to safety occurred repeatedly throughout participants’ narratives or were a central focus of their mental health stories. Participants sometimes used the word ‘trauma’ when referring to such incidents, or referred to particular events, people, or situations that had a negative impact on their mental health, including making them feel anxious, depressed, unsafe, afraid, or physically or emotionally hurt.

Traumatic and impactful experiences described by participants included external (outside self) experiences, such as bullying, racism, homophobia, abusive relationships with family or romantic partners, sexual assault, death of or illness in family members or friends, and distressing experiences of school, university, work, or health care. They also included physical health difficulties and internal (inside self) experiences, such as self-harm and suicidality, influenced by their external experiences.

Example quotes from each of the interviews with the nine participants whose mental health stories reflected the overarching narrative of ‘Traumatic and impactful experiences’ can be seen in Table 3.

Narrative 2: Body-mind-society interaction

The 10 participants whose mental health stories reflected the overarching narrative of ‘Body-mind-society interaction’ tended to describe the interplay of their physical body with their mental health, including experiences of eating disorders, difficulties related to their body image (e.g., body dysmorphia, gender identity), physical health conditions and disabilities, and stigmatising or discriminatory experiences stemming from societal or cultural norms and attitudes. Dislike of appearance, low self-worth or self-esteem, self-consciousness, struggling with self-acceptance, body or image insecurities, and/or difficulties associated with physical health conditions and disabilities were focal topics within participants’ mental health stories. These feelings and experiences sometimes coincided with experiences of anxiety and depression.

The body-mind connection was often described as bidirectional or intertwined, with physical health difficulties, eating disorders, or their own or others’ perspectives on their physical appearance or health influencing their mental health, and vice versa. Participants also described the influence of societal or cultural expectations and pressures on their perspective on their body and appearance, and in turn on their mental health. This included making comparisons between their self and others within their social circles or with celebrities, feeling pushed to live up to the unattainable and unfair appearance or body standards endorsed by the dominant culture or society, not having role models who look like you within society, experiencing racism, and feeling pressure from social media or society to look a particular way, especially as a young woman.

Example quotes from each of the interviews with the 10 participants whose mental health stories reflected the overarching narrative of ‘Body-mind-society interaction’ can be seen in Table 4.

Narrative 3: Prolonged distress and disruption

The 10 participants whose mental health stories reflected the overarching narrative of ‘Prolonged distress and disruption’ tended to describe how their experiences of anxiety and/or depression were longstanding mental health difficulties, which they had “always” experienced or which they had experienced for a long time, often since childhood. However, during childhood, participants and their families did not necessarily recognise nor label what they were going through as mental health issues. Feelings of stress, worry, and/or low mood were recurring difficulties throughout participants’ mental health stories and throughout their lives.

Participants sometimes referenced particular events that had influenced or exacerbated their experiences of anxiety and depression, including family illness or death, events happening in the wider world, or their experiences of school or university, such as in terms of academic and exam pressure, trying to make friends, or handling change. However, it was sometimes not clear from participants’ perspectives what the trigger was for their experiences of mental health difficulties.

The level of emotional distress experienced by participants was described as disruptive to life in multiple ways, across multiple areas, and at multiple timepoints. For example, participants described stopping attending school or university, experiencing social or self isolation and difficulties in their relationships with family and friends, and having a loss of motivation to engage with life, particularly socially and academically. Their emotional distress sometimes coincided with experiences of eating disorders, self-harm, and suicidality.

Example quotes from each of the interviews with the 10 participants whose mental health stories reflected the overarching narrative of ‘Prolonged distress and disruption’ can be seen in Table 5.

The second typology answers our second research question: What are the stories of these young women and girls about how they would like to be supported in relation to their mental health? It consisted of three groups. Each group represents an overarching narrative that was common across participants’ stories in that group. A summary of the key characteristics of each group within the typology is presented in Table 6.

Narrative 1: Empathy, understanding, and connection

The 12 participants whose mental health support stories reflected the overarching narrative of ‘Empathy, understanding, and connection’ tended to discuss the importance of feeling listened to, understood, and empathised with, without judgment. Participants’ narratives spoke to the therapeutic relationship as a key mechanism behind the positive impact of support from mental health professionals, as well as to the importance of having supportive relationships with others within their social context, including family and friends, work colleagues, and school or university staff. Consistency and the availability of support when needed was important from participants’ perspectives.

