Gender-Nonconformity, Homophobic Peer Victimization, and Mental Health Among Young Dutch Adolescents
Thesis II
Gabriël van Beusekom, Bsc.
Under supervision of Henny M.W. Bos, PhD Research Master Educational Sciences
University of Amsterdam July 18, 2013
Abstract
Based on a sample of 1,027 Dutch adolescents (boys: n = 517) between the ages of 12- to 16-year-old (Mage=13.36), the current investigation assessed the mediating role of homophobic name-calling in the relation of gender-nonconformity and mental health (self-esteem, social anxiety and psychological problems). It was also examined whether this mediation would be moderated by feelings of same-sex attraction (SSA) and (biological) sex. Data were collected at five secondary schools residing in urban areas in the Netherlands by means of paper–pencil questionnaires. Results showed that adolescents with high levels of gender-nonconformity were more often targeted by their peers with homophobic names, had less self-esteem, more social anxiety, and more psychological problems than their peers with low levels of gender-nonconformity. Exposure to homophobic name-calling accounted partly for the increased levels of social anxiety and psychological problems among youth who scored high on gender-nonconformity. These partial mediations were found to hold stronger for same-sex attracted youth and boys. Homophobic name-calling was not found to mediate the relation between gender-nonconformity and self-esteem.
Gender-Nonconformity, Homophobic Peer Victimization and Mental Health Among Young Dutch Adolescents
With the onset of adolescence, gender role adherence becomes more salient and youth face increased pressure to conform to stereotypical gender norms (Alfieri, Ruble, & Higgins, 1996; Eder, Evans & Parker, 1995). Gender-nonconformity refers to a gender expression or gender-identity that is more strongly related to the opposite sex (Bailey & Zucker, 1995; Lippa, 2000, 2002). Studies have shown that adolescents with high levels of gender-nonconformity are more likely to be excluded, to be bullied or picked on, and to be called names by their peers than adolescents who adhere more to stereotypical notions of their gender (Aspenlieder, Buchanan, McDougall, & Sippola, 2009; Ewing Lee & Troop-Gordon 2011; Young & Sweeting 2004).
Previous research showed that same-sex attraction (SSA) is related to gender-nonconformity (Bailey & Zucker, 1995; Rieger, Linsenmeier, Gygax, & Bailey, 2008; Steensma, Van Der Ende, Verhulst, & Cohen-Kettenis, 2012). It should be mentioned, however, that these studies do not indicate that all individuals with SSA are
gender-nonconforming, nor that gender-nonconformity is absent among individuals without SSA. Nonetheless, gender-nonconforming individuals are more often perceived by others as gay or lesbian, while gender-conforming individuals are perceived by others as heterosexual
(Johnson & Ghavami, 2011; Valentova, Rieger, Havlicek, Linsenmeier, & Bailey, 2011). It has been suggested that the tendency to perceive gender-nonconforming individuals as gay or lesbian may account for the increased risk of peer victimization among
nonconforming youth (Aspenlieder, et al., 2009). Indeed, the peer victimization gender-nonconforming youth are confronted often includes elements of homophobia (Pascoe, 2007; Plummer, 2001; Wyss, 2004). For example, adolescents use homophobic epithets, such as 'faggot', to label non-conforming gender expressions in a boy whose mannerisms are
considered ´effeminate´ (Plummer, 2001). Moreover, studies among same-sex attracted youth have found that gender-nonconformity increases same-sex attracted youths’ exposure to homophobic peer victimization (D’Augelli, Grossman, & Starks, 2006; Toomey, Ryan, Diaz, Card, & Russell, 2010). To illustrate, same-sex attracted adolescents with high levels of gender-nonconformity were more often targeted with verbal victimization due to their sexual orientation (asked as, “because you’re lesbian, gay or bisexual’’) than same-sex attracted youth with low levels of gender-nonconformity (D’Augelli et al. 2006).
Studies among adolescents also indicate that gender-nonconformity is related to poor mental health, including lower levels of self-esteem, more post-traumatic stress symptoms and more psychological distress (Smith & Leaper, 2006; Rosario, Slopen, Calzo, & Austin, 2013; Collier, Bos, & Sandfort 2013). A greater exposure to homophobic peer victimization may account for these elevated levels of mental health problems among youth that are more gender-nonconforming, as opposed to those who are more gender-conforming. Support for this hypothesis comes mostly from studies with same-sex attracted participants. It has been shown, for instance, that experiences with homophobic peer victimization mediated the relation between gender-nonconformity and lower well-being among samples of same-sex attracted youth and adults (Baams, Beek, Hille, Zevenbergen, & Bos, 2013; Sandfort, Melendez, & Diaz, 2007; Toomey, et al., 2010).
