Unequal burdens: Sexist discrimination and psychological well-being among women in Egypt—A quantitative community-based cross-sectional assessment

Abstract

Background

The psychological well-being of Egyptian women is shaped by entrenched social, religious, and cultural norms, often resulting in heightened stress and internalized distress. Despite advances in women’s education and activism, empirical work linking everyday sexist discrimination to mental health outcomes in Egypt remains limited.

Objectives

To assess gender differences in multidimensional psychopathology in Egypt and to examine how the frequency and type of sexist experiences relate to mental health symptom severity among Egyptian women.

Design

Quantitative, community-based cross-sectional survey.

Methods

A structured survey was administered to 310 adults—including 195 women—recruited in Cairo and surrounding regions. Validated instruments measured multiple mental health domains (including depression, anxiety, anger, and somatic symptoms) and the frequency of sexist events using the Schedule of Sexist Events. Bonferroni-corrected nonparametric tests and multivariate linear regressions were conducted to evaluate gender differences and associations between sexist discrimination and symptom severity.

Results

Women reported significantly higher anger, anxiety, and somatic symptoms than men, whereas no other demographic variables predicted symptom burden after correction. Among women, more frequent sexist experiences—particularly sexual degradation and sexism in close relationships—were robustly associated with greater severity across all assessed mental health domains (R² = 0.307).

Conclusion

Sexist discrimination emerges as a central determinant of Egyptian women’s mental health, with specific forms of sexism showing strong links to broad psychopathological burden. Policymakers and practitioners should prioritize gender-sensitive prevention strategies, clinical care, and structural reforms to address both public and private sources of sexism-related adversity.

Plain Language Summary

This study explores how everyday sexism affects the mental health of women in Egypt. Sexism refers to being treated unfairly, disrespected, or judged simply because one is a woman. In many parts of Egyptian society, women may face restrictions on how they dress, where they go, how they behave, and the roles they are expected to play at home and work. Experiences such as harassment in public spaces, being spoken to disrespectfully, or being denied opportunities can have a strong emotional impact over time. To better understand this, we surveyed 310 adults living in Egypt, including 195 women. Participants answered questions about their daily experiences and their mental health. The results showed that women reported higher levels of anxiety, anger, and physical stress symptoms (such as headaches or fatigue) compared to men. We also found that women who experienced more frequent sexist behavior reported more emotional distress overall. One of the strongest findings was that experiences of sexual harassment and controlling or disrespectful treatment in close relationships were closely linked to increased mental health symptoms. This suggests that sexism occurring in personal relationships, not only in public spaces, has a powerful effect on well-being. These results highlight that sexism is not just a social issue, but a public health concern. Supporting women’s mental health in Egypt requires efforts to reduce gender discrimination, promote respectful treatment, and create safe spaces in families, workplaces, schools, and communities. Addressing sexism can help improve women’s emotional well-being and contribute to healthier, more supportive environments for everyone.

Keywords

women mental health sexism Egypt discrimination

Introduction

Women in Egypt experience psychological well-being through the lens of deeply rooted social, religious, and political forces that permeate daily life, from the family home to the broader street and workplace. Generational traditions, such as the emphasis on female modesty and family reputation, often dictate expectations for women’s behavior and opportunities, sometimes resulting in pressures that restrict autonomy and fuel internalized distress.^1,2 For example, the practice of early marriage^3,4—still prevalent in some rural communities—or the social scrutiny surrounding women’s dress and mobility in urban centers like Cairo, reflect the enduring weight of patriarchal norms, and demonstrate how personal freedom and mental health are shaped by the demands of conformity and social control.

Modern Egyptian women must also contend with ongoing transitions and contradictions that shape their emotional lives. The dramatic surge in women’s university enrollment and participation in the workforce since the 1952 Revolution is frequently counterbalanced by legal inequality in family law,⁵ experiences of street harassment, or media narratives that reinforce traditional gender roles. Public debates over laws protecting women from violence, as well as landmark activism such as the 2011 “Tahrir Square” protests, reveal both the potential for progress and the resilience of barriers to change.⁶ These intersecting pressures—where gains in public life are offset by persistent private or institutional discrimination—result in sociospatial patterns of anxiety, tension, and somatization that are uniquely Egyptian, and affirm the necessity of research tailored specifically to women’s mental health in this setting.

In Egypt, women’s lives are governed by a uniquely intense set of expectations about modesty, reputation, and obedience, which are reinforced by both some aspects of some religious doctrines and everyday practices. Even among the rising generation of university-educated women, daily routines commonly involve juggling unpaid labor at home with paid professional responsibilities, while deflecting critique about the suitability of their career choices.⁷ This dual burden—evident in the lives of women teachers, doctors, or small-business owners who remain the default caretakers after work—creates a persistent source of psychological stress, fueling anxiety, somatization, and feelings of isolation that mainstream mental health narratives often overlook in the Egyptian context.⁸

Patriarchal systems in Egypt are reinforced by intersecting axes of power, including class, urban-rural divides, and specific religious traditions that dictate women’s status and mobility.⁹ For many women, access to education and employment remains constrained by family expectations or societal perceptions, regardless of legal changes.¹⁰ Within this framework, experiences of both overt and covert discrimination can have an insidious impact, shaping self-concept, agency, and avenues for help-seeking.

Women’s suffering is often expressed through culturally acceptable forms such as somatic complaints or suppressed emotions, as open discussion of mental health remains stigmatized—particularly for women.¹¹ These patterns reflect a broader societal tendency to silence or delegitimize female pain, leaving women isolated with psychological burdens that are rarely validated or acknowledged. Feminist scholars highlight that this dynamic is not merely the result of cultural inertia, but an active byproduct of systems that prioritize family honor and social reputation over individual wellness.^12,13

Throughout Egypt’s recent history, periods of modernization and reform have produced only intermittent improvements in women’s public and private status.¹⁴ While recent legislative efforts have aimed at enhancing rights and safety, the lived experiences of women—particularly regarding gender-based harassment, economic inequality, and legal marginalization—continue to expose them to profound and unique pressures. The psychological cost of resisting or managing these pressures manifests as heightened susceptibility to anxiety, anger, somatization, and depressive symptoms.

For women across different regions of Egypt, the intersection of religion and mental health can add layers of complexity not fully appreciated in Western models of care.¹⁵ Some religious prescriptions often shape women’s access to resources, expectations of silence or endurance, and the ways mental health is interpreted and discussed within families and communities.¹⁶ Such pressures can affect whether and how symptoms are reported and, crucially, how available systems of care can (or cannot) meet their needs.

Despite steps forward in female education and the efforts of advocacy groups, a considerable gap persists in understanding how everyday experiences of sexist discrimination shape women’s mental health in Egypt. Most large-scale studies and government reports neglect the specific forms of distress faced by women, while public health strategies tend to generalize findings across the population, minimizing the gendered realities that make Egyptian women’s psychological burdens unique. As a result, the distinct pathways linking discrimination, social control, and emotional suffering remain largely invisible in the clinical or policy landscape.

This underrepresentation is especially evident in both national data collection and medical research, where women’s voices and lived realities are often filtered through male-oriented perspectives or dismissed as less pressing than “universal” health needs.¹⁷ Without research that brings women’s firsthand accounts and psychosocial contexts to the forefront, there is a risk that interventions will continue to overlook, or even reproduce, gender-based disadvantages by failing to tailor care and attention to women’s specific experiences. Cosequently, this article seeks to fill the gap by examining how Egyptian women perceive sexist tendencies in society through their own lived experiences.

Equally important is the need to establish rigorous, context-sensitive gender comparisons, so the full scope of psychological harm—and possible points of resilience—can be understood within the wider population. Only by juxtaposing women’s experiences and outcomes against those of men can researchers and clinicians identify which mental health disparities are genuinely gendered in origin and which may be attributable to other social factors. This research thus seeks not only to center women’s voices and foster actionable knowledge for feminist mental health scholarship, but also to build a more robust evidentiary basis for gender-sensitive policy and practice in Egypt and the region.

The present study is grounded in feminist and stress-process frameworks that conceptualize sexism as a chronic, gendered stressor that accumulates over the life course, shaping emotional, cognitive, and somatic functioning in women. Within feminist theory, gendered power relations and institutionalized patriarchy are understood to generate both overt and subtle forms of discrimination that undermine womens autonomy, constrain their choices, and normalize the silencing of distress, thereby increasing vulnerability to internalizing problems such as anxiety, depression, and somatic symptom disorders.¹⁸ At the same time, stress-process models emphasize that exposure to recurrent stressors, limited access to coping resources, and constrained opportunities for role negotiation interact to create cumulative psychological burden, particularly for marginalized groups.¹⁹ In Egypt, where legal, economic, and familial structures often reinforce traditional gender hierarchies, these frameworks together suggest that sexist discrimination is not merely an isolated experience, but a central social determinant of womens mental health that is likely to manifest in anger, anxiety, and physical complaints as much as in classic depressive symptomatology.

