Gender and socioeconomic inequalities in adolescent mental well-being in Barcelona: a repeated cross-sectional study

Abstract

Aim: This study analysed gender and socioeconomic (SE) inequalities in adolescent mental well-being in Barcelona, Spain, using data from two cross-sectional waves (2016 and 2021), examining the potential impact of the COVID-19 pandemic and considering pre-existing disparities. The research aimed to understand how these factors influenced mental well-being at two time points, with a particular focus on intersecting vulnerabilities. Subject and methods: A repeated cross-sectional analysis was performed using data from the FRESC survey (students aged 13–16 years: 2016, N = 2274; 2021, N = 2179). Mental well-being was measured using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Multivariate linear regressions accounted for individual- and school-level SE characteristics, including clustering at the school level, and effect sizes (Cohen’s d) were used to assess changes over time. Analyses included stratification by sex and exploration of collinearity among SE indicators. Results: Mental well-being scores were significantly lower in 2021 compared to 2016, with sharper reductions observed in girls (effect size = –0.43, 95% CI –0.52 to –0.35) than in boys (–0.28, 95% CI –0.36 to –0.19). Students from low SE backgrounds and state schools experienced the steepest declines, particularly girls (adjusted β = –4.71, p < 0.001). By contrast, immigrant students showed smaller differences between years, although they reported lower levels of well-being in both waves. Conclusion: The study revealed persistent gender and SE inequalities in adolescent mental well-being, with notable declines in 2021 coinciding with the aftermath of the COVID-19 pandemic. These findings emphasise the need for intersectional, gender- and equity-sensitive strategies, particularly those addressing youth facing multiple and intersecting social disadvantages.