Relatively few studies have assessed differences between youth with and without SSA in the associations of gender-nonconformity with homophobic peer victimization and mental health. Their results indicate that the combination of SSA and gender-nonconformity is not associated with increased risk for homophobic peer victimization (Van Beusekom,
Roodenburg, & Bos, 2012) and mental health problems (Rieger & Savin-Willams, 2010; Roberts, Rosario, Slopen, Calzo, & Austin, 2012; Roberts et al. 2013) than SSA and gender-nonconformity by itself. For example, in a Dutch study among 1205 secondary school
students, gender-nonconformity was found to be associated with increased exposure to homophobic name-calling by peers (e.g., “fag” or “dyke”), and these associations were not different for youth with and without SSA (Van Beusekom et al., 2012). Similar findings by Rieger and Williams (2012), showed that childhood gender-nonconformity (measured by retrospectively assessing behaviors and feelings) and present gender-nonconformity (defined as current interest in typically male- and female- hobbies and activities, for girls and boys, respectively) were better predictors of the well-being of youth than sexual orientation, which was not significantly related to any of the studied measures of well-being.
Further understanding of this issue is offered by an 11-year longitudinal study
(Roberts, et al., 2012) with a population-based cohort of 10,655 participants (ages 11 to 16 at wave 1). The authors found that, irrespective of sexual orientation differences, greater gender-nonconformity before the age of 11 was associated with increased risk of depressive symptoms across adolescence and early adulthood. It was also found that peer victimization accounted for the increased risk for depressive symptoms among youth with high levels of gender-nonconformity. Although Roberts and colleagues (2012) did not assess whether the peer victimization included homophobic elements, their findings might suggest that
experiences with homophobic peer victimization would also mediate the relation between gender-nonconformity and mental health for youth without SSA, in a similar manner as it would for same-sex attracted youth.
Studies that explored for sex differences in the associations of gender-nonconformity with homophobic peer victimization and mental health have found stronger associations for boys as compared to girls (D’Augelli, et al., 2006, Ewing Lee & Troop-Gordon, 2011; Roberts, et al., 2013; Young & Sweeting, 2004). For instance, Young and Sweeting (2004) reported in their study of 15-year-olds that, especially among boys, gender non-conformity was related with more peer victimization, more lonesomeness, and lower levels of
psychological well-being. In addition, a study among same-sex attracted adolescents also found that boys with SSA experience more negative rejections due to their
gender-nonconformity than girls with SSA (D’Augelli, et al., 2006). However, research among same-sex attracted youth and adult participants found no support for a sex difference in the mediating role of homophobic peer victimization in the relation between
gender-nonconformity and mental health (Baams, et al., 2012; Toomey et al., 2010). It might be that the sample sizes of these studies were too small (192, and 245 participants, respectively) to assess the accumulated risk for male participants that are gender-nonconforming.
The present study
Homophobic peer victimization has been identified as a mediator of the relation between gender-nonconformity and mental health in samples of same-sex attracted youth and adult participants (e.g., Baams et al., 2012). It remains unclear, however, whether this
mediation is the same for same-sex attracted youth and youth without same-sex attracted feelings. Previous studies found no support for a sex difference in the relation between
gender-nonconformity and mental health through homophobic peer victimization (e.g., Baams et al., 2012). The sample sizes of these studies may have been too small to assess possible differences regarding the sexes of participants. In the current study, we investigate whether homophobic peer victimization mediates the relation between gender-nonconformity and mental health among adolescents in general. We also examine whether this hypothesized mediation is moderated by SSA (SSA versus opposite attraction) and (biological) sex. Figure 1 presents the hypothesized moderated mediation model.