Empirically, international research has shown consistent associations between sexist events and poorer mental health outcomes for women, including higher levels of depressive symptoms, anxiety, anger, substance use problems, and functional impairment.²⁰ Studies using the Schedule of Sexist Events and related measures indicate that both everyday microaggressions and more severe forms of harassment and degradation are robustly linked to broad psychopathology scores, even after accounting for sociodemographic factors and other stressors. However, very few investigations have examined these relationships in Middle Eastern or North African contexts, and existing Egyptian data on womens mental health rarely incorporate validated sexism scales or compare womens outcomes directly to mens within a unified analytic framework. By explicitly situating sexist discrimination within feminist and stress-process theories, and by applying a comprehensive cross-cutting psychopathology measure alongside the Schedule of Sexist Events in a mixed-gender Egyptian sample, the current study directly addresses these theoretical and empirical gaps and provides a clearer rationale for focusing on (a) womens levels of sexist experiences and psychopathological dimensions, (b) gender differences across symptom domains, and (c) the associations between sexist events and multidimensional psychopathology among Egyptian women.

With these challenges and gaps in mind, this study is structured around three guiding research questions: Amongst Egyptian women, what are the levels of perceived sexist experiences and mental health dimensions? In Egypt, are there significant differences across genders in dimensions of mental health? Amongst Egyptian women, are there associations between levels of mental health issues and experiences of sexist events?

In addressing these questions, the present study adopts a cross-sectional observational design, which is well suited to estimating the strength and pattern of associations between reported sexist experiences and current psychopathological dimensions, but does not permit conclusions about temporal ordering or causality. To respect these inferential limits, all analyses and interpretations in this manuscript are framed in terms of statistical associations rather than directional or causal effects, and we avoid language that would imply that sexist events “cause” specific symptom profiles. Instead, the findings are presented as evidence of robust correlations between dimensions of sexism and multidimensional psychopathology in this sample, which can inform hypotheses for future longitudinal or experimental research but cannot, by themselves, establish the mechanisms through which these relationships arise.

Methods

Participants

The study was approved by the appropriate Institutional Review Board (Research Ethics Committee from Ajman University, # M-F-H-20-May) and conducted in accordance with the Declaration of Helsinki, with all participants providing written informed consent prior to participation. Inclusion criteria required participants to be at least 18 years old and residents of Egypt. Recruitment followed a convenience sampling approach, with individuals invited from universities and public spaces in Cairo and its surroundings. To ensure representation across key demographic sectors, some stratification was used in the sampling process based on religion, socio-economic status, educational level, and place of origin (countryside or city). Participation was voluntary, and all eligible individuals accessed the survey via a QR code. Responses were collected in a time frame from July 2025 to September 2025.

A priori power analyses were conducted to ensure adequate sample size for both primary types of analyses. For the whole sample, the power calculation was based on the two-tailed Mann-Whitney U test (non-parametric), with parameters set to an alpha of 0.05, a desired power of 0.80, and a conservative, medium expected effect size (r = 0.25). To maximize robustness and ensure adequate sensitivity, this most conservative scenario was chosen, yielding the largest minimum sample size requirement, and a 2:1 anticipated female-to-male respondent ratio was set, due to expectations that women would be more likely to participate. With these parameters, required minimum sample size was 118. The final whole-sample size exceeded this requirement. Some potential bias in sampling was identified, but in order to avoid it, some level of stratification was put in place in key demographic variables such as gender and age groups.

For analyses focusing only on women, a separate power analysis was performed for linear regression, using a significance level of 0.05, desired power of 0.80, and a moderate effect size (f² = 0.15), and 10 predictors. Under these parameters, minimum required sample size was 118. This analysis confirmed that the women-only subgroup was sufficiently powered for multivariate analysis.

Measures

The survey began with the collection of detailed demographic data, including age, gender (female or male), marital status (yes/no), religion (Christian/Islam), completed educational level (“none,” “primary,” “secondary,” “university [undergraduate],” “university [graduate]”), socio-economic status (“poor,” “struggling,” “stable,” “secure,” “rich”), and place of residence (city/countryside). For statistical analysis, all ordinal demographic variables were systematically converted to numerical codes: educational level was coded from 1 (none) to 5 (university graduate), and socio-economic status from 1 (poor) to 5 (rich), while binary categories such as gender and marital status were converted to 0/1 coding as appropriate. These codings ensured that all variables could be used efficiently in parametric and non-parametric statistical models.

This numerical recoding of ordinal variables was a technical step to facilitate data handling and model specification and did not, in itself, alter the underlying measurement level or impose interval-scale properties on the data. In line with this, all primary hypothesis tests for associations and group differences relied on non-parametric methods that respect the ordinal nature of these variables, while linear regression models used the coded values as ordered predictors under the usual assumption that higher categories reflect monotonic increases in the construct of interest. By explicitly separating the practical need to assign numeric labels from any stronger assumptions about equal spacing between categories, we sought to minimize conceptual ambiguity and to ensure that our analytic choices remained consistent with the scales’ original level of measurement.

The study included the Schedule of Sexist Events (SSE) scale, a validated instrument designed to assess the frequency and burden of sexist experiences across various domains.²¹ The SSE captures both direct and indirect sexism through dimensions such as “sexual degradation and its consequences,” “sexist discrimination in distant relationships,” “sexism in close relationships,” and “sexual discrimination in the workplace.” Respondents rated the frequency of experiencing events like “How often have you been put down or treated with condescension due to your gender?” on a structured Likert response scale, with scores producing both subscale and total scores. The reliability and construct validity of the SSE have been demonstrated across cross-cultural samples in prior research.^20,22,23 To align with local sensitivities, the wording of one item (referring to women’s private parts) was modified to exclude a potentially offensive term in Egypt.

Additionally, the survey included the Diagnostic Statistical Manual 5 (DSM-5-TR) Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult, a validated measure which assesses a series of core mental health dimensions: depression, anger, mania, anxiety, somatic problems, suicidal ideation, psychotic symptoms, sleep disturbances, memory problems, repetitive thoughts and behaviors, dissociation, personality problems, and substance use.²⁴ For each dimension, participants were asked to indicate how often they had experienced symptoms related to that domain during the past two weeks, using the following response options: (A) Not at all, (B) Rare, less than a day or two, (C) Several days, (D) More than half the days, or (E) Nearly every day. Domain-specific scores were calculated by summing responses within each dimension, enabling a comprehensive and dimensional analysis of recent symptom burden. The scale’s psychometric properties—including factor structure, test-retest reliability, and criterion validity—are well established in the literature.^25–27 In alignment with IRB recommendations for cultural and religious sensitivity in Egypt, the item on alcohol use was excluded from this study’s version of the instrument.

All measurements—demographics, SSE, and DSM-5-TR symptom domains—were administered online through a secure self-report survey, accessible via QR code. Each question was presented in both Arabic and English, ensuring clarity and inclusiveness for all Egyptian participants. The Arabic and English versions of the questionnaires were developed using a standardized forward–backward translation procedure to enhance conceptual and semantic equivalence. First, two independent bilingual psychologists whose native language was Arabic produced separate forward translations of the original English items, which were reconciled into a single version by an expert panel with clinical and methodological expertise in Egyptian mental health. A third bilingual expert, blinded to the original instruments, then back-translated the reconciled Arabic items into English, and discrepancies between the back-translation and the source versions were discussed and resolved by consensus. Particular attention was paid to items touching on sexuality and substance use, where wording was adapted to respect local religious and cultural norms while retaining the constructs intended by the original scales, and all proposed adaptations were reviewed and approved by the Institutional Review Board as part of the cultural-sensitivity assessment.

All data collection was complete (by making sure that participants could not upload their replies without filling in all the answers), so there was no need to adjust for incomplete answers.

To address external validity, we implemented a clearly defined sampling strategy and documented sample characteristics relevant to generalizability. Specifically, participants were recruited through convenience sampling from universities and public urban spaces in Cairo and surrounding areas, with stratification procedures applied to approximate diversity in religion, socio-economic status, educational level, and urban–rural origin, thereby enhancing representativeness of key demographic sectors of contemporary Egyptian adults, especially younger cohorts. Inclusion criteria restricted the sample to Egyptian residents aged 18 years or older, whereas individuals who did not meet these criteria (e.g., non-residents or minors) were excluded at the recruitment stage; in addition, all measures were administered via a fully completed online survey, so cases with incomplete data were automatically excluded from the analytic dataset.

Statistical analyses

Descriptive statistics were computed for all study variables to characterize the sample and provide an overview of mental health symptom distributions, as well as socio-demographic and psychosocial characteristics. These analyses included measures of central tendency (mean and median), dispersion (standard deviation, minimum, and maximum), and categorical frequencies for all demographic variables and for the main scales used in the study. This approach allowed for a systematic summary of participant characteristics and symptomatology across the sample.

To minimize the risk of type I error due to multiple comparisons, Bonferroni corrections were systematically applied to all hypothesis-testing procedures, with adjusted alpha levels determined by the number of comparisons within each family of tests. This conservative correction adjusted the alpha level according to the number of comparisons being made within each family of tests, ensuring that only findings robust to stricter significance thresholds were interpreted as statistically significant, as this is a procedure typically recommended by statisticians in this type of study.²⁸ While the Bonferroni correction is widely recommended to control family-wise type I error in multiple-testing contexts, we acknowledge that its conservative nature carries an increased risk of type II errors, particularly in exploratory designs and when examining complex, interrelated constructs such as multidimensional psychopathology. In this study, we therefore interpret non-significant findings with caution and place greater emphasis on patterns that are both statistically robust after correction and theoretically coherent, recognizing that some potentially meaningful associations may fall below the adjusted alpha threshold and warrant follow-up in larger or longitudinal samples.

