Men’s mental health in context: gendered pathways linking early-life hardships to adult depression and life satisfaction compared with women

3.1 Men’s mental health, gender differences, and early-life hardships

Men’s health research underscores that early-life hardships may manifest differently for men than for women, given men’s higher suicide rates, greater reliance on externalizing behaviors, and lower likelihood of seeking professional help [1, 2, 3]. From this perspective, early adversity is not only a developmental disruption but also a pathway into gendered health inequalities that require explicit comparison between men and women. While women often present with internalized symptoms such as depression and anxiety, men disproportionately translate early hardships into substance misuse, social withdrawal, and suicidality, highlighting the necessity of gender-sensitive approaches to cumulative disadvantage [4, 5].

Research on early-life adversities has traditionally centered on the concept of Adverse Childhood Experiences (ACEs), a framework identifying ten categories of abuse, neglect, and household dysfunction [8, 14]. Foundational studies established their cumulative effects on adult mental health, demonstrating strong associations with depression, anxiety, suicidality, and reduced life satisfaction [6, 7]. Meta-analyses suggest that about 60% of individuals report at least one ACE, while 16% report four or more, underscoring the prevalence of adversity across societies [9].

However, scholars increasingly advocate for expanding the scope beyond the original ACE framework to encompass early-life hardships—stressful or traumatic events extending into socioeconomic and contextual domains, including parental bereavement, divorce, school dropout due to financial hardship, kinship caregiving, and extreme poverty [10, 11]. Such hardships are not isolated events but processes that disrupt caregiving, constrain educational attainment, and reinforce long-term socioeconomic deprivation. This broader conceptualization is particularly salient in the Korean context, where rapid industrialization, highly competitive education, and weak social safety nets have intensified the long-term consequences of childhood hardship. For instance, early dropout due to financial hardship has disproportionate effects in Korea’s credential-driven labor market, while kinship caregiving reflects family-centered coping practices rooted in Confucian traditions but often associated with psychosocial instability [15, 16].

For men in Korea, these hardships intersect with entrenched gender norms that discourage emotional disclosure and reinforce breadwinner identities, making educational failure or economic deprivation especially damaging to long-term well-being. By examining hardships such as school dropout and kinship caregiving, this study not only extends the ACE framework but also situates it within men’s health scholarship, where gender norms mediate how adversity is internalized and expressed.

The life course perspective provides a powerful lens for interpreting these patterns. According to the theory of cumulative disadvantage, early deprivation triggers chains of inequality that compound over time, intensifying disparities in education, employment, and health [12]. Key concepts—turning points, path dependency, and accumulation of disadvantage—explain how hardships become embedded in structural inequalities. In this view, depression functions not only as a psychological symptom but also as a structural marker of sustained vulnerability [13]. Recent Korean studies likewise show how chronic poverty and disrupted schooling magnify inequality across adulthood, reinforcing the salience of life course dynamics in non-Western welfare regimes [17, 18].

In addition to the life course and cumulative disadvantage frameworks, complementary perspectives from psychology and sociology further elucidate how early hardships shape gendered mental health trajectories. Theories of stress and coping [19] highlight how individuals cognitively appraise and respond to early trauma, suggesting that men and women differ in the ways they externalize or internalize distress. The social support perspective underscores that relational and community resources buffer adversity, yet men’s lower likelihood of seeking help often limits this protective function [1]. Finally, role identity theory provides a gender-sensitive lens, explaining how disruptions to core roles—such as breadwinner or caregiver—can destabilize self-concept and long-term well-being [20]. Integrating these frameworks enriches the analysis of early-life hardships by linking structural inequalities to psychosocial coping mechanisms across gender, thereby bridging the gap between macro-level disadvantage and individual adaptive processes.

Parallel to life course scholarship, the rise of trauma-informed frameworks has reshaped research and practice. Trauma-informed care (TIC) emphasizes recognizing the prevalence of early adversity, identifying its manifestations, and building systems that respond without re-traumatization [21]. While U.S. states have institutionalized ACE screening protocols, in Korea such frameworks are only beginning to gain traction, largely through pilot programs in mental health and school counseling. Expanding TIC in East Asian contexts requires sensitivity to family-based caregiving norms, stigma surrounding mental illness, and the limited availability of community mental health resources.