_________________________ Insert Figure 1 about here _________________________
Method Participants
Participants in this study were 1,027 secondary school students (boys: n = 517) from the Netherlands. The mean age of participants was 13.36 (SD = 0.93) and ranged from 12 to 16 years. Participants attended secondary education at various levels: 20.1% attended vocational secondary education, 27.4 % senior general secondary education, and 52.5% pre-university education. In total 92.5% of the participants reported their parents had a Dutch or Western ethnic background and 7.5% of the participants reported that either their father or mother were from a Western ethnic background. Two most common reported non-Western ethnic backgrounds for mothers were Poland (6.5%) and Irak (5.2%), and for fathers these were Indonesia (5.2%) and Irak (5.2%)
Procedure
Data for this study were collected in the school year 2011 – 2012 at five different secondary schools from urban areas in the Netherlands. In the five participating schools, first-, second-first-, and third-year students were eligible to participate.
Before data collection started, the board of each school sent a letter to all parents containing information about the date, purpose, and subject of the study. The letter explained to parents that their children would be asked questions about their SSA,
gender-nonconformity, experiences with peers, and mental health status. The letter also informed parents that their children’s participation was voluntary. Parents were asked to contact the researchers if they did not want their children to participate. Fourteen parents did not allow their children to participate.
At each participating school research assistants explained to the students the subject of the study, the voluntary nature and confidentiality of their participation, and informed
students that their individual responses would not be shared with their teachers, parents, or other students. None of the students declined to participate.
Data were obtained by means of paper-pencil questionnaires, which were distributed by research assistants during class. The questionnaires were filled out in an exam setting so students could not read each other’s answers. Students that were not given permission by their parents to participate remained in class and were asked to work in private on their school assignments. The University of Amsterdam’s institutional review board has approved of the study design and protocol.
Measurement
nonconformity. An adjusted version of the Childhood
Gender-nonconformity Scale was used to assess adolescents’ current as opposed to childhood gender-nonconformity (Collier, et al., 2013; for original version see Rieger, et al.,2008). The scale consists of 5 separate items for boys and girls (e.g., for boys: “I often feel that I have more in common with girls than boys”; and for girls: “I often feel that I have more in common with boys than girls”). Responses were rated on a 7-point Likert scale (1= absolutely not true of me to 7= always true of me). Cronbach’s alpha was .68.
Homophobic Name-Calling. In the current study experiences with homophobic peer victimization has been operationalized as experiences with homophobic name-calling. A modified version of the Homophobic Content Target Subscale was used to assess participants’ experiences with being called with homophobic epithets by their peers within the past month (Collier, et al., 2013, see for original version Poteat & Espelage, 2005). We presented the following prompt to participants. “Some youth call each other names such as ‘fag’, ‘gay’, ‘lesbo’ or ‘dyke’. How many times in the past month were you called these names?”. Using a 5-point Likert scale (1 = never; 5 = seven times or more), participants indicated whether they were called names by (1) a friend; (2) a class member (3) a fellow student from a
different class; (4) someone at your school you do not know; (5) someone you do not like. Cronbach’s alpha was .81
Mental health. Participants’ self-esteem was measured with the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1979). The RSES was originally developed to assess global self-esteem among adults, but has been validated among adolescents (Hagborg, 1993;
Phillips, Spears, Montgomery, Millings, Sayal, & Stallard, 2013; Rosenberg, 1989). The scale consists of 10 items (e.g., “I am just as good as anybody else”). Response options ranged on a 4-point Likert scale (1= not true of me and 4= very true of me). Chronbach’s alpha’s was .86.
A shortened version of the Social Interaction Anxiety Scale (for original version see Mattick & Clarke, 1998) was used to assess participants’ anxiety in situations involving social interactions with others. The scale consists of 10 items on which participants rated how anxious they felt in social situations (e.g., “I get nervous when I need to speak with someone in authority”). One item that asked participants to indicate the extent to which they felt nervous when they need to speak with “attractive members of the opposite sex,” was changed to “with attractive persons.” Response options ranged on a 5-point Likert scale: 1= not true of me to 5= very true of me. Cronbach’s alpha was .89
Psychological problems were assessed with a shortened version of the Brief Symptom Inventory (Sandfort, Bos, Collier, & Metselaar, 2010; for the original version, see Derogatis, 1993). Using a 5-point Likert scale (1= not at all to 5 = extremely), participants were asked to rate the occurrence of 24 symptoms in the past week (e.g., “Having difficulty making
decisions”). Chronbach’s alpha was .93.
Same-sex attraction. We measured SSA with the following single item: “Have you ever had romantic and/or sexual feelings for someone of the same sex?” This question has been used successfully in previous research on same-sex attracted youth in the
Netherlands (e.g., Collier, et al., 2013). The item was rated on a 5-point Likert scale ranging from 1= never to 5= very often. Adolescents who answered they never felt feelings of SSA were coded as adolescents without SSA (1). Those who reported SSA sometimes to very often were coded as adolescents with SSA (2).