Non-parametric methods—the Mann-Whitney U test for group comparisons and Spearman correlation for associations—were used throughout, as the primary mental health and exposure variables were ordinal in nature; as a result, these methods do not require the assumptions of normality or homogeneity of variance that characterize parametric tests.²⁹ This approach ensured the statistical results remained robust and interpretable even without the need to check parametric assumptions, and all corrected significance thresholds were explicitly reported in both tables and narrative.

For all findings that remained statistically significant after Bonferroni correction, linear regression analyses were performed to further evaluate the robustness of results while controlling for potential confounding demographic variables (including age, educational level, socio-economic status, religion, marital status, and urban/rural residence). In the case of analyses examining associations between the Schedule of Sexist Events (SSE) and DSM-5-TRsymptom domains, additional multivariate linear regression models were used that not only broke down the predictive value by specific SSE dimensions but also included all relevant demographic factors as covariates, providing an adjusted and nuanced understanding of these relationships.

In all linear regression models, covariates were included a priori when they represented core demographic characteristics identified in the literature as potential confounders of the relationship between sexist experiences and mental health (age, educational level, socio-economic status, religion, marital status, and urban/rural residence). These variables were retained in the models regardless of their individual statistical significance, in order to provide appropriately adjusted estimates of the associations between sexist events and symptom dimensions. In addition, model goodness-of-fit indices (R and R²) are reported for each regression model to document overall model performance and the proportion of variance explained in the corresponding outcome.

This observational cross-sectional study was designed and reported in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, as per the usual recommendations.³⁰ The STROBE checklist was used during protocol development to inform key methodological decisions, including sampling strategy, measurement selection, management of missing data, and the choice of statistical analyses, ensuring transparency and reproducibility. During manuscript preparation, each checklist item was reviewed to confirm that essential details—such as study design, setting, participant flow, variable definitions, potential biases, and study limitations—were clearly presented within the Introduction, Methods, Results, and Discussion sections. A completed STROBE checklist, indicating where each item is addressed in the manuscript, is available from the corresponding author upon request.

All analyses were conducted using Jamovi (version 2.7.17), which provides transparent syntax export to facilitate replicability. Non-parametric tests (Mann–Whitney U and Spearman correlations) were used for the primary hypothesis testing, and subsequent linear regression models were specified and reported using terminology consistent with these procedures, thereby maintaining coherence between the treatment of ordinal variables and the inferential framework.

The total duration of the study was 4 months.

Results

Descriptive

All descriptive results are presented in Table 1.

Table 1.

Descriptive results.

Variable	Group	N	Mean	Median	SD	%
Age	All	310	26.3	23	9.18
Gender	Female	195	-	-	-	62.9
	Male	115	-	-	-	37.1
Religion	Muslim	280	-	-	-	90.3
	Christian	30	-	-	-	9.7
Marital Status	Unmarried	188	-	-	-	60.6
	Married	122	-	-	-	39.4
Residence	City	163	-	-	-	52.6
	Countryside	147	-	-	-	47.4
Educational Level	None	13	-	-	-	4.2
	Primary	7	-	-	-	2.3
	Secondary	90	-	-	-	29
	Univ. Undergrad	128	-	-	-	41.3
	Univ. Graduate	72	-	-	-	23.2
Socio-economic Status	Poor	11	-	-	-	3.5
	Struggling	42	-	-	-	13.5
	Stable	206	-	-	-	66.5
	Secure	45	-	-	-	14.5
	Rich	6	-	-	-	1.9
Depression	All	310	4.93	5	1.97	-
Anger	All	310	2.62	3	1.14	-
Mania	All	310	4.5	4	1.95	-
Anxiety	All	310	7.01	7	2.89	-
Somatic	All	310	4.95	5	2.12	-
Suicidal Ideation	All	310	1.69	1	1.08	-
Psychotic Symptoms	All	310	3.36	2	1.87	-
Sleep	All	310	2.45	2	1.22	-
Memory	All	310	2.1	2	1.17	-
Repetitive Thoughts & Behaviors	All	310	4.4	4	2.12	-
Dissociation	All	310	2.14	2	1.23	-
Personality	All	310	4.41	4	2.2	-
Substance Use	All	310	3.19	2	1.63	-
DSM Total Score	All	310	47.7	44	16.7	-
Schedule of Sexist Events Total	Women only	195	36.3	33	14.2	-
Sexual Degradation & Consequences	Women only	195	17	15	7.34	-
Sexist Discrim. In Distant Relationships	Women only	195	8.26	7	3.75	-
Sexism in Close Relationships	Women only	195	3.9	3	2.16	-
Sexual Discrim. In the Workplace	Women only	195	4.64	3	2.55	-

The final analytic sample included 310 participants with a mean age of 26.3 years (SD = 9.18, median = 23, range: 2–60), of whom 195 (62.9%) were female and 115 (37.1%) were male. The majority identified as Muslim (90.3%), with Christians making up 9.7% of the sample. Most were unmarried (60.6%), while 39.4% reported being married. Regarding place of residence, 52.6% lived in urban (city) settings, and 47.4% in rural (countryside) areas. Completed educational levels were diverse: 4.2% had no formal education, 2.3% had only primary education, 29.0% reported secondary education, 41.3% were university undergraduates, and 23.2% were university graduates. Socio-economic status was largely concentrated in the “stable” category (66.5%), with the remainder identifying as “poor” (3.5%), “struggling” (13.5%), “secure” (14.5%), or “rich” (1.9%).

Descriptive statistics for mental health symptom dimensions and total psychopathology revealed a mean depression score of 4.93 (SD = 1.97, median = 5, range: 2–10), mean anger score of 2.62 (SD = 1.14), mania 4.5 (SD = 1.95), anxiety 7.01 (SD = 2.89), somatic symptoms 4.95 (SD = 2.12), suicidal ideation 1.69 (SD = 1.08), and psychotic symptoms 3.36 (SD = 1.87). Other dimensions included sleep (mean = 2.45, SD = 1.22), memory problems (mean = 2.1, SD = 1.17), repetitive thoughts and behaviors (mean = 4.4, SD = 2.12), dissociation (mean = 2.14, SD = 1.23), personality issues (mean = 4.41, SD = 2.2), and substance use (mean = 3.19, SD = 1.63). The combined DSM total score had a mean of 47.7 (SD = 16.7, median = 44, range: 22–102), reflecting wide variation in overall symptom burden across the sample.

Among women participants (n = 195), the mean total score on the Schedule of Sexist Events was 36.3 (SD = 14.2, median = 33). Subscale means were as follows: sexual degradation and its consequences (mean = 17.0, SD = 7.34, median = 15), sexist discrimination in distant relationships (mean = 8.26, SD = 3.75, median = 7), sexism in close relationships (mean = 3.90, SD = 2.16, median = 3), and sexual discrimination in the workplace (mean = 4.64, SD = 2.55, median = 3). These results indicate considerable variability across dimensions, with the highest scores observed for sexual degradation and its consequences, and the lowest for sexism in close relationships.

Inferential

The use of both non-parametric tests and regression models in the present study is appropriate, as these techniques address different analytical purposes. Non-parametric tests were employed to examine group differences and associations without assuming normality, making them suitable for variables that did not meet parametric assumptions. Regression models, on the other hand, were used to explore predictive relationships and assess the combined effect of multiple variables, providing complementary insights that go beyond bivariate comparisons. This mixed analytical approach ensures a more robust and comprehensive interpretation of the data.

Gender comparisons are presented in Table 2.

Table 2.

Gender comparisons.

Dimension	Group	Mean	Median	SD	U	p Value	Effect size (r)	Significant after Bonferroni correction	Higher in
Depression	Female	5.15	5	2.01	9362	0.014	0.16508	No	-
-	Male	4.56	5	1.86	-	-	-	-	-
Anger	Female	2.78	3	1.16	8866	0.001	0.20932	Yes	Women
-	Male	2.34	2	1.07
Mania	Female	4.32	4	1.92	9574	0.029	0.14613	No	-
-	Male	4.81	4	1.97	-	-	-	-	-
Anxiety	Female	7.41	7	3.05	9003	0.004	0.19706	Yes	Women
-	Male	6.32	6	2.44	-	-	-	-	-
Somatic	Female	5.29	5	2.16	8487	<0.001	0.24308	Yes	Women
-	Male	4.38	4	1.91	-	-	-	-	-
Suicidal	Female	1.68	1	1.1	10651	0.391	0.05012	No	-
-	Male	1.72	1	1.05	-	-	-	-	-
Psychotic	Female	3.33	2	1.89	11051	0.82	0.0144	No	-
-	Male	3.4	2	1.85	-	-	-	-	-
Sleep	Female	2.49	2	1.3	10818	0.593	0.03523	No	-
-	Male	2.37	2	1.06	-	-	-	-	-
Memory	Female	2.13	2	1.25	11159	0.942	0.00477	No	-
-	Male	2.03	2	1.02	-	-	-	-	-
Repetitive thoughts & behaviors	Female	4.32	4	2.14	10406	0.282	0.07197	No	-
-	Male	4.54	4	2.1	-	-	-	-	-
Dissociation	Female	2.22	2	1.26	10143	0.14	0.09543	No	-
-	Male	2	2	1.18	-	-	-	-	-
Personality	Female	4.54	4	2.3	10408	0.284	0.07179	No	-
-	Male	4.19	4	2.01	-	-	-	-	-
Substance	Female	2.94	2	1.47	8582	<0.001	0.2346	Yes	Men
-	Male	3.63	3	1.79	-	-	-	-	-
DSM total	Female	48.61	44	17.87	10620	0.437	0.05284	No	-
-	Male	46.29	44	14.38	-	-	-	-	-

Before Bonferroni correction, women reported significantly higher scores than men on depression (mean = 5.15, SD = 2.01 for women; mean = 4.56, SD = 1.86 for men; U = 9362, p = 0.014), anger (mean = 2.78, SD = 1.16 for women; mean = 2.34, SD = 1.07 for men; U = 8866, p = 0.001), mania (mean = 4.32, SD = 1.92 for women; mean = 4.81, SD = 1.97 for men; U = 9574, p = 0.029), anxiety (mean = 7.41, SD = 3.05 for women; mean = 6.32, SD = 2.44 for men; U = 9003, p = 0.004), and somatic symptoms (mean = 5.29, SD = 2.16 for women; mean = 4.38, SD = 1.91 for men; U = 8487, p < 0.001), while men reported higher substance use scores (mean = 3.63, SD = 1.79 for men; mean = 2.94, SD = 1.47 for women; U = 8582, p < 0.001).