Participants described how talking to and spending time with those who love them, know them well, care, and who can distract, reassure, or comfort them helps with their mental health. This included family members, pets, friends, and romantic partners. Participants also described the value of not feeling alone and being able to connect with or relate to others in supporting their mental health. Hearing about others’ lived experiences of mental health struggles, coping, and recovery helps, and it makes you feel less lonely, isolated, or different to others. Participants cited their friends, social media, and support groups as vehicles for this.

Participants described receiving help from mental health professionals to understand their own mental health, such as through diagnosis, practical and psychoeducational support, discussing ways of coping, and analysing and challenging thoughts. Participants referenced how feeling understood by health care professionals, school or university staff, family, and friends is helpful. However, participants also described how they would like others in their lives to have a better understanding of their mental health and support needs. Participants suggested that more education and awareness around mental health and how to support it is needed in general within society.

Example quotes from each of the interviews with the 12 participants whose mental health support stories reflected the overarching narrative of ‘Empathy, understanding, and connection’ can be seen in Table 7.

Narrative 2: Support from/for intersecting (overlapping) identities

The nine participants whose mental health support stories reflected the overarching narrative of ‘Support from/for intersecting (overlapping) identities’ tended to describe how mental health support could benefit from being appropriate for and tailored to mental health needs in the context of multiple or salient aspects of identity and other needs, including neurodivergence, sexual orientation, gender, and ethnicity. Support should be evidence-based and multi-layered, with consideration of specific identities and who you are as an individual or ‘whole person’.

Participants described the utility of receiving support from a mental health professional with the same cultural or ethnic background as you, or with cultural humility, as it means that you and your needs can be understood and respected within your own cultural or ethnic context and community. This would help to prevent incorrect assumptions or judgments being made about or in relation to your cultural or ethnic background by mental health professionals.

Participants also explained how they had found that not all types of therapy or treatment environments were suitable for people who are neurodivergent. For example, cognitive behavioural therapy (CBT) can feel incompatible for Autistic individuals when one is asked to analyse thoughts and behaviours that may feel like completely rational responses from the perspective of an Autistic person. Participants suggested that more education, awareness, and resources are needed in general to enable health care professionals and wider society to better understand and tailor support for neurodivergent women and girls.

Example quotes from each of the interviews with the nine participants whose mental health support stories reflected the overarching narrative of ‘Support from/for intersecting (overlapping) identities’ can be seen in Table 8.

Narrative 3: Heard, seen, and accepted

The eight participants whose mental health support stories reflected the overarching narrative of ‘Heard, seen, and accepted’ tended to describe the utility of having a safe space (either with mental health professionals or within their social networks) to talk or open up about their experiences and feelings if they want to, get things off their chest, and process or manage issues collaboratively with someone whom they can trust. In general, having people who are there when you need them is important in order to reduce the reported burden of difficulties.

At the same time, participants described struggling to open up to others, including mental health professionals, family, and friends, about their feelings and experiences. Thus, they alluded to the importance of not feeling pressured to talk about issues that they are not ready to, scared to, or that they do not want to discuss. Factors identified by participants as helpful in encouraging them to talk about their mental health included building trust, feeling accepted and not judged, time passing, reducing stigma, and using more creative approaches in therapy. Having their feelings or experiences recognised, validated, or taken seriously is helpful and empowering.

Participants also described how it is important that individuals in their lives, including mental health professionals, do not make assumptions about who they are, what their mental health journey should look like, and what they need. Instead, value is placed on recognising individual differences, needs, and experiences. Participants explained that they had found some types of therapy unhelpful because the approach did not work for them, they were not given the support that they really needed, valued, or wanted at the time, or what they said was misinterpreted.

Example quotes from each of the interviews with the eight participants whose mental health support stories reflected the overarching narrative of ‘Heard, seen, and accepted’ can be seen in Table 9.

We conducted a narrative inquiry, through the construction of typologies, to examine the broad range of lived experiences of young women and girls aged 12 to 24 years in the UK (across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community) about, first, their mental health and, second, how they like to be supported with their mental health. The first typology consisted of three overarching narratives, which characterised participants’ mental health stories: ‘Traumatic and impactful experiences’; ‘Body-mind-society interaction’; and ‘Prolonged distress and disruption’. The second typology also consisted of three overarching narratives, which characterised participants’ mental health support stories: ‘Empathy, understanding, and connection’; ‘Support from/for intersecting (overlapping) identities’; and ‘Heard, seen, and accepted’.

