Conditional Impact of Sexual Labels on the Relationship Between Body-Esteem and Depression Among Lesbian-Identified Women in Hong Kong

Background: Considering the association between body-esteem and psychological well-being, the majority of studies have focused on heterosexual females and increasingly on heterosexual males. Nonetheless, little attention has been paid to lesbians especially in Chinese society, where homosexuality remains stigmatized. Similar to the butch-femme dichotomy in Western societies, the most commonly known sexual labels within the Hong Kong Chinese lesbian community are “TB” (tomboy with a masculine gender style) and “TBG” (tomboy’s girlfriend with a feminine gender style). This research tested the conditional moderating effects of lesbian sexual labels, including TB and TBG, on the relationship between body-esteem and depression. 

Methods: The study conducted a cross-sectional online survey in collaboration with community-based LGBT organizations in Hong Kong. Data were collected from a convenience sample of 438 Chinese lesbians in Hong Kong [age range 18-35, M (SD) =24.7 (4.60)]. Measures included: The Body-Esteem Scale (23 items, α=0.91) and the Hospital Anxiety and Depression Scale (7 items, α=0.76). Sexual label variables included TB and TBG, which were indicated by respondents. For data analyses, first, the study used an independent sample t-test to compare the mean differences in body-esteem and depression by sexual labels. Second, conditional process analysis, suggested by Hayes (2013), was conducted to test the interaction effects of body-esteem and sexual labels on depression. Bootstrapping from a conditional analysis provided the significance of interaction effects of body-esteem and sexual labels on depression.

Results: The independent sample t-test showed that lesbian respondents who identified themselves as TB had lower levels of depressive symptoms than a non-TB group. However, there was no significant difference in depression between a TBG group and a non-TBG group. A conditional process analysis produced a significant direct effect of the sexual label, TB, on depression (β=4.52, p<.01) and a significant interaction effect of body-esteem and a sexual label, TB, on depression (β=-2.62, p<.05). Bootstrapping from the conditional analysis showed that for lesbian respondents who identified as a TB, the effect of body-esteem on depression was greater than non-TB lesbians (β= - 3.013, p<0.001). Lesbians who identified themselves as TB with higher body-esteem had lower levels of depression. On the other hand, the direct effect of TBG on depression and the interaction effects of body-esteem and a sexual label, TBG, on depression were not significant.

Conclusions and Implications: Our findings show that Chinese lesbians who identified themselves as TB reported lower levels of depression compared with lesbians who did not embrace this label. Also, the negative association between body-esteem and depression was moderated by the sexual label, TB. Contrary to traditional gender expectations in Chinese society, this research signifies that female masculinity, as expressed by lesbians with the TB label, could function as a protective role in lesbians’ psychological well-being. It sensitizes social workers to different labels and body-esteem among lesbians. Further research is needed to test how one’s sexual label interacts with environmental variables (e.g. life stressors, social support) so as to develop comprehensive theoretical frameworks and interventions aimed at reducing depression among lesbians.