However, after applying the Bonferroni correction (adjusted alpha = 0.004), significant gender differences remained only for anger (p = 0.001), anxiety (p = 0.004), somatic symptoms (p < 0.001)—with women scoring higher in all three—and substance use (p < 0.001), where men scored higher. No other DSM-5-TR symptom domains, including depression, mania, suicidal ideation, psychotic symptoms, sleep, memory, repetitive thoughts and behaviors, dissociation, personality, or total DSM score, showed significant gender differences after correction.

For each symptom dimension with significant gender differences, linear regression models included demographic controls and reported both uncorrected and Bonferroni-adjusted levels of significance for the gender predictor. For somatic symptoms, the model yielded R = 0.246, R² = 0.0606, with gender as a significant predictor before and after Bonferroni correction (estimate = -1.04, SE = 0.26, t = -4.01, p < 0.001; β = -0.49; reference: female). For anger, the linear regression model showed R = 0.235, R² = 0.0552, and gender remained a significant factor both before and after correction (estimate = -0.41, p = 0.004; β = -0.36). For substance use, the model had R = 0.271, R² = 0.0735, and gender significantly predicted higher scores for men both before and after correction (estimate = 0.72, p < 0.001; β = 0.44). In all three models, none of the other demographic variables (age, educational level, socio-economic status, religion, marital status, city/countryside) were significant predictors either before or after Bonferroni correction. Variance inflation factors for these predictors ranged from 1.11 to 2.18, with tolerance values between 0.459 and 0.901, all comfortably within standard cutoffs (VIF < 5, tolerance > 0.20), indicating that multicollinearity was not a concern and that the usual collinearity assumptions for multiple regression were satisfactorily met in this analysis.

Among women (n=195), the associations between the Schedule of Sexist Events (total score) and each DSM-5-TR symptom domain among women were assessed using Spearman correlations, both before and after Bonferroni correction (adjusted alpha = 0.003). All investigated associations were statistically significant prior to correction, and every association remained significant following Bonferroni adjustment. The strongest correlations were with depression (r = 0.484, p < 0.001) and the total DSM score (r = 0.488, p < 0.001). These results are presented in Table 3.

Table 3.

Spearman correlations with schedule of sexist events.

DSM-5-TR symptom domain	Spearman r	p Value	Significant before Bonferroni	Significant after Bonferroni
Depression	0.484	<0.001	Yes	Yes
Anger	0.312	<0.001	Yes	Yes
Mania	0.335	<0.001	Yes	Yes
Anxiety	0.406	<0.001	Yes	Yes
Somatic	0.399	<0.001	Yes	Yes
Suicidal	0.326	<0.001	Yes	Yes
Psychotic	0.294	<0.001	Yes	Yes
Sleep	0.457	<0.001	Yes	Yes
Memory	0.281	<0.001	Yes	Yes
Repetitive Thoughts/Behaviors	0.351	<0.001	Yes	Yes
Dissociation	0.399	<0.001	Yes	Yes
Personality	0.375	<0.001	Yes	Yes
Substance Use	0.308	<0.001	Yes	Yes
DSM Total	0.488	<0.001	Yes	Yes

For the women-only analyses (n=195), a multivariate linear regression was conducted to predict total DSM-5-TR symptom score, producing R = 0.554 and R² = 0.307. The model is presented in Table 4. When all SSE dimensions and demographic variables were included as predictors, both sexual degradation and its consequences (estimate = 0.90, p < 0.001, β = 0.37) and sexism in close relationships (estimate = 2.05, p = 0.004, β = 0.25) were significant predictors of total DSM score, both before and after Bonferroni correction (adjusted alpha = 0.005). Other SSE dimensions and demographic factors did not retain significance after Bonferroni adjustment. The model explained approximately 31% of the variance in total DSM symptom score among women. Variance inflation factors for all predictors ranged from approximately 1.16 to 2.62, with corresponding tolerance values between about 0.38 and 0.87, which are well within commonly accepted thresholds (VIF < 5, tolerance > 0.20), indicating that the collinearity assumptions for multiple regression were adequately met in this model.

Table 4.

Linear regression. Outcome variable: Total DSM-5-TR symptom score.

Predictor	Estimate	P	β	Significant before Bonferroni	VIF	Tolerance
Sexual Degradation & Consequences	0.90	<0.001	0.37	Yes*	2.23	0.448
Sexist Discrim. in Distant Relationships	-0.76	0.11	-0.16	No	2.62	0.382
Sexism in Close Relationships	2.05	0.004	0.25	Yes*	1.91	0.523
Sexual Discrim. in the Workplace	0.62	0.321	0.09	No	2.11	0.475
Age	0.03	0.905	0.01	No	2.43	0.411
Educational Level	-0.24	0.85	-0.01	No	1.47	0.679
Socio-economic Level	-2.45	0.242	-0.08	No	1.16	0.866
Religion (Islam–Christian)	3.93	0.383	0.22	No	1.42	0.704
Married/Non-married	-4.01	0.254	-0.22	No	2.18	0.458
City/Countryside	1.83	0.466	0.10	No	1.31	0.764

*Significant after Bonferroni correction.

Discussion

The demographic profile of the study sample offers a meaningful cross-section of contemporary Egyptian society, characterized by a majority of female participants and a relatively young mean age. This distribution closely mirrors demographic patterns in large Egyptian cities,³¹ where women and younger adults are more likely to participate in research, especially in the context of higher education and urbanization. The socioeconomic and educational levels reflect an upward trend in access to education, with most participants reporting secondary or university education—contrasting with older national statistics that documented lower educational attainment.³² Moreover, the religious and marital composition aligns with national census data, while the near-even urban-rural split ensures that mental health findings remain broadly representative of both city and countryside dwellers in Egypt.

In terms of mental health, the sample exhibits notably high symptom scores for depression, anxiety, and somatic complaints, consistent with findings from recent Egyptian and regional mental health surveys.³³ These patterns reflect a substantial burden of psychological distress and echo well-established trends in Middle Eastern populations, where emotional issues frequently manifest as physical symptoms, perhaps amplified by the sociocultural stigma surrounding mental disorders.³⁴ The use of a comprehensive cross-cutting DSM-5-TR symptom measure offers a nuanced understanding, capturing not only diagnosable disorders but also subclinical distress—a critical perspective in a context where mental health needs often remain unaddressed.

For women, the distribution of sexist experiences as measured by SSE indicates both a high overall burden and considerable variability across different domains of sexism. The highest scores were observed for sexual degradation and its consequences, which aligns with global literature showing that direct, interpersonal discrimination has the greatest psychological impact.³⁵ The variability across subscales, with lower scores reported for workplace and close-relationship sexism, may reflect differences in public versus private discrimination, or shifting gender norms in contemporary Egyptian society.³⁶ These findings underscore the urgency of addressing both overt and subtle forms of gender-based adversities to improve mental health outcomes for women.

The observed gender differences in mental health symptom dimensions in Egypt—particularly the persistence of higher anger, anxiety, and somatic symptoms among women even after strict statistical correction—must be interpreted in light of feminist theory and the lived realities of women in patriarchal societies.^37–39 Feminist scholarship establishes that the chronic exposure to gender-based discrimination, legal inequity, and social surveillance systematically increases women’s vulnerability to internalizing problems, including anxiety and psychosomatic distress. Within Egypt, deeply entrenched norms and frequent exposure to harassment and sexism may amplify these effects even further, as evidenced by the consistently elevated scores among women, not only in the present study but in numerous reports across the Arab region.⁴⁰

The robust gender gap in somatic symptoms among Egyptian women reflects classic theories of somatization in response to psychosocial suffering.^41,42 In cultures with high stigma around mental illness—especially for women—emotional pain is often redirected into bodily complaints, because this is more socially legitimate and elicits less censure.^43,44 The prevalence of somatic manifestations among women in the present study supports the notion that restrictive gender roles do not merely shape how distress is experienced but also how it is communicated to others. These findings echo other Arab world investigations, affirming that somatic complaints can mask the presence of significant emotional distress in women.^45,46

Similarly, the higher anxiety levels among women can be linked to role strain and chronic vigilance necessitated by unsafe public spaces and gendered expectations, as it is still a recurrent issue in Egyptian society.^47,48 Feminist theories highlight that women’s psychological distress often originates from power imbalances, threats to bodily autonomy, and the “double burden” of domestic and public responsibilities.^49–51 Recent research from Arab countries has found that women consistently report more anxiety than men, a pattern the current Egyptian data reinforce.^52,53 This regional consistency, despite local differences, testifies to the powerful influence of gendered oppression on women’s emotional well-being.