By reframing early-life hardships and situating them within both global theory and the specific institutional context of Korea, this study contributes to men’s health by showing how adversities uniquely shape male psychological outcomes in comparison with women, while foregrounding the need for trauma-informed and gender-sensitive interventions. This orientation clarifies conceptual boundaries and deepens understanding of how cumulative disadvantage operates in societies with rapid demographic change and strong family-based safety nets.

3.2 Men’s health and gendered pathways linking early-life hardships and life satisfaction

A growing body of men’s health scholarship suggests that early-life hardships uniquely compromise men’s long-term well-being by undermining masculine role expectations, autonomy, and social functioning [1, 2, 3]. For men, acute or identity-threatening adversities—such as parental death or school dropout—pose particular risks, often translating into lower life satisfaction, externalizing behaviors, and heightened suicidality. These dynamics differ from women’s experiences, which more often reflect the cumulative toll of chronic and relational adversities. Thus, understanding life satisfaction trajectories requires a gender-comparative perspective that situates men’s vulnerabilities within broader structures of cumulative disadvantage [4, 5].

A substantial body of longitudinal research has demonstrated that early-life hardships—including parental loss, school interruption due to financial hardship, economic deprivation, and caregiving instability—are negatively associated with adult life satisfaction. Yet, the literature increasingly emphasizes that these associations are neither uniform nor universal; rather, they vary by hardship type and gender. Life satisfaction is not merely a subjective psychological state but a reflection of accumulated opportunities and constraints across the life course [12]. Within this framework, gender operates as a structural axis that differentiates how traumatic events are experienced, internalized, and translated into long-term well-being.

Women exposed to chronic or relational forms of early adversity, such as extreme poverty, caregiving disruptions, or being raised outside the nuclear family, consistently report diminished life satisfaction in adulthood [10, 11]. These experiences often erode autonomy and perceived control, undermining women’s long-term psychosocial trajectories. The internalization of such adversities manifests as persistent emotional disconnection and reduced resilience, aligning with Schilling et al.’s [22] finding that cumulative exposures exert stronger effects than isolated incidents. In contrast, men are disproportionately vulnerable when facing acute disruptions—such as parental death or school dropout—that directly threaten masculine identities tied to achievement, independence, and self-efficacy [17].

Empirical evidence also underscores mediating and moderating mechanisms. Yin et al. [10] demonstrate that women’s exposure to early-life hardships predicts later-life declines in well-being through pathways such as poor sleep quality and social isolation. Mosley-Johnson et al. [7] report that while income buffers the adverse effects of childhood trauma for men, it fails to offset life satisfaction losses among women, highlighting the intersection of trauma, gender, and structural vulnerability. Social support and emotional intelligence have been identified as resilience factors [9], but these protective effects are often more pronounced among men, who may rely heavily on external social resources in the absence of formal help-seeking.

Contextual and demographic factors further shape these gendered associations. Higher household income and marriage are consistently linked to greater life satisfaction, with particularly strong protective effects for women. Conversely, alcohol consumption and rural residence are negatively associated with men’s well-being. Age also emerges as a crucial variable: midlife represents a critical juncture when the cumulative effects of early hardship are most visible, consistent with the life course emphasis on turning points and path dependency [13].

Taken together, these findings illustrate that the relationship between early-life hardships and adult life satisfaction is deeply gendered, reflecting the interplay of adversity type, structural inequalities, and life course processes. Whereas women’s vulnerabilities are amplified by chronic hardships undermining caregiving stability and socioeconomic agency, men’s vulnerabilities emerge most strongly in response to acute disruptions that challenge role identity, autonomy, and masculine self-concept. Recognizing these divergent pathways underscores the necessity of a men’s health perspective embedded within a gender-sensitive life course framework.

3.3 Men’s mental health and gendered vulnerability to depression following early-life hardships

Men’s mental health research highlights that early-life hardships are particularly consequential for men, whose vulnerabilities often manifest in suicide, externalizing behaviors, and suppressed emotional disclosure [1, 2, 3]. While women consistently show higher prevalence of diagnosed depression, men’s depressive states are more likely to remain hidden, expressed through substance misuse, withdrawal, or risk-taking. Acute and identity-threatening adversities—such as parental death or school dropout—are especially destabilizing for men, as they directly undermine masculine role expectations and pathways of socioeconomic attainment. In contrast, women’s depression risk tends to accumulate through chronic and relational hardships. Understanding depression as a men’s health issue, therefore, requires situating gendered trajectories of vulnerability within a life course framework that explicitly compares men and women [4, 5].

