ORIGINAL PAPER

Trait Mindfulness and Self-Compassion as Moderatorsof the Association Between Gender Nonconformityand Psychological Health

Shian-Ling Keng1& Kenny Wei Lun Liew2

# Springer Science+Business Media New York 2016

Abstract Much research has established a negative associa-tion between gender nonconformity and psychological health.Less is known however regarding factors that may attenuatethe link between gender nonconformity and psychologicalhealth. The present study aimed to investigate the associationbetween gender nonconformity and psychological health in aSingaporean sample, and to examine trait mindfulness andself-compassion as potential moderators of the association.A community sample of 206 adults was recruited and com-pleted an online survey anonymously. The survey includedmeasures of gender nonconformity, sexual orientation, traitmindfulness, self-compassion, depression, anxiety, and sub-jective well-being. Results showed that gender nonconformitypositively and significantly predicted depressive symptoms,and negatively predicted subjective well-being. Trait mindful-ness moderated the association between gender nonconformi-ty and depression, anxiety, and subjective well-being respec-tively, with the direction of the moderation effects indicatingthe role of trait mindfulness as a protective factor against psy-chological distress. Self-compassion moderated the relation-ship between gender nonconformity and subjective well-be-ing. Specifically, the association between gender nonconfor-mity and subjective well-being was positive at high levels ofself-compassion, and negative at low levels of self-compas-sion. While cross-sectional in nature, the findings provide pre-liminary support for the role of trait mindfulness and self-

compassion as potential buffers against negative psychologi-cal effects of gender nonconformity.

Keywords Gender nonconformity .Mindfulness .

Self-compassion . Depression . Anxiety . Subjectivewell-being . Protective factor

Introduction

Gender nonconformity (also known as gender atypicality)refers to the incongruence between the biological sexassigned at birth and the socially prescribed gender role(American Psychological Association (APA) 2012). Peoplewith a high level of gender nonconformity have a genderexpression that does not match the societal expectations oftypically masculine or feminine appearance, behaviors,and interests. Being gender atypical however does not neces-sarily imply a desire to change one’s biological sex. Whilegender atypical individuals may not adhere to gender rolenorms, their gender identity may still be congruent withtheir biological sex.

Research has demonstrated an association between gendernonconformity and sexual orientation. Gay men and lesbiansreport higher levels of gender nonconformity compared toheterosexual men and women (Bailey and Zucker 1995;Lippa 2008; Rieger and Savin-Williams 2012). Heterosexualmen who exhibited gender nonconformity were also oftenperceived as of having a same sexual orientation, often inrelation to stereotypes and a conflation of gender role behaviorwith sexual orientation (Johnson and Ghavami 2011;Valentova et al. 2011). Despite the established relationshipbetween gender nonconformity and sexual orientation, bothconstructs are conceptually distinct from one another.

* Shian-Ling Kengpsykeng@nus.edu.sg

1 Department of Psychology, National University of Singapore, Box39, Singapore 117570, Singapore

2 Institute of Mental Health, Singapore, Singapore

MindfulnessDOI 10.1007/s12671-016-0639-0

Much research has established a negative association be-tween gender nonconformity and psychological well-being.As suggested by the minority stress model, experiences ofprejudice and lack of acceptance associated with being genderatypical contribute to increased distress experienced by gendernonconforming individuals (Meyer 2003). In a study involv-ing high school seniors, Rieger and Savin-Williams (2012)found that gender nonconformity negatively and significantlypredicted well-being in both males and females. Anotherstudy focusing on lesbian, gay, bisexual, and transgender(LGBT) youths found a negative association between gendernonconformity and psychosocial adjustment (Toomey et al.2010). There is some evidence that the relationship betweengender nonconformity and well-being may be stronger inmales compared to that in females. For example, Skidmoreet al. (2006) reported that current gender nonconformity sig-nificantly correlated with depressive symptoms and traitanxiety in males, but not females. Lippa (2008) also foundchildhood gender nonconformity to be associatedwith anxietysymptoms for men, but not for women. Interestingly, there issome evidence suggesting that gender nonconformity may bebeneficial for females, although this finding was mostly iden-tified only in specific domains, such as workplace achieve-ment (Impett et al. 2006; Thornton and Leo 1992; Wong et al.1985). Taken together, while there are some inconsistenciesrelated to gender differences, research overall supports theassociation between gender nonconformity and poorer psy-chological health. Notably however, research on gender non-conformity has primarily been conducted on sexual minoritypopulations, and there is a need to examine psychologicalcorrelates of gender nonconformity in populations with morediverse sexual orientations and gender identities.