The finding that anger scores are significantly higher among women in Egypt stands in contrast to Western assumptions of male-typical emotionality^54,55 but fits within a feminist theoretical culture-clash perspective. In patriarchal societies, overt expressions of female anger are discouraged; thus, women’s anger may become internalized or expressed indirectly,⁵⁶ contributing to broader symptom loads. Egyptian women, facing persistent inequality and lack of systemic redress,^57,58 may experience anger as a natural and justified reaction—one that is forced underground due to social sanction but that nonetheless contributes to their overall psychological distress.

Egyptian women’s documented higher emotional symptom burden is further contextualized by social determinants—legal, economic, and familial—unique to their environment. Gendered violence, employment discrimination, limited autonomy, and legal constraints are not only sources of chronic stress but also reinforce each other,^59–61 deepening psychological vulnerability over time. Research from Saudi Arabia, Oman, and Palestine demonstrates that such disadvantage is directly linked to adverse mental health, with role conflict, family obligation, and harassment correlating with both depressive and anxiety symptoms.^62,63

It is significant that, after robust correction, depression scores no longer show gender differences in this sample, despite a global literature that identifies women as more likely to experience depression.^64,65 Some regional studies in Kuwait and a national survey in Egypt have documented greater female vulnerability to depression,⁶⁶ while others report gender convergence—suggesting that, locally, shifting gender roles, underreporting by men, or measurement issues may conceal gendered distress.

Instead, the gendered pattern that emerges highlights how internalizing distress may be diverted from classic depressive symptoms into anger, anxiety, and physical complaints—all domains where Egyptian women are at clear disadvantage. This pattern resonates with Pearlin’s stress-process theory, which holds that, for marginalized groups, distress is shaped by cumulative adversity and by coping resources that are often depleted by the very structures that create risk.^67,68 Within this model, Egyptian women’s daily exposure to microaggressions, discrimination, and constrained life choices is not simply a private affliction, but an artifact of entrenched institutional power.

The striking difference in substance use, with higher scores among men, may at first glance seem less relevant to women’s mental health. However, the gap itself—reinforced by legal, cultural, and social deterrents to women’s public consumption or even disclosure of substance use—serves as a further index of the asymmetrical regulation of male and female behavior in Egypt. Research by Alodhayani et al. and retrospective work in Egypt confirm that substance use is especially taboo for women in Arab societies.^69,70 Thus, lower reported rates among women may not denote less distress, but rather the role of stigma in shaping the acceptability of coping behaviors.⁷¹

Demographically, the absence of significant predictive power for age, education, socioeconomic status, religion, or marital status in the linear regression models signals the overarching importance of gender itself as a structuring force for women’s mental health. This supports intersectional feminist assertions that, in highly gender-stratified societies, psychosocial outcomes cannot be adequately explained without full recognition of gender as a foundational analytic category.^72–75

Comparisons with other Arab countries further reinforce the generalizability of these patterns. In Qatar, Saudi Arabia, and Lebanon, recent studies have found that women universally express greater emotional distress, higher somatic symptom reporting, and more frequent anxiety complaints—even after controlling for education, age, and social status.⁷⁶ This suggests that the gendered mental health gap in Egypt is not an anomaly but rather indicative of regional sociocultural dynamics.

From the standpoint of policy and prevention, these findings necessitate gender-sensitive approaches. Adaptation of services to recognize and destigmatize women’s emotional and somatic complaints is a priority in Egypt and across the Middle East. Further, feminist intervention frameworks emphasize the need for not only individual, but also collective, structural solutions—targeting the social roots of gender inequality that drive women’s distress.

Practice implications also stem from these findings: clinicians and mental health workers should be cued to the fact that Egyptian women, even when presenting with physical complaints or non-specific anger, may be manifesting symptoms of underlying, gendered psychosocial adversity. Interventions that legitimize women’s psychological pain, disrupt isolation, and provide avenues for addressing anger safely and collectively align with feminist therapeutic approaches.

The patterns of help-seeking behavior reflected in recent Egyptian and regional studies reinforce the importance of reducing stigma and creating supportive environments for women to seek care.^77,78 A study found that Egyptian women are generally more likely to pursue help for emotional symptoms, while men’s distress often remains hidden—a trend mirrored in the present analysis, where men’s symptoms apart from substance use are less marked.⁷⁹

These findings are best understood as a reflection of how Egyptian women, shaped by intersecting structural disadvantages, experience and articulate distress. Gender emerges not only as a risk factor, but as the defining social determinant of mental well-being in this setting—a reality borne out by both the present research and comparative studies throughout the Arab world.

A growing body of research demonstrates a robust association between experiences of sexist events and elevated mental health symptomatology among women,^80–82 and the present study of Egyptian women provides strong and direct evidence for this link. The use of the SSE allowed for a nuanced investigation of the ways in which varied forms of sexism—including sexual degradation, discrimination in both distant and close relationships, and workplace sexism—are linked to a spectrum of mental health outcomes. This is particularly important in the Egyptian context, where patriarchal gender norms, public harassment, and institutionalized discrimination are commonly documented stressors for women.

The results show that, among Egyptian women, higher SSE scores were significantly associated with greater severity across all measured DSM-5-TR mental health symptom dimensions, including depression, anxiety, anger, somatic symptoms, and substance use, even after stringent Bonferroni correction. Notably, the strongest associations were observed between SSE scores and both overall psychopathology (DSM-5-TR total score) and depression, suggesting that the aggregate burden of sexist experiences is a powerful predictor of women’s global mental health status. This finding is echoed by international research demonstrating that sexist discrimination is among the most salient psychosocial risk factors for women’s depression and general psychological distress.^83,84

Beyond bivariate associations, the results of multivariate linear regression analysis reinforce the centrality of sexism’s impact. When all SSE subscales and demographic features were entered simultaneously, two facets of sexism—sexual degradation and its consequences, and sexism in close relationships—emerged as especially potent predictors of mental health symptom burden. The effect sizes (β = 0.37 and β = 0.25, respectively) and the proportion of variance explained (R² = 0.307) are substantial for a social science model, highlighting not only the direct impact of sexism but also its potential to overshadow other demographic influences such as age, socioeconomic status, or marital status.

These results align with feminist theories, which posit that repeated experiences of sexism—both overt and subtle—constitute a form of chronic psychosocial stress that “gets under the skin,” dysregulating emotional and physiological processes and eroding protective coping resources over time.^85–87 Feminist scholars have further argued that, in environments where sexist behaviors are normalized or dismissed, women’s attempts to resist, confront, or process discrimination are often stymied, resulting in heightened vulnerability to internalizing disorders.^88–90

It is significant that the subscales related to sexual degradation and close-relationship sexism had stronger predictive value than more distal or work-based discrimination. This may reflect the particular intimacy and frequency of these experiences in daily Egyptian life, and the difficulty of escaping their psychological and social consequences. In patriarchal societies, such as Egypt, sexism is interwoven with familial, romantic, and sexual relationships, meaning that even private domains can be sources of repeated, hard-to-avoid distress.^91,92

The present study also fits within intersectional models of stress and minority health.^93–95 These frameworks posit that, while sexism may be a universal stressor for women, its effects are compounded for those facing intersecting forms of disadvantage—whether related to religion, class, or regional context. Although the Egyptian sample was relatively diverse demographically, it is telling that demographic covariates did not retain significant predictive value once sexist events were accounted for, highlighting the primacy of sexist exposure as a determinant of women’s mental health.

Importantly, the associations documented in this study are not merely statistical artifacts; they translate into real-life psychological suffering and functional impairment. Some research suggests that the chronicity and unpredictability of sexist encounters create a climate of social danger that can promote hypervigilance, rumination, and persistent stress arousal—known contributors to anxiety, depression, and somatic complaints,^96–101 as found in the present sample.

From a public health perspective, these associations underscore the urgent need for interventions that not only target women’s individual resilience, but also address the structural and cultural roots of sexism in Egypt. Evidence from intervention studies and advocacy organizations suggests that efforts to make workplaces, schools, and public spaces safer and more gender-equitable can produce significant downstream benefits for women’s mental health. Furthermore, culturally tailored clinical and community approaches are needed to help women process and recover from the psychological harms of sexism, especially in patriarchal contexts, such as Egyptian society.

More recent scholarship has broadened the examination of sexism and mental health by employing stress-process, minority-stress, and intersectional frameworks that are not exclusively feminist in orientation. Quantitative, daily-diary, and mixed-methods studies indicate that the psychological impact of sexist experiences is often shaped by co-occurring structural stressors (such as economic hardship or political instability),¹⁰² as well as by individual coping resources and social support. These findings suggest that sexism rarely acts as a simple, isolated risk factor; instead, it operates within a wider web of structural and interpersonal adversity, in which its effects on symptoms can be amplified or buffered by contextual and personal characteristics. Seen in this light, the present results from Egypt are consistent with international evidence of robust associations while also pointing to the importance of situating sexist experiences within broader social and material conditions.