Depression is the most consistently documented outcome of early-life hardships, with a robust dose-response relationship repeatedly observed across diverse settings [6, 8]. Yet the psychological toll of specific adversities differs markedly by gender, reflecting both biological susceptibilities and sociocultural norms that structure coping mechanisms. Women are especially vulnerable to the mental health consequences of chronic and relational forms of hardship—including persistent poverty, caregiving disruptions, and parental divorce—that undermine long-term stability and are often internalized as sustained emotional distress and diminished self-worth [11, 18]. Men, by contrast, face heightened risk of depression when acute turning points—such as parental death or financial dropout—erode self-efficacy and challenge traditional masculine identities [17].

The life course perspective clarifies these divergences. Concepts such as cumulative disadvantage and path dependency [12] highlight how relational and chronic adversities accumulate for women, narrowing caregiving stability and economic agency, whereas acute disruptions act as critical turning points for men, destabilizing identity and threatening future trajectories. In this sense, depression should be understood not merely as an individual pathology but as a structural marker of sustained vulnerability [13] (Miech & Shanahan, 2000).

Empirical studies underscore the gendered mechanisms linking early-life hardships to depression. Björkenstam et al. [23] report that childhood adversity sharply elevates suicide risk, particularly among women, while also noting that men are more prone to externalizing responses—such as alcohol use, withdrawal, or aggression—that conceal underlying depressive states. Women more often engage in rumination and self-blame, exacerbating internalized symptoms [24]. Furthermore, Yin et al. [10] demonstrate that poor sleep and social isolation mediate the relationship between early adversity and depression in women, while Mosley-Johnson et al. [7] show that income acts as a partial buffer for men but fails to offset women’s heightened vulnerability. Zhu et al. [9] stress the importance of moving beyond cumulative indices to disaggregated approaches that illuminate these gender-specific trajectories.

Contextual and demographic moderators further shape these associations. Marriage consistently buffers depression more strongly for women, reflecting the protective role of relational stability, while rural residence and alcohol consumption are more closely associated with increased depressive symptoms among men. Age also matters: midlife represents a critical juncture when the cumulative shadow of early hardships becomes most pronounced, in line with the life course emphasis on turning points and accumulation of disadvantage [13].

Taken together, these findings underscore that the relationship between early-life hardships and depression is profoundly gendered, shaped by the interplay of adversity type, structural inequalities, and life course processes. For women, depression risk is amplified by chronic and relational adversities that erode caregiving stability and social support. For men, vulnerabilities are heightened by acute disruptions that destabilize masculine identities, undermine autonomy, and obstruct socioeconomic mobility. This divergence underscores the urgent need for trauma-informed, gender-sensitive mental health systems that explicitly recognize men’s hidden depression and address how early adversities are embodied differently across genders.

4.1 Data source and sample

This study draws on the Korean Welfare Panel Study (KoWePS), a nationally representative longitudinal survey jointly administered by the Korea Institute for Health and Social Affairs (KIHASA) and Seoul National University. Conducted annually since 2006, KoWePS provides one of the most comprehensive sources of household- and individual-level socioeconomic information in East Asia, making it uniquely valuable for life course research. Unlike many existing studies that rely on Western samples, the use of Korean data broadens the scope of comparative welfare research by capturing the dynamics of mental health within a rapidly aging society marked by intense educational competition, persistent income inequality, and evolving gender norms.

For this analysis, we focus on a balanced 12-year panel spanning 2011 to 2022. The extended observation period provides several methodological advantages. First, repeated measures of mental health outcomes allow for continuity and averaging across adulthood, minimizing random year-to-year fluctuations that often bias cross-sectional estimates. Second, the multi-wave design reduces risks of multicollinearity by capturing within-person variation over time while retaining the explanatory power of time-invariant predictors such as gender and childhood traumatic events. Third, the panel framework strengthens causal inference by distinguishing intra-individual changes (life course dynamics) from inter-individual differences (structural inequalities).