Demographics. Several demographic characteristics were also assessed. These included, biological sex, ethnic background, age and educational level.
Analyses
The data for this study were collected from students within 5 different schools. It was determined first whether multi-level analysis would be appropriate. Dividing the variance indicated that there was no significant variation across schools in homophobic name-calling scores and mental health scores. The design-effects were all below 2.0 for homophobic name-calling and each mental health outcome. Based on these outcomes it was decided to pursue with ordinary least square analysis.
Prior to testing the hypothesis that homophobic name-calling mediates the association between gender-nonconformity and mental health, it was assessed first whether conditions relevant for mediation analysis were met (Baron & Kenny, 1986). Pearson correlations were conducted to assess significant relations between: (a) the independent variable (gender-nonconformity) and the dependent variables (self-esteem, social anxiety, and psychological problems); (b) the independent variable and the potential mediator (homophobic name-calling); and (c) the potential mediator and the dependent variables.
Subsequently, we carried out bootstrapped mediation analyses, seperatly for each studied mental health variable, to assess the indirect effects of gender-nonconformity on the mental health variables through homophobic name-calling (Hayes, 2012, Preacher & Hayes, 2008). In bootstrapping random samples are generated based on the orginal data (in the current analysis, 10,000 random samples) to obtain bias corrected 95% confidence intervals
(CI’s) for the size of the indirect effects. The obtained confidence intervals were used to infer whether the indirect effects were significant (does not contain the value 0). As recommend by Preacher and Kelly (2011), the Kappa Squared (κ2) statistic was used as a measure of effect size for the indirect effects. This statistic calculates the magnitude of the observed indirect effect in proportion to the maximum indirect effect possible that could be calculated from the data. In addition, κ2 can be interpreted in the same way as squared correlation coefficients to describe mediation effect sizes, with small, medium, and large effect sizes corresponding to values of 0.01, 0.09, and 0.25 respectively (Preacher & Kelly, 2011).
Lastly, bootstrapped moderated-mediation analyses (Hayes, 2012) were carried out to examine whether the mediating role of homophobic name-calling in the relations of gender-nonconformity with mental health, were moderated by SSA (SSA vs. Non-SSA) and biological sex. These analyses were carried out separately for each potential moderator variable and mental health variable. In addition, the potential moderator variables and mental health variables were mean centered in these analyses.
Results Descriptive analyses `
SSA differences. Of the 1,054 participants, 8% reported some degree of SSA. Boys and girls did not differ significantly in the extent to which they reported feelings of SSA (boys: 6%; girls: 9%). Furthermore, no significant differences were found between youth with and without SSA in their age, ethnic background, and educational level. Youth with SSA were found to be more gender-nonconforming (M = 1.84, SD = 0.12) than youth without SSA (M = 1.50, SD = 0.02), F (1,1026) = 19.14, p < .001. Youth with SSA also scored lower on self-esteem (M = 2.86, SD = 0.68) than their peers without SSA (M = 3.17, SD = 0.53), F (1,1026) = 23.60, p < .001. High scores on social anxiety were also more prevalent among youth with SSA (M = 2.14, SD = 0.14) than among youth without SSA (M = 1.84, SD =
0.53), F (1,1026) = 21.63, p < .001. Furthermore, youth with SSA scored higher on psychological problems (M = 2.10, SD = 0.86) than youth without SSA (M = 1.60, SD = 0.54), F (1,1026) = 50.45, p < .001. Same-sex attracted youth also reported more experiences with homophobic name-calling (M = 1.75, SD = 0.99) as opposed to youth without SSA (M = 1.47, SD = 0.69), F (1,1025) = 11.27, p < .001.
Sex differences. There were no significant differences between boys and girls in their age, ethnic background, and educational level. Boys scored lower on gender-nonconformity (M = 1.46, SD = 0.52) than girls did ( M =1.59, SD = 0.73), F (1,1026) = 10.03, p = .002. Higher levels of self-esteem were more common for boys (M = 3.29, SD = 0.49) than for girls (M = 3.00, SD = 0.57), F (1,1026) = 77.62, p < .001. Boys also scored lower on social
anxiety (M = 1.79, SD = 0.52) than girls (M = 1.93, SD = 0.58), F (1,1026) = 19.01, p < .001. Boys also reported less psychological problems (M = 1.52, SD = 0.49) than girls did (M = 1.79, SD = 0.63), F (1,1026) = 59.13, p < .001. Experiences with homophobic name-calling were found to be more present among boys (M = 1.70, SD = 0.82) than among girls (M = 1.27, SD = 0.53), F (1,1025) = 99.99, p < .001.