To date, little research has examined potential factors thatmay moderate or explain the adverse effects of being genderatypical on psychological well-being. Existing research haslargely focused on examining factors that may moderate theeffects of adopting a sexual minority status, as opposed tobeing gender nonconforming in general, on psychologicalhealth. For example, Doty et al. (2010) found that social sup-port pertinent to coping with sexual minority-related stressorsmoderated the relationship between sexual minority stress andemotional distress in a group of LGBT youths. Opennessabout one’s sexual orientation has also been linked to bettermental health outcomes, although only for non-heterosexualfemales and not their male counterparts (Kuyper and Fokkema2011). Szymanski (2009) found support for the moderatingrole of self-esteem: experiences of prejudice did not predictpsychological distress for gay and bisexual men with highself-esteem, but there were higher levels of distress associatedwith events of stigmatization for those with low self-esteem.Lastly, gender nonconformity has been found to predict well-being independently of sexual orientation (Rieger and Savin-Williams 2012).

Despite research pointing to the role of several factors inameliorating the adverse effects of sexual minority status onpsychological health, little work has examined factors thatmay buffer s t ress associa ted with being gendernonconforming in the general population. Further, severalidentified factors may be more subject to external circum-stances as opposed to being changeable at the individual level.For example, while social support specific to sexuality stressis known to be a stress buffer, it is nonetheless a resource thatis in part subject to environmental circumstances. Experiencesof prejudice may also be challenging to modify at an individ-ual level (Herek 2007). While it is important to engage incontinuous effort to reduce prejudice at the societal level(e.g., through education of the public), there is value in exam-ining modifiable personality characteristics that may protectindividuals from negative consequences associated with devi-ating from gender norms.

Among various potential coping resources, mindfulnessmay serve as a buffer for the adverse impact of gender non-conformity on psychological health. Mindfulness has beendefined as the ability to bring one’s attention to the experi-ences in the present moment in an accepting andnonjudgemental manner (Baer et al. 2006). It can be concep-tualized as a dispositional or trait-like characteristic, a set ofskills, or a state of awareness (Brown and Ryan 2003; Germeret al. 2005). Trait mindfulness (reflecting individual differ-ences in the tendency to be mindful in daily life) has beenfound to predict higher psychological well-being, life satisfac-tion, and self-esteem, as well as lower depressive and anxietysymptoms (Brown and Ryan 2003; Cash and Whittingham2010; Keng et al. 2011; Rasmussen and Pidgeon 2011).Interventions aiming at systematically cultivating mindfulnesspractices and skills, such as mindfulness-based stress reduc-tion (MBSR), have also been found to result in reductions indepression and anxiety (with moderate effect sizes) in bothclinical and non-clinical populations (Hofmann et al. 2010).

There is preliminary work suggesting that trait mindfulnessmay buffer the negative effects of being socially marginalizedon well-being. Graham et al. (2013) found that trait mindful-ness significantly moderated relationship between the fre-quency of past-year experiences with racism and anxietysymptoms in a sample of African American adults. In partic-ular, the association between frequency of racist events andanxious arousal was significantly positive among individualswith low trait mindfulness, but not significant among thosehigh on trait mindfulness. While this study focused on expe-riences unique to racism, the findings highlight the potentialvalue of mindfulness in mitigating negative consequencesresulting from social prejudice in general. In particular, mind-fulness may enable a gender nonconforming individual tocope with stigmatization-related stress by becoming moreaware of his or her experiences and relating to them in anonjudgmental and less reactive manner (Baer et al 2006;

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Graham et al. 2013). When encountering experiences of prej-udice, mindful individuals may be more able to disengagefrom ruminating on the experience, which breaks the negativefeedback loop between rumination and psychological distress(Nolen-Hoeksema 2000). Mindfulness may also facilitate theprocess of reappraisal, by enabling these individuals to ac-quire a more balanced perspective towards stressful situations(e.g., reframing the experience of stigmatization as an oppor-tunity to cultivate resilience) (Garland et al. 2009).