At the same time, several recent investigations explicitly question the assumption that sexism straightforwardly causes poorer mental health, proposing instead bidirectional or more complex pathways in which existing distress, personality traits, or prior victimization may increase vigilance to, or reporting of, discriminatory events.¹⁰³ Longitudinal and experimental designs have begun to test whether changes in sexist exposure predict later changes in symptoms more strongly than the reverse, but results are mixed and do not always support a simple one-way causal model from sexism to psychopathology.¹⁰⁴ These developments underscore the interpretative limits of cross-sectional research like the current study, where even strong and theoretically coherent associations cannot determine temporal ordering or rule out unmeasured third variables. Accordingly, our findings should be read as evidence of robust correlations within this Egyptian sample rather than proof of causality, and they highlight the need for future longitudinal, experimental, and mixed-methods work to clarify when, how, and for whom sexist experiences exert causal effects on women’s mental health.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes any conclusions about temporal ordering or causality between exposure to sexist events and psychopathological symptoms, so the observed associations must be understood as correlational rather than indicative of directional effects. Second, the sampling strategy, which relied on convenience recruitment in urban and university-linked settings in Cairo and surrounding areas, likely underrepresents older, less educated, and more marginalized rural women, limiting the generalizability of the results to Egyptian adults with similar socio-demographic profiles to those in our sample. Third, all data were collected through self-report questionnaires, which are vulnerable to recall bias, social desirability effects, and culturally shaped norms regarding the expression of distress, and may therefore not fully capture the complexity of participants’ lived experiences. In particular, the DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure is a frequency-based self-report scale that provides dimensional scores for broad symptom domains but does not allow for a sufficiently fine-grained, qualitative evaluation of how each psychopathological trait is clinically manifested or meaningfully interpreted in individual women. As a result, our findings cannot substitute for detailed clinical assessment of the forms and meanings of psychological distress associated with sexism; future studies should complement such dimensional self-report tools with clinician-rated instruments, structured diagnostic interviews, and qualitative or mixed-methods approaches to more fully characterize the clinical profiles and subjective experience of sexism-related suffering among Egyptian women.

We also acknowledge that the reliance on urban and university-linked recruitment likely underrepresents older, less educated, and more marginalized rural women, and therefore we interpret our findings as most generalizable to Egyptian women and men who share similar socio-demographic profiles to our sample rather than to the national population as a whole.

Conclusion

This study provides compelling evidence that the psychological well-being of Egyptian women is strongly shaped by their day-to-day exposure to both overt and subtle forms of sexist discrimination. The data show that the lived realities of gender inequality—manifested through harassment, societal control over behavior, and institutional barriers—carry mental health consequences that extend beyond mere discomfort, emerging as heightened risks for anger, anxiety, and somatic symptoms, even after rigorous statistical correction. These patterns highlight the urgent need for greater recognition of women’s unique psychosocial burdens within Egypt’s health and social policy frameworks.

The robustness of associations between the Schedule of Sexist Events scores and broad domains of psychological distress suggests that sexism is not a peripheral stressor, but a central determinant in women’s mental health. Especially notable is the strength of predictive relationships for experiences of sexual degradation and close-relationship sexism, which often occur in private or “intimate” social spaces that are frequently overlooked by public policy and public health initiatives. This underscores the importance of tackling both public and private spheres of discrimination if communities genuinely seek to improve women’s overall mental health outcomes.

Gender comparisons further reveal that while men report higher substance use, it is women who bear an outsized burden of emotional and somatic symptoms. This trend persists even in the absence of significant gender differences in depression, challenging global assumptions and affirming that cultural context and gendered pathways to distress can alter the expression and visibility of psychological suffering. Such findings argue against one-size-fits-all approaches and demand gender-sensitive screening, intervention, and education efforts across Egypt.

At the same time, these patterns must be interpreted in light of the study’s sampling strategy. Because participants were recruited through convenience sampling in universities and public urban spaces in Cairo and its surroundings, the sample may be skewed toward younger, more educated, and predominantly urban respondents, particularly university students. This overrepresentation may have limited the participation of older women, those with lower educational attainment, or those residing in more remote rural areas, which could systematically influence the observed levels of both sexist experiences and psychopathological dimensions. Consequently, the generalizability of the findings to the wider population of Egyptian women is constrained, underscoring the need for future research that relies on probability-based or community-partnered sampling frames capable of capturing a broader spectrum of women’s social locations across Egypt.

The study’s results highlight stark policy implications. Health authorities, lawmakers, and educators in Egyptian society must focus not only on reducing the immediate manifestations of psychological symptoms, but also on dismantling the broader structural and cultural sources of sexism that perpetuate distress. There is a clear need for targeted legislative reforms addressing sexual harassment, workplace discrimination, and legal inequalities, as well as for the expansion of gender-responsive mental health services and training for clinicians in recognizing and legitimizing the impact of gendered adversity.

From a public health standpoint, the findings strongly advocate for integrated community-based interventions that validate women’s experiences, foster supportive peer networks, and reduce the stigma surrounding both mental health and disclosure of adversity. Schools, mosques, and civil society organizations throughout Egypt should be enlisted to shift attitudes and practices on gender roles and relationships, while media campaigns can play an important role in combatting stereotypes and encouraging help-seeking among women of all backgrounds.

The way forward for research involves moving beyond cross-sectional designs toward longitudinal and mixed-methods studies amongst Egyptian women, that can illuminate the causal relationships and trajectories linking sexist experiences to mental health over time. Efforts to oversample rural, low-income, or otherwise marginalized women will be essential for building a truly representative evidence base, while qualitative investigations can provide the kind of context-rich detail needed to inform culturally competent policies and practices.

Ultimately, by centering Egyptian women’s voices, realities, and vulnerabilities, future research and public policy can foster pathways toward both individual and societal resilience. Addressing sexist discrimination as a core determinant of women’s mental health is not only a matter of justice but also a prerequisite for building a healthier, more equitable Egypt. The findings of this study offer a substantive foundation for feminist mental health scholarship and a mandate for evidence-driven, gender-sensitive policy reform in the region.

Footnotes

ORCID iDs

Gabriel Andrade

Dalia Bedewy

Ethical considerations

This study was reviewed and approved by the Institutional Review Board (IRB) of the hosting institution, # M-F-H-20-May. All procedures were carried out in accordance with the ethical standards of the IRB and the Declaration of Helsinki and its amendments.

Consent to participate

Written informed consent was obtained from all individual participants included in the study.

Author contributions

GA, MA, EM and DB all equally contributed in design, data collection, analysis and writing of the article.

Funding

Ajman University supported this research by covering the publication fees.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.*

Use of artificial intelligence

Artificial Intelligence (Perplexity) was used to correct grammatical mistakes and improve the style of some sentences.

References

Elnashar

EL-Dien Ibrahim

EL-Desoky

, et al. Female sexual dysfunction in Lower Egypt. BJOG: An International Journal of Obstetrics & Gynaecology 2007; 114: 201–206. https://doi.org/10.1111/j.1471-0528.2006.01106.x

Miller-Graff

Paulson

Hosny

, et al. Trauma, resilience, and distress in post-revolution Egypt. Psychological Trauma: Theory, Research, Practice, and Policy 2024; 16: 49–56. https://doi.org/10.1037/tra0001239

Hamed

Yousef

. Prevalence, health and social hazards, and attitude toward early marriage in ever-married women, Sohag, Upper Egypt. Journal of Egyptian Public Health Association 2017; DOI: https://doi.org/10.21608/EPX.2018.22044, Epub ahead of print 1.

Younis

. Daughters of the Nile: The Evolution of Feminism in Egypt. Wash & Lee J Civil Rts & Soc Just 2006; 13: 463.

Bier

. Revolutionary Womanhood: Feminisms, Modernity, and the State in Nasser’s Egypt. Stanford University Press, 2011.

Kadry

. Gender and Tahrir Square: contesting the state and imagining a new nation. Women, Culture, and the January 2011 Egyptian Revolution. Routledge, 2017.

Barsoum

. Women, work and family’: Educated women’s employment decisions and social policies in Egypt. Gender, Work & Organization 2019; 26: 895–914. https://doi.org/10.1111/gwao.12285

Hattar-Pollara

Meleis

Nagib

. Multiple Role Stress and Patterns of Coping of Egyptian Women in Clerical Jobs. J Transcult Nurs 2003; 14: 125–133. https://doi.org/10.1177/1043659602250633

Fernea

. Gender, sexuality and patriarchy in modern Egypt. Critique: Critical Middle Eastern Studies. DOI: https://doi.org/10.1080/1066992032000130602. Epub ahead of print 1 October 2003.

10.

Samari

. Education and fertility in Egypt: Mediation by women’s empowerment. SSM - Population Health 2019; 9: 100488. https://doi.org/10.1016/j.ssmph.2019.100488

11.

Barsky

Peekna

Borus

. Somatic Symptom Reporting in Women and Men. Journal of General Internal Medicine 2001; 16: 266–275.

12.

Arneson

. Feminism and Family Justice. Public Affairs Quarterly 1997; 11: 313–330.

13.