There is a large body of literature linking experiences of traumatic events or adverse life experiences with poor mental health outcomes (e.g., [19, 28]). Research indicates that young women are more likely to have experienced high levels or multiple incidents of traumatic events than young men (e.g., [20, 48]). Rates of traumatic events (including sexual victimisation) are also higher among neurodivergent young women (e.g., [3, 13, 44]). The mental health narrative of ‘Traumatic and impactful experiences’ that we identified reflects and adds to this existing literature by highlighting the range of traumatic events that young women and girls report experiencing, such as bullying, racism, homophobia, abusive relationships, and sexual assault, some of which were directly attributed to being a young woman or girl, and which damaged participants’ mental health. Similarly, previous UK-based qualitative research has described how the stress caused by young women’s experiences of discrimination, such as in relation to gender or ethnicity, can lead to or exacerbate mental health difficulties [49].

The detrimental impact that mental health difficulties can have on young people’s current and future emotional, social, and academic functioning has been well-documented in existing research (e.g., [4, 35, 51]). The mental health narrative of ‘Prolonged distress and disruption’ that we identified reflects and expands on this research by illustrating the extent and nature of the long-term disruption that mental health difficulties can cause to young women and girls’ lives, including hindering attendance and achievement at school and university, and contributing to social isolation and relationship difficulties. Participants also described how they and their families did not necessarily recognise nor label what they were experiencing as mental health issues during childhood. Unfamiliarity with or lack of recognition of mental ill-health symptoms has frequently been reported as a barrier to young people seeking help for mental health difficulties (e.g., [38, 54]), and in turn for young people’s parents in seeking help on their behalves (e.g., [39, 40]). Thus, from a prevention perspective, our findings could point to support needs around mental health literacy for young people and their families to aid early recognition of symptoms and, in turn, help-seeking behaviour. This also echoes the calls for more education and awareness about mental health and neurodivergence within society in general made by participants in our study.

Previous qualitative research exploring young women’s body image concerns has similarly identified the negative influence of a perceived ‘ideal’ appearance, comparisons with others, and images on social media on young women’s perceptions of and attitudes towards their bodies [42]. Our identification of the mental health narrative of ‘Body-mind-society interaction’ adds to this research by showing that perceiving one’s body as not adhering to societal standards or expectations has a detrimental impact on self-esteem and self-worth, and in turn on mental health. Potentially underpinning our findings, objectification theory purports that women in particular are subject to “the experience of being treated as a body (or collection of body parts) valued predominantly for its use to (or consumption by) others” [12], p. 174), which can lead to self-objectification, whereby the self is defined by how the body is viewed by others [2, 25]. These processes also likely encourage individuals to make appearance comparisons with others [25]. Our findings also showed that the uninclusive and unattainable (Western) societal standards or expectations that participants held themselves to went beyond body shape and size to include other factors relating to what women’s bodies should look like and how they should function, including: gender identity, disability, and ethnicity.

Relationships with others was a central theme cutting across the three overarching narratives in the second typology representing participants’ stories about support for their mental health, in terms of the importance of connecting with and talking to others, feeling listened to, and feeling understood in relation to their experiences, mental health needs, and facets of their identities. Aligning with the ‘Empathy, understanding, and connection’ and ‘Heard, seen, and accepted’ narratives identified in our study, previous qualitative research examining young people’s experiences of therapy has similarly highlighted the importance to young people of feeling heard and safe in the therapy space, with a positive therapeutic relationship being key [11, 18]. However, in our study, the ‘others’ that participants referred to in a supportive relationships context not only included mental health professionals, but also included friends, romantic partners, family members, work colleagues, and school or university staff. In general, social support is a protective factor for mental health [5], particularly in young women [21].

In contrast to the negative consequences of social media highlighted in the ‘Body-mind-society interaction’ narrative in the first typology, participants whose mental health support stories reflected the ‘Empathy, understanding, and connection’ narrative in the second typology also highlighted the positive side of social media, in terms of being able to connect with others with similar experiences. Indeed, previous research has shown that accessing the lived experiences of others via social media can reduce isolation and increase hope, help generate ideas for coping strategies, and facilitate learning about the process of seeking and receiving professional help [23, 31]. However, the risks of such support include the potential for accessing incorrect or misleading information, receiving hostile or derogatory comments, experiencing distress from hearing experiences similar to yours, or viewing graphic images, such as of self-harm [23, 32].

