The Mediating Effect of Self-Esteem on the Relationship Between Gender Role and Depression Among Chinese Lesbians in Hong Kong

Background: Studies have generally shown that lesbian, gay, and bisexual individuals are at a higher risk of anxiety, depression, and suicide attempts compared with heterosexuals. Nevertheless, existing research has also recognized that gender role and self-esteem serve as key factors in one’s psychological well-being. Little is known about the ways in which masculinity, femininity, and self-esteem affect the psychological well-being of Chinese lesbians, who are subject to traditional expectations of femininity and remain stigmatized due to their sexual orientation in the Hong Kong Chinese context. This study used a mediation model to test the hypothesis that self-esteem among Chinese lesbians mediated the relationship between gender role and depression. By incorporating masculinity, femininity, and self-esteem into a unified framework, we hope to provide fresh insights into the complex phenomenon of depression among Chinese lesbians in Hong Kong.

Methods: This study used a cross-sectional online survey of lesbian-identified Chinese women in Hong Kong. A convenience sample of 438 lesbians were recruited by e-mail invitations through community-based LGBT organizations [Age range 18-35, M (SD) =24.7 (4.60)]. Measures included: The Bem Sex Role Inventory (20 items: masculinity, α=0.81; 20 items: femininity, α=0.74), the Rosenberg Self-Esteem Scale (10 items, α=0.89), and the Hospital Anxiety and Depression Scale (7 depression items, α=0.76).

Separate mediating effects of masculinity and femininity on depression via self-esteem were tested, followed by the mediation model of gender role (defined as both masculinity and femininity) on depression through self-esteem. The mediation models were tested using the process analyses suggested by Preacher, Rucker, and Hayes (2007). Bootstrapping from a process analysis provided the significance of direct and indirect effects and their effect size.

Results: First, the process analysis showed that self-esteem fully mediated the relationship between masculinity and depression, but it partially mediated the relationship between femininity and depression. Bootstrapping from the process analyses indicated that the indirect mediating effects were significant for both models. Also, the results of the third mediation model of gender role on depression showed that self-esteem significantly mediated the relationship. The direct effect of gender role on depression was reduced from -1.66 to -0.54 when self-esteem was controlled, but still remained significant (partial mediation). Higher levels of gender role (defined by both masculinity and femininity scores) were significantly associated with higher levels of self-esteem and then higher levels of self-esteem were significantly associated with lower levels of depression among lesbians.

Conclusions and Implications: The findings suggested that self-esteem mediated the relationship between gender role and depression among Chinese lesbians. High levels of both masculinity and femininity and self-esteem jointly contributed to the alleviation of depression among Chinese lesbians. Through highlighting gender differences within a single-sex system and investigating the mechanism which shapes lesbians’ psychological well-being, this research enhances social workers’ understanding of the impact of diverse gender roles and self-esteem on the psychological well-being of Chinese lesbians. It helps inform the development of intervention programmes that are sensitive to non-heterosexual women’s self-esteem in relation to their gender and sexual roles.