Effects of gender nonconformity and biological sex on the relationship between sexual orientation microaggressions and anxiety and depressive symptoms among lesbian, gay, and bisexual Taiwanese young adults: A moderated-moderation study

Background: Sexual orientation microaggressions (SOMs) may negatively affect lesbian, gay, and bisexual (LGB) individuals' mental health. However, the moderating effects of gender nonconformity and biological sex on the relationship between SOMs and anxiety and depressive symptoms has never been examined. We evaluated the moderating effect of gender nonconformity on the association of SOMs with anxiety and depressive symptoms among LGB young male and female adults. We hypothesized that the associations of SOMs with anxiety and depressive symptoms weakened with increasing gender nonconformity among gay and bisexual men but strengthened with increasing gender nonconformity among lesbian and bisexual women. Methods: In total, 1000 self-identified LGB young adult individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, anxiety was assessed using the State subscale on the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. The two-way moderation models stratified by sex examined the moderating effects of gender nonconformity on the association between SOMs and anxiety symptoms in the male and female participants. The three-way moderated moderation models were used to determine whether gender nonconformity and sex jointly moderated the associations between SOMs and anxiety and depressive symptoms. Results: In the two-way moderation models stratified by sex, gender nonconformity exerted opposite moderating effects on the association between SOMs and anxiety and depressive symptoms in the male and female participants. For the male participants, the association between SOMs and anxiety (β = −0.08) and depressive symptoms (β = −0.09) weakened with increasing gender nonconformity. For the female participants, the association between SOMs and anxiety (β = 0.08) and depressive symptoms (β = 0.13) strengthened with increasing gender nonconformity. The three-way moderated moderation models further confirmed that sex moderated the moderating effects of gender nonconformity on the associations between SOM and anxiety (β = −0.16, p = .047) and depressive symptoms (β = −0.22, p < .001). Limitation: The cross-sectional study design limited the inferences that could be made concerning the temporal relationship between SOMs and mental health problems. Conclusions: The association between SOMs and anxiety and depressive symptoms weakened with increasing gender nonconformity in gay and bisexual men, whereas the association between SOMs and anxiety and depressive symptoms strengthened with increasing gender nonconformity in lesbian and bisexual women.