Participants whose experiences reflected the ‘Support from/for intersecting (overlapping) identities’ overarching narrative that we identified described how mental health support was helpful when it took into consideration intersecting or salient aspects of their identities and other needs, including neurodivergence, sexual orientation, gender, and ethnicity. Participants described the utility of receiving support from a mental health professional with the same cultural or ethnic background as them. Ethno-cultural concordance between patients and health care providers can promote relationship building through making patients feel comfortable, safe, and understood [30]. However, young people’s perceptions of their therapists’ level of cultural understanding have also been found to be a more significant predictor of treatment engagement than ethnic background matching [9]. Indeed, participants in our study also alluded to the utility of receiving support from a professional with cultural humility. Core tenets of cultural humility include health care professionals seeing culture as an individual experience rather than as a group trait, minimising power differences, promoting respect, and recognising biases [56]. Aligning with our findings, this speaks to the need for more culturally informed mental health support, particularly for young people from minoritised ethnic groups, which has long been highlighted in existing literature [1]. Moreover, participants also explained how they had found that not all types of therapy or treatment environments were suitable for neurodivergent individuals. This has likewise been echoed in previous research, which has identified the limitations of professional support from Autistic individuals’ perspectives (e.g., [10, 34, 50]). This is because it has often not been designed with their needs in mind [10, 50], such as with consideration of consistency, sensory needs, and communication preferences [34].

This study gives voice to young women and girls (across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community) to share their experiences about their mental health and associated support. From participants’ mental health stories, we have learned about the traumatic events (both external and internal or inside self) that young women and girls can face, the prolonged nature of the mental health difficulties that they can experience over their life course, and the detrimental influence that societal standards about what one’s body should look like can have on young women and girls’ mental health. The findings have implications for prevention and treatment efforts for this population. In general, participants valued mental health support that was individualised, consistent, and available. From participants’ perspectives, effective support involves the provision of a safe space to talk about their mental health with someone who they trust, who empathises with and validates their feelings, and who tailors the support to their individual needs around mental health, trauma, neurodiversity, sexual orientation, gender, and ethnicity. Hearing about others’ lived experiences, such as via friends, social media, or support groups, can be helpful.

In terms of the limitations of our study, our findings reflect fewer experiences from girls at the younger end of our study age range. It is also important to note that a range of factors can influence what participants share during research interviews. Therefore, the findings of our study are grounded within and specific to the issues that participants chose to or remembered to raise during their interviews. Indeed, the typologies developed through our analysis of the interviews are intended to describe the experiences and perspectives of our sample. They are not intended to generalise beyond our study sample, nor do they claim to represent the experiences of others outside of this study. However, our findings do provide knowledge about the experiences of young women and girls that could potentially be transferable or recognisable by other young women and girls beyond our study sample.

Future research could seek to test the applicability of the typologies created in our study within a wider sample of young women and girls, in order to examine the degree of fit of the existing typologies and explore opportunities for the creation of additional types and refinement of the existing ones offered here. Moreover, group sizes were too small to draw meaningful conclusions about the potential relationships between the narratives identified through participants’ mental health stories and the narratives identified through participants’ mental health support stories. It is possible that with a larger sample in future research, more meaningful conclusions could be drawn about what having a particular type of mental health story might means for your mental health support story. For example, are participants whose mental health story reflects the ‘Traumatic and impactful experiences’ narrative more likely to have particular preferences regarding support?

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All our thanks go to our participant group for taking the time to share their experiences with us. Thanks also to the reviewers of our draft manuscript for their helpful suggestions.

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ES conceived of and designed the study and led on the conduct of the study, data analysis, and write-up; AL conducted the study, data analysis, and write-up; GR conducted the study and contributed to data analysis and write-up; MC conceived of the study and contributed to the conduct of the study, data analysis, and write-up; JD conceived of and led the study and contributed to the design of the study and write-up; HB conceived of the study and contributed to the conduct of the study and write-up; HL contributed to the conduct of the study and write-up; CAR contributed to the write-up and intellectual content of the manuscript; JEC conceived of and led the study and contributed to the design and conduct of the study, data analysis, and write-up. All authors read and approved the final manuscript.

Correspondence to Julian Edbrooke-Childs.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for this study was granted by the University College London (UCL) Research Ethics Committee (ID number 14037/008).

When participants were under the age of 16 years, informed consent was sought from participants’ parents or carers and assent was sought from participants themselves for them to take part and for the publication of their anonymised data. When participants were aged 16 years and over, informed consent was sought from participants for them to take part and for the publication of their anonymised data.

The authors declare no competing interests.

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