Gender-nonconformity, homophobic name-calling and mental health
Table 1 presents the intercorrelations of the studied variables along with their means and standard deviations. The results showed that gender-nonconformity was significantly correlated with self-esteem (r(1027) = -.22, p < .001), social anxiety (r(1027) = .30, p < .001) and psychological problems (r(1027) = .30, p < .001). Adolescents who reported higher levels of gender-nonconformity reported lower levels of self-esteem, and higher levels of social anxiety and psychological problems. Furthermore, gender-nonconformity was found to be significantly correlated with homophobic name-calling, r(1026) = .18, p < .001. Those who reported high levels of gender-nonconformity reported higher levels of homophobic name-calling. Lastly, homophobic name-calling was found to be significantly correlated with
self-esteem (r(1026) = -.08, p = .014), social anxiety (r(1026) = .12, p < .001) and
psychological problems (r(1026) = .24, p < .001). Adolescents who reported higher levels of homophobic name-calling reported lower levels of self-esteem, and higher levels of social anxiety and psychological problems.
_________________________ Insert Table 1 about here _________________________
The Mediation of Homophobic Name-Calling on the Relations between Gender-Nonconformity and Mental Health
It has already been demonstrated that the conditions required for testing mediation were met. A set of bootstrapped mediation analyses were carried out, separately for each mental health variable (self-esteem, social anxiety, and psychological problems) to assess the mediating role of homophobic name-calling in the relations of gender-nonconformity with mental health.
Results from the bootstrapped analysis for self-esteem showed a significant direct effect of gender-nonconformity (B = -.17, SE = .03, t = -6.73, p < .001). However, the indirect effect of gender-nonconformity through homophobic name-calling was not significant (B = -.01, SE = .01, 95% bootstrap CI [-.02, .00]), indicating that homophobic name-calling does not mediate the relation between gender-nonconformity and self-esteem.
Furthermore, significant direct effects of gender-nonconformity on social anxiety (B = .24, SE = .03, t = 9.41, p < .001) and psychological problems (B = .22, SE = .03, t = 8.72, p < .001) were found, as well as significant indirect effects of gender-nonconformity through homophobic name-calling (social anxiety: B = .01, SE = .01, 95% bootstrap CI [.00, .03]; psychological problems: B = .03, SE = .01, 95% bootstrap CI [.01, .06]). These results establish homophobic name-calling as a partial mediator of the relations of
gender-nonconformity with social anxiety and psychological problems. The mediation effects were in the expected direction. Higher levels of gender-nonconformity predicted more exposure to homophobic name-calling (B = .20, SE = .03, t = 5.94, p < .001), and a higher exposure to homophobic name-calling predicted more social anxiety (B = .05, SE = .03, t = 2.18, p = .030), and more psychological problems (B = .16, SE = .02, t = 6.70, p < .001). Homophobic name-calling mediated 1% of the relation between gender-nonconformity and social anxiety (κ2= .01, SE = .01, 95% bootstrap CI .[00, .03]) and 4% of the relation between gender-nonconformity and psychological problems (κ2= .04, SE = .01, 95% bootstrap CI [.02, .07]). The Mediation of Homophobic Name-calling on the Relations Between
Gender-Nonconformity and Mental Health, Moderated by SSA and Biological Sex
We assessed whether SSA (SSA vs. opposite attraction) and biological sex were moderators of the relations of gender-nonconformity with social anxiety and psychological problems through homophobic name-calling. Bootstrapped moderation-mediation analyses were carried out, in which gender-nonconformity and the potential moderator variable, as well as the interaction of gender-nonconformity × the potential moderator variable were entered into the model to predict homophobic name-calling (see Tables 2 and 3).