Apart from trait mindfulness, self-compassion may alsohelp individuals cope with stress associated with being genderatypical. Self-compassion refers to the ability to adopt a caringand compassionate attitude towards oneself, recognize one’sexperience as part of the larger human experience, and bringnonjudgmental awareness to one’s painful thoughts and expe-riences rather than over-identifying with them (Neff 2003).Similar to mindfulness, self-compassion may be conceptual-ized as a modifiable trait (reflecting the general tendency to becompassionate towards oneself in times of difficulty) (Kenget al. 2012; Leary et al. 2007; Neff and Davidson 2016). Forexample, studies have demonstrated improvements in traitself-compassion over 8 weeks of training in MBSR (Kenget al. 2012; Shapiro et al. 2007). In the context of gendernonconformity, adopting an attitude of kindness towards one-self may facilitate self-validation and counteract distressresulting from being negatively judged by others.Understanding that pain and suffering are universal aspectsof life may facilitate the process of acceptance, which lowersdistress resulting from resisting or avoiding one’s painful ex-periences (Hayes 2004). Self-compassion has been associatedwith numerous positive psychological outcomes, includinglower depression and anxiety, as well as greater satisfactionwith life (Neff 2003; Neff et al. 2005, 2008; Raes 2010).Interventions aiming at increasing self-compassion, such asthe mindful self-compassion program (MSC), have also beenfound to be effective in improving well-being in the generalpopulation (Neff and Germer 2013).

Preliminary research suggests that self-compassion may bea valuable inner resource that mitigates prejudice- orvictimization-related stress. Trait self-compassion has beenfound to predict decreased self-stigma, negative mood, andfear of negative evaluation, as well as positive identity devel-opment among sexual minority populations (Chandler 2013;Crews 2012). More broadly speaking, self-compassion hasbeen found to moderate reactions to distressing situations in-volving rejections, failure, or negative feedback. Leary et al.(2007) found that whereas people low in self-compassion tendto attribute positive feedback more to themselves but neutralfeedback less to themselves, people high in self-compassionrespond more similarly to positive and neutral feedback.Further, the study found that people with lower self-compassion tend to rate their performances more negativelycompared to those with higher self-compassion. These

findings suggest that highly self-compassionate people judgethemselves less harshly, and respond to positive and negativesituations with greater equanimity in general. No research hasyet examined whether people with higher self-compassionmay be less susceptible to the negative effects of stigmatiza-tion (associated with being gender atypical) compared to thosewith lower self-compassion.

Using a cross-sectional design, the present study aimed to(1) examine the relationship between gender nonconformityand psychological health (particularly, depressive symptoms,anxiety symptoms, and subjective well-being), and (2) exam-ine trait mindfulness and self-compassion as moderators of therelationship between gender nonconformity and psychologi-cal health in a sample of Singaporean adults. Based on previ-ous research, it was hypothesized that gender nonconformitywould be positively associated with symptoms of depressionand anxiety, and negatively associated with subjective well-being (Alanko et al. 2009; Rieger and Savin-Williams 2012).We also hypothesized that trait mindfulness and self-compassion would each moderate the association betweengender nonconformity and psychological functioning, suchthat higher levels of these traits would predict a weaker asso-ciation between gender nonconformity and psychologicalsymptoms (depression and anxiety), and a stronger associa-tion between gender nonconformity and subjective well-being.

Method

Participants

Participants for this study were recruited through advertise-ments on various online platforms (e.g., social media plat-forms and emails). To increase the variability of gender non-conformity within the sample (across both gender identitiesand sexual orientations), effort was made to reach out to emaillists of local organizations involved in advocacy for the wel-fare of the LGBT population (e.g., Oogachaga, a SingaporeanLGBT counseling organization). The participants were alsorecruited from the National University of Singapore (NUS)Department of Psychology undergraduate subject pool. Thestudy’s eligibility criteria were as follows: (1) age between 18and 65 years old and (2) proficient in English. There were noexclusion criteria. The study was approved by the NUS’ insti-tutional review board.

