Mental health practitioners' experiences providing mental healthcare services to students in a higher education institution: A qualitative study.

Sex and gender equity in research has had a growing focus, with global institutions like World Health Organization (WHO) (), Canadian Institutes of Health Research (CIHR) (), United States National Institute of Health, European Commission Directorate-General for Research and Innovation (), and Intergovernmental Authority on Development (IGAD) () pushing for guidelines informing its inclusion in research, and emphasizing the use of sex and gender-sensitive data and indicators. However, there is still laxity in integrating sex and gender in mental health research globally (). This oversight leads to continued gender bias, limits presentation of health concerns, and adoption of sex- and gender-sensitive interventions. Failure to clearly note the impact of sex and gender undermines equitable research (). With the rise of equity-related discussions in health policy, there is a global call to include gender in mental health research impact assessment by funders, researchers, and institutions. Sex and gender interact in complex ways that affect health. The interaction of biological and social vulnerability contributes to the differences in prevalence, expression, and management of mental health conditions in males and females. Sex differences in the prevalence of these disorders vary with age and the interplay with different environmental exposures (). Generally, women tend to have more internalizing disorders like anxiety and depression, while men have more externalizing disorders, like substance abuse and antisocial personality (). In childhood and adolescence, boys have a higher prevalence of conduct disorders, compared to disorders related to body image and self-esteem, like depression and eating disorders in girls (). Globally, depression and anxiety have been identified to have a higher prevalence in women (). These mental health patterns result from socially constructed gender roles, power imbalance, and biological differences, all influencing the nature of disorders and health-seeking behaviors (). For example, different roles and responsibilities place women in positions with little say over certain choices, creating a sense of lack of autonomy, with men having issues relating to socialization and expressing their concerns and emotions (). All these shape differences in resilience (), reporting, and identifying the true burden of CMDs globally. This calls for a comprehensive view and understanding of the differences in mental health disorders from a multifaceted approach (). Common mental disorders (CMDs) are highly prevalent globally, anxiety and depression being the most common. Anxiety disorders cause a significant burden in different regions, with some conflicting sex differences noted in studies conducted in various settings and populations. Over the past few decades, there has been a growing research focus on common mental disorders. Empirical studies conducted in different sub-Saharan African regions, and investigating diverse populations, have documented the prevalence and burden of these disorders. The reviews (, ) and studies have noted different findings with the experience and prevalence of anxiety and PTSD in men and women. A review conducted among Internally Displaced People (IDPs) in SSA reported female gender as a significant determinant contributing to PTSD prevalence (). During the COVID-19 pandemic, a review in Africa noted higher anxiety prevalence among women (). However, not all studies reported consistent sex differences. For instance, among adolescents in Nigeria, one study noted higher prevalence of anxiety in boys (32.1%) compared to girls (21.9%) (). Similarly, a study among South African university students, using a psychometric measurement approach to determine whether sex contributes to the differences in measurement of anxiety reported no significant difference in prevalence and symptom presentation ().