The significant interactions between gender-nonconformity × SSA (B = .34, SE = .09, t = 3.94, p < .001) and gender-nonconformity × biological sex (B = -.25, SE = .06, t = -3.87, p < .001) confirmed moderated mediations. Results showed that the indirect effect of
homophobic-name calling in the relation between gender-nonconformity and social anxiety holds stronger for SSA youth (B = .02, SE = .02, 95% bootstrap CI [.00, .06]) as compared to youth without SSA (B = .01, SE = .00, 95% bootstrap CI [.00, .02]), and also stronger for boys (B = .02, SE = .01, 95% bootstrap CI [.00, .05]) as compared to girls (B = .01, SE = .00, 95% bootstrap CI .[00, .02]).
The indirect effect of homophobic name-calling in the relation between gender-nonconformity and psychological problems was also found to be stronger for SSA youth (B = .07, SE = .03, 95% bootstrap CI [.03, .12]) than youth without SSA (B = .02, SE = .00, 95% bootstrap CI [.01, .03]), and also stronger for boys (B = .06, SE = .02, 95% bootstrap CI [.03, .10]) than girls (B = .02, SE = .01, 95% bootstrap CI [.01, .04]).
_________________________ Insert Table 2 about here _________________________ _________________________
Insert Table 3 about here _________________________
Discussion
The current study has found that adolescents with high levels of gender-nonconformity were more often targeted with homophobic epithets by their peers than adolescents with low levels of gender-nonconformity. In addition, youth who were more gender-nonconforming than their peers also had less self-esteem, more social anxiety, and more psychological problems. Homophobic name-calling by peers was found to partially mediate the relations of gender-nonconformity with psychological problems and social anxiety. These mediations were found to be stronger for same-sex attracted youth and boys.
While previous studies among same-sex attracted youth and adult participants identified homophobic peer victimization as a mediator of the relation between gender-nonconformity and mental health (Baams et al., 2013; Sandfort et al., 2007; Toomey et al., 2010), the current study is one of the first that examined this mediation among adolescents in general. We found that exposure to homophobic name-calling partially explained why youth that are more gender-nonconforming than their peers reported higher levels of social anxiety
and psychological problems. Homophobic name-calling by peers, however, did not mediate the relation between gender-nonconformity and self-esteem. According to Cooley (1956), an important factor for one’s self-esteem is appraisal from significant others. It might be that peers who perpetrate into homophobic victimization do not constitute as significant others for those who are victimized, and that the quality of adolescents’ relations with significant others, such as parents, is better able to explain the relation between gender-nonconformity and self-esteem.
This is also one of the first studies that found the mediating role of homophobic name-calling in the relations of gender-nonconformity with social anxiety and psychological
problems to be stronger for same-sex attracted youth as compared to youth without SSA. A possible explanation for these findings might be that same-sex attracted youth with high levels of gender-nonconformity are more likely to disclose their same-sex attracted feelings to others (Savin-Williams, 2005), which has been described as an important risk factor for peer victimization (D’Augelli et al., 2006; D’Augelli, Pilkington, & Hershberger, 2002; Pilkington & D’Augelli, 1995). In contrast, prior studies did not find any differences between youth with and without SSA in the relations of gender-nonconformity with homophobic peer victimization and mental health (e.g., Van Beusekom et al., 2012; Rieger & Savin-Williams, 2012). These studies, however, are mostly based on youth in their late adolescence. It could be that the combination of SSA and gender-nonconformity is more problematic during the early and middle adolescent years in which youth are more likely to adhere to group norms than during the late adolescent years when youth perceive groups norms as more flexible (Nucci, 2001).
We also found that the mediating role of homophobic name-calling in the relations of gender-nonconformity with social anxiety and psychological problems was stronger for boys than it was for girls. These findings align with previous studies that have indicated that
gender-nonconformity is less socially accepted and associated with more mental health problems in boys/males than in girls/females (D’Augelli, et al., 2006, Ewing Lee & Troop-Gordon, 2011; Roberts, et al., 2013;). Our findings are important, particularly, because previous studies have paid little attention to the role of biological sex in the relation between gender-nonconformity and mental health, through homophobic peer victimization.
The current study is not without its limitations. Of particular concern was the fact that our mediation and moderated-mediation effects were small. This may be due to the fact that this study was carried out in the Netherlands, which has a lower level of gender role
differentiation and a higher level of acceptance of lesbian, gay and bisexual (LGB) people than other Western societies (Hofstede, 1998; Keuzenkamp, 2011; Sandfort, 2005).
The small mediation and moderated-mediation effects could also be a function of how homophobic peer victimization has been operationalized in the current study. We focused on adolescents’ experiences with homophobic name-calling in particular. The inclusion of other indices of homophobic peer victimization, such as physical or relational victimization by peers might have provided a more realistic view of the challenges gender-non-conforming youth experience.
