Self-Restraint In Gender Expression As a Mechanism of Mental Health Disparities Among LGBTQ+ Individuals and Individuals with Diverse Gender Expressions: An Empirically Informed Theoretical Exploration

Background and Purpose: LGBTQ+ individuals and those with diverse gender expressions report elevated levels of depression and anxiety, yet underlying mechanisms remain incompletely understood. Guided by Pachankis’ Psychological Implication Model of Stigma Concealment and Meyer’s Minority Stress Model, this study tested self-restraint in gender expression as a potential stress process that helps explain these mental health disparities.

Methods: Structural equation models were estimated using cross-sectional survey data from 844 college students in Beijing, China (85.90% LGBTQ+). Study 1 examined whether self-restraint in gender expression mediated associations between LGBTQ+ identity and recent depression and anxiety. Study 2 examined whether self-restraint in gender expression mediated associations between gender “conformity/nonconformity” (measured on a 4-point scale as the degree to which one’s gender expression aligns or does not align with societal expectations of masculinity or femininity) and recent depression and anxiety, and whether LGBTQ+ identity moderated these mediation pathways. Models controlled for covariates (e.g., ID gender marker, self-esteem) and included an additional mediating pathway through SOGIE-based victimization.

Results: In unadjusted group comparisons, compared with non-LGBTQ+ participants, LGBTQ+ participants reported significantly higher levels of gender nonconformity (M = 1.90 vs. 1.65, SD = 0.67 vs. 0.60), self-restraint in gender expression (M = 4.62 vs. 1.51, SD = 2.29 vs. 1.78), SOGIE-based victimization severity (M = 0.74 vs. 0.18, SD = 2.30 vs. 0.69), and recent depression (M = 17.56 vs. 16.06, SD = 6.19 vs. 6.07), with all ps < 0.05, while the difference in recent anxiety was not significant. In bivariate models, gender nonconformity was significantly positively associated with recent depression (p < .01) but not recent anxiety. Study 1 showed that self-restraint in gender expression significantly mediated the association between LGBTQ+ identity and recent depression (Std. β = .061, p < .001), and the association between LGBTQ+ identity and recent anxiety (Std. β = .034, p < .05), with direct effects not significant in both models. In study 2, the indirect effect of gender nonconformity on depression via self-restraint in gender expression was significant for both non-LGBTQ+ (Std. β = .088, p < .05) and LGBTQ+ participants (Std. β = .010, p < .05), with the direct effect still significant (Std. β = .070, p < .05). For recent anxiety, self-restraint in gender expression showed significant mediating effects among LGBTQ+ participants (Std. β = .006, p < .05) but not among non-LGBTQ+ participants; the direct effect was not significant.

Conclusions and Implications: Concealing a socially stigmatized gender expression in response to cisheteronormative social gender expectations may function as a stress process contributing to mental health disparities among LGBTQ+ individuals and those with diverse gender expressions. Future research should examine its causal role and the intersectional dynamics between diverse gender expressions and LGBTQ+ identity, as the stress processes related to gender expression may differ across groups. Practitioners should address risks associated with constrained gender expression and consider potentially protective effects of affirming environments that support authentic gender expression.