The analytic sample includes adults aged 25 and older who reported at least one early-life hardship, drawn from twelve consecutive waves. Participants were included if they completed at least two consecutive waves between 2011 and 2022 and provided valid responses for key variables such as depression and life satisfaction. Individuals with missing values on major covariates or incomplete data on childhood hardships were excluded. After listwise deletion of missing data, the final dataset consists of 7200 individuals (approximately 3200 men and 4000 women), contributing over 70,000 person-year observations. This dataset is uniquely valuable for men’s health research, as it provides a sufficiently large male subsample observed across multiple decades, enabling robust analysis of gender-differentiated trajectories in depression and life satisfaction [25, 26]. The richness of KoWePS enables robust modeling of gender-differentiated pathways linking early-life hardships and traumatic events to adult life satisfaction and depression, while situating these dynamics within Korea’s distinctive institutional and cultural context. This life course perspective provides insights into cumulative disadvantage that extend beyond Western-centered approaches, highlighting how gendered vulnerabilities unfold across diverse social settings.

4.2 Variables

Variable Selection and Operationalization.

As shown in Table 1. Variable Composition, the selection of the five childhood hardship variables in this study—parental bereavement, parental divorce, school dropout due to financial hardship, being raised in a relative’s household, and extreme childhood poverty—was theoretically and empirically grounded in prior scholarship on early-life adversity and adult mental health. Research on early-life hardships and traumatic events has consistently identified parental loss, family dissolution, and economic deprivation as central predictors of long-term psychological outcomes, particularly when viewed through a life course perspective of cumulative disadvantage [8]. These categories capture both acute traumatic events and chronic structural hardships that, according to the life course perspective, may alter developmental trajectories through cumulative disadvantage and turning-point effects [12].

Parental bereavement and divorce represent prototypical relational disruptions that undermine family stability and are repeatedly linked to elevated risks of depression and diminished well-being in adulthood [17, 27]. School dropout, particularly when prompted by financial hardship, has been identified as a critical turning point event, limiting educational attainment and long-term socioeconomic mobility while exacerbating vulnerability to psychological distress [22, 28]. Similarly, kinship caregiving—growing up in a relative’s household—reflects unstable caregiving environments and has been theorized as a form of relational trauma with enduring mental health consequences [11]. Finally, extreme childhood poverty captures the chronic structural deprivation that shapes cumulative life-course inequalities, consistent with empirical evidence demonstrating its long-term effects on both subjective well-being and depressive symptomatology [9, 10].

For men, these five hardships intersect with masculine role expectations in unique ways. School dropout due to financial hardship not only reduces educational attainment but also undermines male identity tied to breadwinner roles and socioeconomic achievement. Parental death may impose premature role responsibilities on sons, reinforcing stress pathways distinct from those experienced by women. Extreme poverty, while universally harmful, often carries stigmatizing implications for men’s perceived ability to achieve and provide, thereby exacerbating depressive outcomes [25, 29].

By including these five indicators, the study balances analytical parsimony with theoretical comprehensiveness. They collectively span the spectrum of early-life hardships: acute losses (bereavement, dropout), relational instability (divorce, kinship care), and chronic structural deprivation (poverty). This operationalization thus aligns with both trauma-informed frameworks and life course theory, enabling a more precise investigation of how specific forms of childhood adversity differentially shape adult outcomes across genders.

Control variables—such as gender, age, marital status, household income, alcohol use, residential location, and economic activity status—were further incorporated to account for demographic and contextual heterogeneity. Particular attention was given to alcohol use and marital status, as these variables are strongly gendered in their psychological implications—often serving as externalizing coping mechanisms or protective buffers for men, respectively [3, 5]. This ensured robust estimation of the net associations between childhood hardships and adult mental health.

4.3 Empirical strategy and model specification

To examine the long-term associations between early-life hardships and adult outcomes, we employed random-effects panel regression models. This approach was chosen over fixed-effects models because it allows for the inclusion of substantively important time-invariant predictors, such as gender and childhood hardships, while simultaneously capturing within-individual variation over the twelve-year observation period.