Procedure

Potential participants were invited to provide their informedconsent and complete a survey. The study was advertised as asurvey regarding BMasculinity, Femininity and Well-being.^Several self-report questionnaires assessing demographic

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information, gender nonconformity, depressive symptoms,anxiety symptoms, stress, trait mindfulness, and self-compassion (see below) were administered in the survey. Inline with recommendations of previous studies that examinedsensitive topics, such as sexuality and same-sex attraction, ananonymous online survey approach was adopted to facilitaterecruitment (Alanko et al. 2009; Baams et al. 2013). Thisapproach is particularly relevant for the setting of the presentstudy, where issues related to sexuality and gender identity attimes remain highly taboo subjects (Detenber et al. 2013;Kwara 2014). Before completing the survey, the participantswere informed that they need not answer any question thatthey did not wish to. At the end of the survey, all the partici-pants were provided with information regarding locally avail-able psychological services and resources.

Measures

Demographics A demographic questionnaire obtained infor-mation regarding participants’ age, gender, ethnicity, sexualorientation, religious affiliation, and education background.

Sexual OrientationAlthough the participants were instructedto report their sexual orientation in the demographic question-naire, the Kinsey scale was administered to assess sexual ori-entation on a continuum (Kinsey et al. 1948). Although theremay be inconsistencies between an individual’s self-identifiedsexual orientation and the subjective degree of same-sex at-traction, studies in the domain of gender nonconformity haveoperationalized and measured sexual orientation using thisscale (APA 2012; Rieger and Savin-Williams 2012). Scoresof the scale ranged from 0 (exclusive sexual attraction towardsthe opposite gender) to 6 (sexual attraction towards the samegender only). Higher scores reflect higher levels of same-sexattraction.

Gender Nonconformity The 10-item Continuous GenderIdentity Scale (CGIS) assesses participants’ subjective assess-ment of their current masculinity or femininity (Bailey et al.1998). Items were rated on a 7-point scale (1 = stronglydisagree; 7 = strongly agree). The measure was originally de-veloped for male-identified participants, and was adapted inthis study to also include a version for female-identified par-ticipants. In particular, references to either gender in the orig-inal version were revised to the opposite gender in the versionfor female-identified participants. A final score was computedby summing all item scores, with higher scores indicating agreater level of current gender nonconformity. Scores on thisscale have been shown to correlate moderately with third-party assessment of gender nonconformity in a sample ofgay men (Bailey et al. 1998). In this sample, the internal con-sistency of the scale was good for both the form for male-

identified participants (Cronbach’s α = 0.80) and the formfor female-identified participants (Cronbach’s α = 0.84).

Depression and Anxiety The depression and anxiety sub-scales of the 21-item Depression Anxiety Stress Scale(DASS-21) were administered to assess symptoms of depres-sion and anxiety (Lovibond and Lovibond 1995). High scoreson each of these subscales correspond to higher symptoms ofdepression and anxiety respectively. Items are rated on a 4-point Likert-type scale. The DASS-21 demonstrated adequateconstruct validity, internal consistency, temporal stability, andreliability in a non-clinical population (Crawford and Henry2003). It has also been validated in Singapore and showedgood internal consistency and factorial validity (Oei et al.2013). In this sample, the internal consistency of depressionand anxiety subscales was 0.88 and 0.80, respectively.

Subjective Well-Being The 9-item Personal Wellbeing Index(PWI) measures the degree of satisfaction experienced by in-dividuals in multiple dimensions of their life (InternationalWellbeing Group 2006). Participants rate their subjective sat-isfaction of their life as a whole and of other specific domains(e.g., health, personal relationships, and spirituality) on a 10-point scale (0 = completely dissatisfied; 10 = completelysatisfied). A composite score was computed, according tooriginal scoring instructions by summing up 8 item scores(item 2 through 9), where a higher score represents a higherlevel of subjective well-being. In this sample, the internal con-sistency for the scale was good (Cronbach’s α = 0.83).