Hasan

. The politics of honor: patriarchy, the state and the murder of women in the name of family honor. Journal of Israeli History. DOI: https://doi.org/10.1080/13531040212331295842, Epub ahead of print 1 January 2002.

14.

El-Safty

. Women in Egypt: Islamic Rights Versus Cultural Practice. Sex Roles 2004; 51: 273–281. https://doi.org/10.1023/b:sers.0000046611.31760.04

15.

Douki

Ben Zineb

Nacef

, et al. Women’s mental health in the Muslim world: Cultural, religious, and social issues. Journal of Affective Disorders 2007; 102: 177–189. https://doi.org/10.1016/j.jad.2006.09.027

16.

Okasha

. Mental health in the middle east: An egyptian perspective. Clinical Psychology Review 1999; 19: 917–933. https://doi.org/10.1016/s0272-7358(99)00003-3

17.

Devi

. Women’s health challenges in post-revolutionary Egypt. The Lancet 2013; 381: 1705–1706. https://doi.org/10.1016/s0140-6736(13)61060-0

18.

Ussher

. Women’s mental health: A critique of hetero-patriarchal power and pathologization. The Palgrave handbook of power, gender, and psychology. Springer, 2023, pp. 437–457.

19.

Pearlin

Lieberman

Menaghan

, et al. The stress process. J Health Soc Behav 1981; 22: 337–356.

20.

Landrine

Klonoff

Gibbs

, et al. Physical And Psychiatric Correlates Of Gender Discrimination: An Application of the Schedule of Sexist Events. Psychology of Women Quarterly 1995; 19: 473–492. https://doi.org/10.1111/j.1471-6402.1995.tb00087.x

21.

Klonoff

Landrine

. The Schedule of Sexist Events. Psychology of Women Quarterly 1995; 19: 439–470.

22.

DeBlaere

Moradi

. Structures of the Schedules of Racist and Sexist Events: Confirmatory Factor Analyses of African American Women’s Responses. Psychology of Women Quarterly 2008; 32: 83–94. https://doi.org/10.1111/j.1471-6402.2007.00409.x

23.

Matteson

Moradi

. Examining the Structure of the Schedule of Sexist Events: Replication and Extension. Psychology of Women Quarterly 2005; 29: 47–57. https://doi.org/10.1111/j.0361-6843.2005.00167.x

24.

American Psychiatric Association . DSM-5 self-rated level 1 cross-cutting symptom measure–adult. . American Psychiatric Publishing.

25.

Amn Md

MTS

. The Pocket Guide to the DSM-5-TR^TM Diagnostic Exam. American Psychiatric Pub, 2022.

26.

Narrow

Clarke

Kuramoto

, et al. DSM-5 Field Trials in the United States and Canada, Part III: Development and Reliability Testing of a Cross-Cutting Symptom Assessment for DSM-5. AJP 2013; 170: 71–82. https://doi.org/10.1176/appi.ajp.2012.12071000

27.

Pacheco

JPG

Kieling

Manfro

, et al. How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample. Psychological Medicine 2024; 54: 2732–2743. https://doi.org/10.1017/s0033291724000849

28.

Sedgwick

. Multiple significance tests: the Bonferroni correction. BMJ 2012; 344: e509. https://doi.org/10.1136/bmj.e509

29.

Murray

. Likert data: what to use, parametric or non-parametric? International Journal of Business and Social Science, 4.

30.

Field

Cohen

Struelens

, et al. Strengthening the Reporting of Molecular Epidemiology for Infectious Diseases (STROME-ID): an extension of the STROBE statement. The Lancet Infectious Diseases 2014; 14: 341–352. https://doi.org/10.1016/S1473-3099(13)70324-4

31.

Alkitkat

. Demographic Profile of Egypt. In: Alkitkat

(ed). Egyptian Female Labor Force Participation and the Future of Economic Empowerment. Springer International Publishing, pp. 15–28.

32.

Buckner

. Access to Higher Education in Egypt: Examining Trends by University Sector. Comparative Education Review 2013; 57: 527–552. https://doi.org/10.1086/670665

33.

Okasha

. Mental health in Egypt. Israel Journal of Psychiatry 2005; 42: 116–125.

34.

Mirzai

Nasiri

Naeim

, et al. Advancing mental health in the Middle East: A Paradigm Shift. Asian Journal of Psychiatry 2024; 101: 104220. https://doi.org/10.1016/j.ajp.2024.104220

35.

Rieker

Jankowski

. Sexism and Women’s Psychological Status. Mental Health, Racism And Sexism. Routledge, 1995.

36.

Ghignoni

Pastore

. The gender wage gap in Egypt: public versus private sector. International Journal of Manpower 2023; 44: 1511–1534. https://doi.org/10.1108/ijm-11-2022-0526

37.

Bondi

Burman

. Women and Mental Health A Feminist Review. Fem Rev 2001; 68: 6–33. https://doi.org/10.1080/01417780110042374

38.

Brown Travis

Compton

. Feminism and health in the decade of behavior. Psychology of Women Quarterly 2001; 25: 312–323. https://doi.org/10.1111/1471-6402.00031

39.

Pugliesi

. Women and mental health: Two traditions of feminist research. Women & Health 1992; 19: 43–68. https://doi.org/10.1300/J013v19n02_03

40.

Hamdan

. Mental Health Needs of Arab Women. Health Care for Women International 2009; 30: 593–611. https://doi.org/10.1080/07399330902928808

41.

Somatization

. Theories and Research. The Journal of Nervous and Mental Disease 1990; 178: 150.

42.

Mai

. Somatization Disorder: A Practical Review. Can J Psychiatry 2004; 49: 652–662. https://doi.org/10.1177/070674370404901002

43.

Ballering

Lucassen

PLBJ

van Tol

, et al. Sex and gender differences in the public stigmatization of persistent somatic symptoms: a systematic review. Social Science & Medicine 2025; 382: 118232. https://doi.org/10.1016/j.socscimed.2025.118232

44.

Lucassen

van der Linden

, et al. Stigma perceived by patients with functional somatic syndromes and its effect on health outcomes – A systematic review. Journal of Psychosomatic Research 2022; 154: 110715. https://doi.org/10.1016/j.jpsychores.2021.110715

45.

Al-Krenawi

Graham

. Somatization Among Bedouin-Arab Women: Differentiated by Marital Status. Journal of Divorce & Remarriage 2004; 42: 131–143. https://doi.org/10.1300/j087v42n01_06

46.

Okasha

. Somatoform Disorders—An Arab Perspective. In: Ono

Janca

Asai

, et al.(eds). Somatoform Disorders. Springer Japan, 1999, pp. 38–46.

47.

Brink

. The Effect of Emigration of Husbands of Husbands on the Status of their Wives: An Egyptian Case. International Journal of Middle East Studies 1991; 23: 201–211. https://doi.org/10.1017/s002074380005604x

48.

Henry

. Egyptian women and empowerment: A cultural perspective. Women’s Studies International Forum 2011; 34: 251–259. https://doi.org/10.1016/j.wsif.2011.03.001

49.

Brown

. Discomforts of the powerless: Feminist constructions of distress. Constructions of disorder: Meaning-making frameworks for psychotherapy. American Psychological Association, 2000, pp. 287–308.

50.

Dubriwny

. The vulnerable empowered woman: Feminism, postfeminism, and women’s health. Rutgers University Press, 2012.

51.

Tseris

. Placing women’s mental health in context: The value of a feminist paradigm. Australian journal of general practice 2023; 52: 449–453. https://doi.org/10.31128/AJGP-02-23-6715

52.

Alansari

. Gender Differences In Depression Among Undergraduates From Seventeen Islamic Countries. Social Behavior and Personality: an international journal 2006; 34: 729–738. https://doi.org/10.2224/sbp.2006.34.6.729

53.

Obermeyer

Bott

Sassine

. Arab Adolescents: Health, Gender, and Social Context. Journal of Adolescent Health 2015; 57: 252–262. https://doi.org/10.1016/j.jadohealth.2015.01.002

54.

Norlander

Eckhardt

. Anger, hostility, and male perpetrators of intimate partner violence: A meta-analytic review. Clinical Psychology Review 2005; 25: 119–152. https://doi.org/10.1016/j.cpr.2004.10.001

55.

Winkler

Pjrek

Kasper

. Anger Attacks in Depression – Evidence for a Male Depressive Syndrome. Psychother Psychosom 2005; 74: 303–307. https://doi.org/10.1159/000086321

56.

Kővári

. RAGE-Glossary to a Woman’s Anger: Investigation into the Anger of Women in an Patriarchal Society.

57.

Kira

Shuwiekh

Kucharska

, et al. The dynamics underlying the negative mental health effects of gender discrimination in two samples: Poland and Egypt. Curr Psychol 2020; 39: 74–88. https://doi.org/10.1007/s12144-017-9730-5

58.

Said

Majbouri

Barsoum

. Sticky Floors and Glass Ceilings: Gender Wage Gap in Egypt. Feminist Economics 2022; 28: 137–165. https://doi.org/10.1080/13545701.2022.2078499

59.

Foster

Dion

. Dispositional Hardiness and Women’s Well-Being Relating to Gender Discrimination: the Role of Minimization. Psychology of Women Quarterly 2003; 27: 197–208. https://doi.org/10.1111/1471-6402.00099

60.