The general specification of the model is expressed as Eqn. 1:

Here, y_it denotes the outcome variable for individual i at time t, representing either life satisfaction or depression. The term X_it captures time-varying covariates, such as income, marital status, and employment. The term Z_i represents time-invariant characteristics, including gender and childhood hardships. The random effect u_i accounts for unobserved heterogeneity at the individual level, while ε_it is the idiosyncratic error term.

The empirical design involved six models in total: three for life satisfaction and three for depression. For each outcome, we estimated (1) a full-sample model that included a gender dummy variable, (2) a male-only subsample model, and (3) a female-only subsample model. This design allowed for direct comparison of effect size, direction, and significance across genders, enabling the identification of gender-specific vulnerabilities and protective factors.

By leveraging the longitudinal depth of the Korean Welfare Panel Study (2011–2022), this study reduced concerns about reverse causality and unobserved heterogeneity while aligning with the life course perspective’s emphasis on turning points, cumulative disadvantage, and path dependency. The use of panel methods thus ensured both temporal continuity and the ability to trace twelve years of average and sustained trajectories of adult mental health.

All analyses were conducted in Stata 17 (StataCorp LLC, College Station, TX, USA), with robust standard errors clustered at the individual level. Statistical significance was assessed at conventional thresholds (^∗p < 0.1, ^∗∗p < 0.05, ^∗∗∗p < 0.01), with robust standard errors clustered at the individual level.

5.1 Descriptive analysis

As presented in Table 2. Descriptive Statistics, data from the Korean Welfare Panel Study (2011–2022) reveal distinct patterns that illuminate men’s mental health vulnerabilities. Although women reported higher mean levels of depressive symptoms (12.83 vs. 9.65), men’s depression often remains under-identified, as their psychological distress is more likely to manifest in externalizing behaviors or masked through alcohol use and withdrawal (Wilhelm, 2001; Courtenay, 2000). This hidden burden suggests that lower reported averages among men may underestimate the true mental health costs of early-life hardships for male populations.

Life satisfaction scores were broadly similar across genders, with men reporting slightly higher averages (3.13 vs. 3.06). However, for men, life satisfaction may be more tightly linked to role identity and socioeconomic achievement, making it especially sensitive to disruptions such as school dropout or parental loss. Consistent with structural gender inequality, men also reported higher logged household incomes (7.56 vs. 7.35), but these economic advantages do not necessarily translate into psychological resilience, as financial responsibility and provider expectations may intensify men’s stress exposure (Wong et al. [26], 2017).

Patterns of childhood hardship further highlight gender-differentiated exposures. Women were more likely to report school dropout due to financial hardship (0.50 vs. 0.42), reflecting relational and structural vulnerabilities in education. In contrast, men disproportionately reported kinship-based caregiving during childhood (0.29 vs. 0.09), a relational disruption that often imposes premature role responsibilities and undermines autonomy, resonating strongly with masculine identity pressures. Parental divorce was also more common among men, while parental bereavement was nearly identical across genders (0.48 vs. 0.47).

Taken together, these descriptive findings reinforce the central premise of this study: men’s mental health vulnerabilities are often rooted in acute and identity-threatening hardships that challenge traditional masculine roles, whereas women’s risks are amplified by chronic and relational adversities. Recognizing these divergent exposure patterns underscores the necessity of gender-sensitive, men-focused analysis to capture the hidden and structural dimensions of psychological distress.

5.2 Regression results on life satisfaction

As indicated in Table 3. Results of Satisfaction Analysis (Panel Regression), for men, income emerged as the strongest positive predictor of life satisfaction (β = 0.284, p < 0.01), underscoring the centrality of socioeconomic achievement to male well-being and masculine role identity. This finding is consistent with theories of gender and health that emphasize how men’s life satisfaction is closely tied to breadwinner expectations and financial stability (Courtenay, 2000; Wong et al. [26], 2017). By contrast, women’s life satisfaction also benefited from higher income (β = 0.231, p < 0.01), but the effect size was smaller, suggesting that men’s psychological well-being is more tightly bound to economic attainment.

Negative predictors for men were concentrated in acute and identity-threatening adversities. School dropout (β = −0.0948, p < 0.01) showed a particularly strong association with reduced life satisfaction among men, reflecting how educational disruption undermines male self-efficacy and long-term socioeconomic trajectories. Childhood poverty also significantly reduced life satisfaction for men (β = −0.106, p < 0.01), further highlighting the lasting psychological scars of structural deprivation when compounded with masculine provider norms.