Another limitation concerns how we assessed adolescents’ sexual orientation. Adolescents were questioned about their feelings of SSA and we did not assess other indicators of sexual orientation, such as identification as LGB, or same-sex sexual experiences. As such, we do not know whether the same-sex attracted adolescents in the current study identify themselves as LGB, engage in same-sex behavior or whether they will do so in the future.
We also did not assess the extent to which adolescents disclosed their same-sex attracted feelings to their peers. Therefore, we could not assess whether the indirect effect of gender-nonconformity through homophobic name-calling was stronger for youth with SSA
than youth without SSA, because same-sex attracted youth with high levels of gender-nonconformity were more likely to have disclosed their same-sex attracted feelings to their peers.
Another limitation involves the cross-sectional design of the study, which made it impossible to look at adolescents’ relationships with their peers from a longitudinal perspective. Therefore, we do not know whether, for example, gender-nonconformity preceded experiences with homophobic name-calling as posited in the current study. Evidence for this direction was found for boys only in a longitudinal study by Ewing-Lee and Troop-Gordon (2011). The authors found that overt forms of peer
victimization (physical or verbal) predicted decreases in gender-nonconformity among boys, whereas overt forms of peer victimization led to an increase in gender-nonconformity among girls. These findings might also explain why we found the mediation to hold stronger for boys as opposed to girls: It could be that adolescent boys need to hide their cues of gender-nonconformity to improve their social status among peers, whereas girls might need to ‘butch up’ to prevent themselves from physical and verbal violence from peers.
Despite the discussed limitations, our findings indicated that among young
adolescents, especially those with SSA and boys, gender-nonconformity is related to poor mental health outcomes, partly due to experiences with homophobic name-calling. Previous research has documented that gender-nonconforming youths’ experiences with peer
victimization during adolescence also has the potential to cause mental health problems in young adulthood (Roberts, et al., 2013). As mentioned above, there are multiple forms of homophobic peer victimization. Therefore, it is important for future studies to investigate the mediating role of different forms of peer victimization in the relation between
gender-nonconformity and mental health. Adolescents’ mental health, however, is not only affected by the quality of their social relations with peers, but also by the quality of their social
relations with other actors in their social network, such as parents or teachers
(Bronfenbrenner, 1979, 2005). Furthermore, community-level factors (e.g., neighborhood networks, youth organizations, and schools), and the broader societal context (e.g., beliefs about sexuality and gender-nonconformity) can also contribute to adolescents’ mental health (Bronfenbrenner, 1979, 2005; Krieger, 2001). In order to have a better understanding of the relation between gender-nonconformity and mental health, it is important to further
investigate the mediating role of multiple contextual factors of adolescents’ surrounding environment. Knowledge about factors that explain the mental health problems associated with gender-nonconformity is important to understand the ways in which the development of these mental health problems can be prevented.
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Table 1,
Intercorrelations between the studied variables along with their means and standard deviations
1 2 3 4 5 M SD 1. Gender-nonconformity - 1.53 .66 2. Homophobic name-calling .18* - 1.49 .72 3. Self-esteem -.22* -.08* - 3.15 .55 4. Social Anxiety .30* .12* -.53* - 1.86 .55 5. Psychological Problems .30* .24* -.60* .53* - 1.66 .58 Note: * p < .001
Table 2,
Moderated mediation results for gender-nonconformity on mental health through homophobic name-calling, moderated by SSA.
Mediator: homophobic name-calling
Predictor B SE
Gender-nonconformity .15*** .05
SSA1 .14*** .09
Gender-nonconformity x SSA .34*** .09
Table 3,
Moderated mediation results for gender-nonconformity on mental health through homophobic name-calling, moderated by biological sex.
Mediator: homophobic name-calling
Predictor B SE
Gender-nonconformity .26*** .03
Biological sex1 -.47*** .04
Gender non-conformity x biological sex -.25*** .06 Note: 1Biological sex: 1 = boys, 2 = girls. * p < .001
Figure 1. Hypothesized mediation of gender-nonconformity with mental health through homophobic name-calling, in which the relation between gender-nonconformity and mental health is moderated by same-sex attraction(SSA: SSA vs. opposite attraction), and (biological) sex.
Gender-Nonconformity Homophobic Name-calling Mental Health
