Self-harm is the second leading cause of death for older adolescent girls. Understanding the intersection between adolescence, mental health and gender is crucial in tackling suicide rates worldwide, says Chisina Kapungu, senior gender and youth specialist at the ICRW.

Marie, a young woman from Ghana, battled low self-esteem and depression. She was dealing with bullies, domestic violence, body image issues and an ailing mother. She was socially isolated, cried excessively, was anxious and hopeless. Marie struggled to cope with how she was feeling, didn’t know who to confide in and had no idea where she could turn to seek help.

She didn’t know it, but Marie was battling with depression. Even if she’d known, she wouldn’t have been able to find anyone to help because, in her community, mental health problems are seen as cases of demonic possession, and the victims are often shunned by society.

Marie attempted suicide twice. At the age of 5, she held a knife to her stomach. At 12, she tried to use fire from the stove to burn her family’s house down with her inside. Marie felt suicide was the only option she had to escape her reality. Marie’s story is gut-wrenching, but far from rare. There are millions of girls around the world like Marie.

Among older adolescent girls, self-harm, which includes intentional efforts to injure oneself or attempt suicide, is the second leading cause of death after pregnancy complications. When international development workers noticed this disturbing new trend, one major question arose: Why are adolescents dying from suicide, and what are the factors that place girls, in particular, at risk?

While we don’t have the answer to those important questions, there are a few things we do know. Mental health problems commonly emerge during adolescence, affecting 10–20 percent of children and adolescents worldwide, with half of all mental illnesses beginning by the age of 14 and 70 percent by age 24. Adolescence presents a critical window of opportunity to prevent the emergence and progression of mental disorders.

Girls face a host of challenges as they navigate the turbulent waters between childhood and adulthood. They experience rapid physical growth and changes, accompanied by shifts in cognitive and emotional development. Environmental factors, including family, peer group, school, neighborhood, policies and societal expectations, can either support or challenge young people’s well-being.

Girls are more likely than boys to be married as children, and previous estimates indicate that nearly 30 percent of adolescent girls aged 15–19 experience violence at the hands of an intimate partner. Gender inequalities that can increase girls’ vulnerability to depression and ultimately to self-harm and suicide also include unequal access to resources and education, limited power to make decisions over their own lives and girls’ low social status, as compared to boys.

Young women and girls are also often under pressure to conform to stereotypical gender norms that tell them how to be a “girl,” which may mean focusing on household tasks, getting married and having children, rather than making their own decisions about their future. Psychological distress, hopelessness and depression may emerge due to loss of education, limited freedom and autonomy.

We know from previous research that meeting the needs of adolescent girls is important for achieving a range of development goals. And we cannot meet adolescent girls’ needs if we neglect their mental health. By and large, the global community has failed to understand and address the drivers of poor mental health outcomes among adolescent girls and has yet to uncover the best ways to respond to adolescent girls’ mental health needs. In fact, very little is known about the intersection between gender, adolescence and mental health.

But there is some good news: Mental health was included in the U.N. Sustainable Development Goals (SDGs) adopted in 2015. Specifically, goal three focuses on ensuring healthy lives and promoting the well-being of people of all ages. The WHO’s Comprehensive Mental Health Action Plan for 2013–2020 highlights steps toward recognizing and addressing suicide and self-harm worldwide. Despite this recognition, there has not been nearly enough attention or funding given to mental health globally. Understanding the intersection between adolescence, mental health and gender is a critical next step to tackling the rates of suicide worldwide.

It’s important that we tackle all of the challenges facing girls, including those that are often hidden, such as depression or mental illness. And while it will take some time to truly understand which factors are contributing to this alarming rise, more research on key factors leading to suicide for adolescent girls, coupled with an overarching framework on adolescent mental health, is necessary to increase the overall psychological well-being of girls.

If Marie had had someone to turn to and if she’d been provided with the developmentally appropriate and gender-specific support she needed, her attempts at suicide may have been avoided. It is well worth the investment to be more responsive to the needs of girls like Marie, to make sure they don’t fall through the cracks.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Women & Girls.