Interestingly, kinship care (β = −0.0366, ns) and parental bereavement (β = −0.0059, ns) were not significant predictors for men, suggesting that while these hardships impose relational disruptions, their effects on men’s life satisfaction may be less direct than economic and educational shocks. Conversely, parental divorce showed a positive and significant effect among men (β = 0.0765, p < 0.05), potentially reflecting adaptive reconfigurations of family roles or greater autonomy following parental separation. This contrasts sharply with women, for whom parental divorce was insignificant or negative.

Alcohol intake (β = −0.0427, p < 0.01) reduced life satisfaction in men, consistent with the view that alcohol functions as a maladaptive coping mechanism for masked depression and stress regulation. Marital status was also a strong positive predictor (β = 0.170, p < 0.01), indicating that marriage continues to provide social and identity stability for men, buffering against early-life adversities.

In comparison, women showed greater vulnerability to relational and chronic hardships. Childhood poverty (β = −0.160, p < 0.01), kinship care (β = −0.144, p < 0.01), and school dropout (β = −0.0845, p < 0.01) had stronger adverse effects on women’s life satisfaction. Women’s life satisfaction was also more negatively influenced by alcohol intake (β = −0.0658, p < 0.01) and urban residence (β = −0.0881, p < 0.01), highlighting how structural and relational factors weigh more heavily on women.

Overall, these results support a gender-differentiated interpretation: men’s life satisfaction is most vulnerable to acute disruptions that threaten role identity (e.g., dropout, poverty), whereas women’s satisfaction is more strongly eroded by chronic and relational hardships. This divergence reinforces the study’s framework that men’s health research must foreground identity-threatening adversities while situating them within broader gendered comparisons.

5.3 Depression outcomes: men’s health and gendered mental health consequences of early-life hardships

As shown in Table 4. Results of Depression Analysis (Panel Regression), for men, the regression results reveal that income and marital status are the strongest protective factors against depression, while school dropout and rural residence emerge as key risk factors. Higher income was associated with substantially lower depressive symptoms in men (β = −3.130, p < 0.01), suggesting that men’s psychological well-being is strongly tied to breadwinner expectations and socioeconomic achievement. Similarly, being married exerted a significant buffering effect (β = −3.286, p < 0.01), highlighting the stabilizing role of relational and identity security for men. These findings align with men’s health research emphasizing that masculine role fulfillment and family stability serve as critical anchors for male mental health (Courtenay, 2000; Wong et al. [26], 2017).

Male vulnerability was most pronounced in response to acute, identity-threatening adversities. School dropout due to financial hardship significantly elevated depressive symptoms for men (β = +0.905, p < 0.05), underlining how disrupted educational trajectories undermine self-efficacy and future socioeconomic mobility. Rural residence was also strongly associated with increased depression among men (β = +1.781, p < 0.01), reflecting contextual stressors tied to isolation, limited economic opportunities, and cultural stigmas surrounding help-seeking. Alcohol intake further predicted higher depressive symptoms in men (β = +0.540, p < 0.01), consistent with theories of externalizing coping, whereby men mask depressive states through substance use rather than emotional disclosure [1, 4].

In contrast, women’s depression risk was more consistently driven by chronic and relational hardships. Childhood poverty (β = +1.297, p < 0.01), kinship caregiving (β = +2.828, p < 0.01), and school dropout (β = +1.789, p < 0.01) had stronger effects on women than on men, underscoring how relational instability and long-term deprivation erode women’s emotional resilience. Parental divorce also significantly increased depressive symptoms for women (β = +1.474, p < 0.05) but was not significant for men (β = −0.443, ns), reinforcing gendered differences in how family dissolution is internalized.

Taken together, these findings suggest that men’s depression is especially sensitive to acute disruptions that threaten masculine role identity—such as dropout, financial insecurity, or rural isolation—while women’s depression is more strongly linked to chronic and relational adversities. Depression thus functions as both a psychological symptom and a structural indicator of sustained gendered vulnerability [13]. Recognizing these divergent pathways reinforces the importance of a men’s health framework within trauma-informed and gender-sensitive mental health policy.