Trait Mindfulness The 39-item Five Facet MindfulnessQuestionnaire (FFMQ) was used to measure participants’ lev-el of trait mindfulness (Baer et al. 2006). It consists of fivesubscales: observing (the ability to observe one’s internal andexternal sensations), describing (the ability to describe one’sexperiences with words), acting with awareness (the ability tomaintain moment-to-moment awareness while engaging indaily actions or routines), non-judging of inner experience(the ability to relate to one’s inner experiences without judg-ment), and non-reactivity to inner experience (the ability tomaintain equanimity towards one’s inner experience). Itemswere rated on a 5-point Likert scale ranging from 1 (never orvery rarely true) to 5 (very often or always true). Given pastresearch indicating that the observing facet tends not to loadon the overarching mindfulness construct in nonmeditatingsamples, the current study used a total trait mindfulness scorethat excluded the observing facet (Baer et al. 2008; Lilja et al.2012). In this sample, the internal consistency of the overallscale (with the observing subscale excluded) was good(Cronbach’s α = 0.82).

Self-Compassion The Self-Compassion Scale (SCS) assessestendencies to be kind towards oneself in times of difficulty or

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pain, to be nonjudgmental about one’s thoughts and feelings,and to see one’s experience as a part of the larger humanexperience (Neff 2003). This 26-item questionnaire is com-posed of six subscales: self-kindness (the tendency to be kindtowards oneself), self-judgment (the tendency to be judgmen-tal towards oneself), common humanity (the tendency to viewone’s experiences as a normal part of human condition), iso-lation (the tendency to feel isolated and alone when encoun-tering difficult experiences), mindfulness (the ability to holdone’s experiences in mindful awareness), and over-identification (the tendency to over-identify with one’sthoughts, feelings, and emotions). All the items are rated ona 5-point Likert-type scale (1 = almost never; 5 = almostalways), with higher scores indicating greater self-compas-sion. Neff (2003) reported internal consistency of α = 0.92for the total score, test-retest reliabilities over 3 weeks ofr = 0.93 for the total score and between 0.80 and 0.88 for thesubscales and good convergent and discriminant validity. Inthis study, the internal consistency of the SCS was excellent(Cronbach’s α = 0.91).

Data Analyses

All analyses were conducted using SPSS. Preliminary analy-ses were conducted to examine the association between theparticipants’ demographic information and gender nonconfor-mity, depressive symptoms, anxiety systems, and subjectivewell-being. We then conducted hierarchical multiple regres-sion analyses (taking into account covariates identified fromthe preliminary analyses) to examine the association betweengender nonconformity and each of the psychological healthvariables. Subsequent analyses examined trait mindfulnessand self-compassion as moderators of the relationship be-tween gender nonconformity and psychological health. Themoderation analyses were conducted using an SPSS macroknown as MODPROBE (Hayes and Matthes 2009). Any in-teraction effect found was probed using the Johnson-Neymantechnique, which identified regions in the range of the mod-erator variable where the effect of the independent variable onthe outcome was significant and not significant. In each ofthese analyses, the DV (depressive symptoms, anxietysymptoms, or subjective well-being) was regressed onto pre-vious identified covariates (i.e., gender and/or sexual orienta-tion), gender nonconformity, trait mindfulness (or self-com-passion), and the gender nonconformity × mindfulness (orself-compassion) interaction term.

Results

A total of 206 participants aged between 18 and 63 years old(M = 26.33, SD = 8.56) participated in this study. Table 1 sum-marizes the participants’ demographic information. Eighty

five (41.3%) identified as male, 115 (55.8%) identified asfemale, 4 (1.9%) identified as transgender male, and 2(1.0%) identified as transgender female. The majority of thesample was Chinese (81.4%), followed by other ethnicitiessuch as Malay, Indian, and Eurasian. With regards to sexualorientation, more than half of the sample (66.5%) identified asheterosexual. For those who identified with a sexual minoritygroup, 43 (20.9%) identified as gay or lesbian, 11 (5.3%)identified as bisexual, 6 (2.9%) identified as questioning,and 7 (3.4%) indicated as others. Another 2 participants(1.0%) indicated that they did not wish to respond.