Khaled

Tsofliou

Hundley

, et al. Perceived stress and diet quality in women of reproductive age: a systematic review and meta-analysis. Nutr J 2020; 19: 92. https://doi.org/10.1186/s12937-020-00609-w

61.

Lundberg

. Influence of paid and unpaid work on psychophysiological stress responses of men and women. Journal of Occupational Health Psychology 1996; 1: 117–130. https://doi.org/10.1037//1076-8998.1.2.117

62.

Alansari

. Internal Consistency Of An Arabic Adaptation Of The Beck Depression Inventory-II With College Students In Eighteen Arab Countries. Social Behavior and Personality: an international journal 2006; 34: 425–430. https://doi.org/10.2224/sbp.2006.34.4.425

63.

Dalgard

Dowrick

Lehtinen

, et al. Negative life events, social support and gender difference in depression. Soc Psychiat Epidemiol 2006; 41: 444–451. https://doi.org/10.1007/s00127-006-0051-5

64.

Parker

Brotchie

. Gender differences in depression. International Review of Psychiatry 2010; 22: 429–436. https://doi.org/10.3109/09540261.2010.492391

65.

Piccinelli

Wilkinson

. Gender differences in depression: Critical review. The British Journal of Psychiatry 2000; 177: 486–492. https://doi.org/10.1192/bjp.177.6.486

66.

Ghanem

Gadallah

Meky

, et al. National survey of prevalence of mental disorders in Egypt: preliminary survey. East Mediterr Health J 2009; 15: 65–75.

67.

Pearlin

. The Stress Process Revisited. In: Aneshensel

Phelan

(eds). Handbook of the Sociology of Mental Health. Springer US, pp. 395–415.

68.

Pearlin

Bierman

. Current Issues and Future Directions in Research into the Stress Process. In: Aneshensel

Phelan

Bierman

(eds). Handbook of the Sociology of Mental Health. Springer Netherlands, pp. 325–340.

69.

AlMarri

TSK

Oei

TPS

. Alcohol and substance use in the Arabian Gulf region: A review. International Journal of Psychology 2009; 44: 222–233. https://doi.org/10.1080/00207590801888752

70.

El-Sawy

Abdel Hay

Badawy

. Gender differences in risks and pattern of drug abuse in Egypt. Egypt J Neurol Psychiat Neurosurg 2010; 47: 413–418.

71.

Melchior

Hüsing

Grundmann

, et al. Substance Abuse-Related Self-Stigma in Women with Substance Use Disorder and Comorbid Posttraumatic Stress Disorder. Eur Addict Res 2019; 25: 20–29. https://doi.org/10.1159/000496113

72.

Bose

. Intersectionality and Global Gender Inequality. Gender & Society 2012; 26: 67–72. https://doi.org/10.1177/0891243211426722

73.

Few-Demo

Allen

. Gender, Feminist, and Intersectional Perspectives on Families: A Decade in Review. Journal of Marriage and Family 2020; 82: 326–345. https://doi.org/10.1111/jomf.12638

74.

Robinson

. Intersectionality and Gender Theory. In: Risman

Froyum

Scarborough

(eds). Handbook of the Sociology of Gender. Springer International Publishing, pp. 69–80.

75.

Shields

. Gender: An Intersectionality Perspective. Sex Roles 2008; 59: 301–311. https://doi.org/10.1007/s11199-008-9501-8

76.

Ghuloum

. Gender differences in mental health in the Middle East. International Psychiatry 2013; 10: 79–80. https://doi.org/10.1192/s1749367600003982

77.

Abdelaai

. Barriers to help-seeking as perceived by adolescents in Egypt and their relationship to self-reported psychological distress. Barriers to help-seeking and psychological distress in Egyptian adolescents 2025. https://sphere.acg.edu/jspui/handle/123456789/2536 (accessed 1 September 2025).

78.

Al-Krenawi

Graham

Al-Bedah

, et al. Cross-National Comparison of Middle Eastern University Students: Help-Seeking Behaviors, Attitudes Toward Helping Professionals, and Cultural Beliefs About Mental Health Problems. Community Ment Health J 2009; 45: 26–36. https://doi.org/10.1007/s10597-008-9175-2

79.

Baklola

Terra

Elzayat

, et al. Pattern, barriers, and predictors of mental health care utilization among Egyptian undergraduates: a cross-sectional multi-centre study. BMC Psychiatry 2023; 23: 139. https://doi.org/10.1186/s12888-023-04624-z

80.

Borgogna

Aita

. Are sexist beliefs related to mental health problems? The Social Science Journal 2024; 61: 405–419. https://doi.org/10.1080/03623319.2020.1809902

81.

Borrell

Artazcoz

Gil-González

, et al. Determinants of Perceived Sexism and Their Role on the Association of Sexism with Mental Health. Women & Health 2011; 51: 583–603. https://doi.org/10.1080/03630242.2011.608416

82.

Feigt

Domenech Rodríguez

Vázquez

. The impact of gender-based microaggressions and internalized sexism on mental health outcomes: A mother–daughter study. Family Relations 2022; 71: 201–219. https://doi.org/10.1111/fare.12622

83.

Swim

Hyers

Cohen

, et al. Everyday Sexism: Evidence for Its Incidence, Nature, and Psychological Impact From Three Daily Diary Studies. Journal of Social Issues 2001; 57: 31–53. https://doi.org/10.1111/0022-4537.00200

84.

Szymanski

Lewis

. Gendered Racism, Coping, Identity Centrality, and African American College Women’s Psychological Distress. Psychology of Women Quarterly 2016; 40: 229–243. https://doi.org/10.1177/0361684315616113

85.

Eagly

Eaton

Rose

, et al. Feminism and psychology: Analysis of a half-century of research on women and gender. American Psychologist 2012; 67: 211–230. https://doi.org/10.1037/a0027260

86.

Meyerson

. Feeling Stressed and Burned Out: A Feminist Reading and Re-Visioning of Stress-based Emotions Within Medicine and Organization Science. Organization Science 1998; 9: 103–118. https://doi.org/10.1287/orsc.9.1.103

87.

Ussher

. Are We Medicalizing Women’s Misery? A Critical Review of Women’s Higher Rates of Reported Depression. Feminism & Psychology 2010; 20: 9–35. https://doi.org/10.1177/0959353509350213

88.

Hammarström

. Why feminism in public health? Scand J Public Health 1999; 27: 241–244.

89.

Keane

. Feminism and the Complexities of Gender and Health. Australian Feminist Studies 2014; 29: 180–188. https://doi.org/10.1080/08164649.2014.928192

90.

Reverby

. Feminism & Health. Health and History 2002; 4: 5–19.

91.

Inhorn

. Infertility and patriarchy: The cultural politics of gender and family life in Egypt. University of Pennsylvania Press, 1996.

92.

Yount

. Women’s family power and gender preference in Minya, Egypt. Family in the Middle East. Routledge, 2008.

93.

Blosnich

. The intersectionality of minority identities and health. Adult transgender care: An interdisciplinary approach for training mental health professionals, 2017, pp. 30–430.

94.

Everett

Steele

Matthews

, et al. Gender, Race, and Minority Stress Among Sexual Minority Women: An Intersectional Approach. Arch Sex Behav 2019; 48: 1505–1517. https://doi.org/10.1007/s10508-019-1421-x

95.

Sattler

Zeyen

. Intersecting identities, minority stress, and mental health problems in different sexual and ethnic groups. Stigma and Health 2021; 6: 457–466. https://doi.org/10.1037/sah0000340

96.

Barlow

Vickers-Jones

Alba

, et al. Sexism. In: Hutton

Sisko

(eds). Multicultural Responsiveness in Counselling and Psychology: Working with Australian Populations. Springer International Publishing, pp. 125–151.

97.

Buckner

Thomas

Morris

. Sexism and alcohol-related problems among women: The role of social anxiety and coping motivated drinking. The American Journal on Addictions 2024; 33: 641–647. https://doi.org/10.1111/ajad.13573

98.

Cunningham

Saleh

. Structural Stigma, Racism, and Sexism Studies on Substance Use and Mental Health: A Review of Measures and Designs. Alcohol Res 2024; 44: 08. https://doi.org/10.35946/arcr.v44.1.08

99.

Mata-Greve

Torres

. Ethnic discrimination, sexism, and depression among Latinx women: The roles of anxiety sensitivity and expressive suppression. Journal of Latinx Psychology 2020; 8: 317–331. https://doi.org/10.1037/lat0000154

100.

Simionato

. Effects of sexism in the workplace on mental health: a systematic review.

101.

Uzdil

Su Topbaş

. The Relationship Between Internalized Sexism and depression, Anxiety, and Stress in Women: Self-Esteem as the Mediator. Journal of Feminist Family Therapy; 1–20.

102.

Hesse-Biber

. Feminist approaches to mixed methods research. SN Hesse.

103.

Johansson

Magnusson

. Sexual harassment, sexual violence, and mental health outcomes: causal inference with ambiguous exposures. Am J Epidemiol 2025; 194: 2336–2341. https://doi.org/10.1093/aje/kwae390

104.

Paulin

Peristera

Nyberg

. Bi-directional associations between gender-based harassment at work, psychological treatment and depressive symptoms. Front Psychol, 14. DOI: https://doi.org/10.3389/fpsyg.2023.1278570, Epub ahead of print 29 November 2023.