Table 2 reports the descriptive statistics and correlationsamong the key study variables. There were no gender differ-ences in the degree of reported gender nonconformity, anxietysymptoms, and subjective well-being, all ps > 0.33.Depressive symptoms were higher among the male partici-pants (M = 6.58; SD = 4.33) compared to those among the

Table 1 Demographic characteristics of participants (N = 206)

Number Percent (%)

Gender

Male 85 41.3

Female 115 55.8

Transgender 6 2.9

Ethnicitya

Chinese 166 81.4

Malay 8 3.9

Indian 11 5.4

Caucasian 9 4.4

Eurasian 1 .5

Others 9 4.4

Self-identified sexual orientationa

Heterosexual 137 66.5

Gay/lesbian 43 20.9

Bisexual 11 5.3

Questioning 6 2.9

Others 7 3.4

Religiona

Buddhism 38 18.6

Christianity 51 25.0

Hinduism 7 3.4

Islam 9 4.4

Taoism 10 4.9

Other religions 3 1.5

No religion 86 42.2

Highest education qualification

Secondary school 8 3.9

Junior college 84 40.8

Polytechnic college 10 4.9

Undergraduate or graduate degree 104 50.5

a Note: there were two missing data points for each of these variables

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female participants (M = 5.13; SD = 4.14), p = 0.04, and trans-gendered participants, (M = 1.83; SD = 1.68), p = 0.02. As de-pressive symptoms varied by gender, gender was included as acovariate in subsequent analyses involving depressive symp-toms as a dependent variable (DV).

There was no correlation between age and reported gendernonconformity, depressive symptoms, and anxiety symptoms,all ps > 0.12. Age positively correlated with subjective well-being, r = 0.16, p = 0.03, and was included as a covariate insubsequent analyses involving subjective well-being as theDV. Levels of gender nonconformity, depressive symptoms,anxiety symptoms, and subjective well-being did not differ byethnicity or education status, ps > 0.21. Sexual orientation(operationalized by levels of same-sex attraction, as measuredby the Kinsey scale) positively correlated with gender non-conformity, r = 0.21, p = 0.002, and depressive symptoms,r = 0.18, p = 0.008, and negatively correlated with subjectivewell-being, r = −0.20, p = 0.004. There was no correlation be-tween levels of same-sex attraction and anxiety symptoms.Given that same-sex attraction correlated with gender noncon-formity and the majority of the DVs, it was included as acovariate in all subsequent analyses.

Association Between Gender Noncomformityand Psychological Health

Hierarchical regression analyses showed that controlling forgender and sexual orientation, gender nonconformity signifi-cantly and positively predicted depressive symptoms,β = 0.15, ΔR2 = 0.02, p = 0.04. Gender nonconformity didnot predict symptoms of anxiety, p = 0.28. Lastly, controllingfor age and sexual orientation, there was a significant negativerelationship between gender nonconformity and subjectivewell-being, β = −0.17, ΔR2 = 0.03, p = 0.01.

As an exploratory analysis, we examined whether the as-sociation between gender nonconformity and psychologicalfunctioning (i.e., depressive symptoms, anxiety, and subjec-tive well-being) was moderated by gender, as suggested bysome previous research (Lippa 2008; Skidmore et al. 2006).

The analyses showed that gender did not moderate the rela-tionship between gender nonconformity and any of the depen-dent variables, ps > 0.56.

Trait Mindfulness as a Moderator of the AssociationBetween Gender Noncomformity and PsychologicalHealth

Analyses using MODPROBE showed that trait mindfulnesssignificantly moderated the association between gender non-conformity and depressive symptoms, β = −0.004,ΔR2 = 0.02, p = 0.01 (see Fig. 1). Specifically, for participantslow on trait mindfulness (those scoring below 95 on theFFMQ), there was a significant, positive relationship betweengender nonconformity and depressive symptoms (p valuesranged from 0.006 to 0.05). As scores on trait mindfulnessincreased, there were increasingly negative relationships be-tween gender nonconformity and depressive symptoms. Themoderating values defining the non-simultaneous Johnson-Neyman significant regions were 95 and 131 respectively.These values demarcate regions in the range of FFMQ scoreswhere the association between gender nonconformity and de-pressive symptoms was significant and not significant.

The analyses also showed that controlling for sexual orienta-tion, trait mindfulness significantly moderated the associationbetween gender nonconformity and anxiety symptoms,β =−0.15,ΔR2 = 0.03, p = 0.01 (see Fig. 2). In particular, partic-ipants low on trait mindfulness (those scoring below 87 on theFFMQ) demonstrated a significant, positive association betweengender nonconformity and anxiety (p values ranged from 0.01 to0.05). Those high on trait mindfulness (particularly, those scoringabove 114 on the FFMQ) demonstrated the reverse pattern: therelationship between gender nonconformity and anxiety symp-toms was negative among these participants (p values rangedfrom 0.01 to 0.05). The moderating values defining the non-simultaneous Johnson-Neyman significant regions were 87 and114 respectively (see above). With regard to subjective well-be-ing, the analyses showed that traitmindfulness significantlymod-erated the association between gender nonconformity and

Table 2 Descriptive statisticsand inter-correlations among keystudy variables

M SD DASS-D DASS-A PWI FFMQ SCS

CGNC 34.69 11.13 0.15* 0.09 −0.17* −0.14* −0.22**DASS-D 5.63 4.21 0.64** −0.53** −0.53** −0.56**DASS-A 5.03 3.86 −0.37** −0.48** −0.35**PWI 50.57 11.64 0.50** 0.53**

FFMQ 98.42 14.29 0.57**

SCS 78.57 15.16 1.00

CGNC Current Gender Nonconformity Scale, DASS-D Depression Subscale of the Depression, Anxiety, andStress Scales,DASS-DAnxiety Subscale of the Depression, Anxiety, and Stress Scales, PWI Personal Well-beingScale, FFMQ Five Facet Mindfulness Questionnaire (with the observing subscale excluded), SCS Self-Compassion Scale. *p < 0.05, **p < 0.01

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subjective well-being, β = 0.14, ΔR2 = 0.02, p = 0.02 (seeFig. 3). Specifically, participants low on trait mindfulness (thosescoring below 92 on the FFMQ) demonstrated a significant,negative relationship between gender nonconformity and well-being (p values ranged from 0.01 to 0.05). At higher levels oftrait mindfulness, the relationship became non-significant. Themoderating value defining the non-simultaneous Johnson-Neyman significant regions was 92.

Follow-up analyses were conducted to examine individualfacets of trait mindfulness (as measured by the FFMQ) as po-tential moderators of the relationship between gender noncon-formity and depression. The analyses showed that there was asignificant interaction effect for Nonjudging (β = −0.07,ΔR2 = 0.02, p = 0.02), and nonsignificant interaction effect(though trending in expected directions) for Acting withAwareness (β = −0.11, ΔR2 = 0.01, p = 0.08), with higherscores on each of these facets predicting a weaker (i.e., lesspositive) relationship between gender nonconformity and de-pressive symptoms. None of the other facets of trait mindful-ness predicted a differential relationship between gender non-conformity and depression. Next, we examined facets of traitmindfulness as moderators of the relationship between gendernonconformity and anxiety symptoms. There was a significantinteraction effect for Nonreactivity (β = −0.17, ΔR2 = 0.03,p = 0.02), and non-significant but trending interaction effectfor Nonjudging (β = −0.11, ΔR2 = 0.01, p = 0.08), with higherscores on each of these facets predicting increasingly weaker(less positive) relationships between gender nonconformity andanxiety symptoms. Lastly, with regard to subjective well-being,

there was a significant interaction effect for Observing(β = −0.14, ΔR2 = 0.02, p = 0.04), Acting with Awareness(β = 0.13, ΔR2 = 0.03, p = 0.048), and Nonjudging (β = 0.23,ΔR2 = 0.05, p < 0.001), with lower scores on the latter twofacets predicting increasingly negative relationships betweengender nonconformity and subjective well-being. For theObserving facet, the trend of the interaction was in the oppositedirection: higher scores on this facet predicted an increasinglynegative association between gender nonconformity and well-being. None of the other facets moderated the relationship be-tween gender nonconformity and subjective well-being.

Self-Compassion as a Moderator of the AssociationBetween Gender Noncomformity and PsychologicalHealth

We conducted further analyses to examine whether self-compassion moderated the association between gender non-conformity and psychological functioning. The analysesshowed that self-compassion did not moderate the associationbetween gender nonconformity and depressive symptoms,p = 0.27, or that between gender nonconformity and anxietysymptoms, p = 0.13.

Further analyses demonstrated a significant moderation ef-fect of self-compassion on the association between gendernonconformity and subjective well-being, β = 0.16,ΔR2 = 0.02, p = 0.01 (see Fig. 4). In particular, for participantslow on self-compassion, there was a significant, negative re-lationship between gender nonconformity and subjective

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Fig. 2 Trait mindfulnessmoderated the relationshipbetween gender nonconformityand anxiety symptoms

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Fig. 1 Trait mindfulnessmoderated the relationshipbetween gender nonconformityand depressive symptoms

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well-being (p values ranged from 0.007 to 0.05). Conversely,the relationship between gender nonconformity and subjectivewell-being was positive among participants high on self-com-passion. The moderating values defining the non-simultaneous Johnson-Neyman significant regions were 71and 118 respectively. Follow-up analyses examined individualaspects of self-compassion (as measured by subscales of theSCS) as predictors of the relationship between gender noncon-formity and subjective well-being. The analyses showed thatthe interaction effects were significant for (the lack of) self-judgment (β = 0.29,ΔR2 = 0.08, p < 0.001), (the lack of) over-identification (β = 0.20, ΔR2 = 0.04, p = 0.002), and (the lackof) isolation (β = 0.21, ΔR2 = 0.05, p = 0.001), with higherscores in each of these facets predicting an increasingly lessnegative (or more positive) relationship between gender non-conformity and subjective well-being. There was also a trendfor self-kindness (β = 0.12,ΔR2 = 0.01, p = 0.06) and commonhumanity (β = 0.11,ΔR2 = 0.01, p = 0.10) to moderate the as-sociation between gender nonconformity and subjective well-being, with higher scores on each of these facets predicting anincreasingly less negative (or more positive) relationship be-tween gender nonconformity and subjective well-being.

Discussion

The present study examined the association between gendernoncomformity and psychological health, as well as traitmindfulness and self-compassion as potential moderators ofthe association in a sample of Singaporean adults. Results

showed that gender nonconformity was positively associatedwith depressive symptoms and negatively associated withsubjective well-being. Trait mindfulness moderated the asso-ciation between gender nonconformity and depression, anxi-ety, and subjective well-being respectively, with the directionof each of the moderation effects indicating the role of traitmindfulness as a protective factor against psychological dis-tress. Self-compassion also moderated the association be-tween gender nonconformity and subjective well-being, suchthat higher levels of self-compassion predicted a more positive(or less negative) relationship between gender nonconformityand subjective well-being.

The findings that gender nonconformity predicted greatersymptoms of depression and lower levels of subjective well-being are consistent with the larger literature demonstrating anegative association between being gender atypical and psy-chological health (e.g., Alanko et al 2009; Rieger and Savin-Williams 2012). In line with Rieger and Savin-Williams(2012), these relationships remained significant after control-ling for sexual orientation, indicating that the negative effectsof gender nonconformity are independent of sexual orienta-tion. Gender nonconformity did not predict anxiety symp-toms. As indicated by later analyses, the association betweenthese two variables is likely masked by the presence of mod-erating variables, particularly, trait mindfulness. Unlike someprevious research that suggested that the association betweengender nonconformity and psychological symptoms may bestronger for males, the present study found that gender did notmoderate the association. The findings suggest that genderatypical individuals continue to experience stress related to

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Fig. 3 Trait mindfulnessmoderated the relationshipbetween gender nonconformityand subjective well-being

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Fig. 4 Self-compassionmoderated the relationshipbetween gender nonconformityand subjective well-being

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their gender expression. Indeed, research conducted inSingapore revealed generally negative public opinions to-wards violations of gender norms, a trend that persisted overthe years (Detenber et al. 2007, 2013). According to a nation-wide survey conducted with sexual minorities, the averagelifetime prevalence of actual experiences of abuse or discrim-ination due to gender identity was 60.2% (OogachagaCounselling and Support 2012). Local media reportshighlighted that individuals in Singapore experience prejudicethat is directed more at their gender nonconformity, rather thansexual orientation, which is in line with the idea that the targetof prejudice may not necessarily be a sexual minority groupstatus, but rather, violations in gender expression (Gordon andMeyer 2007; Ong 2014). Future research should examine thecultural dimensions of gender nonconformity, for example,whether the deleterious effects of being gender atypical maybe stronger in an Asia cultural context versus a Western con-text, given the strong influence of Confucian values that em-phasize traditional gender roles and hierarchy (Li 2000).

To our knowledge, the present study is the first to demon-strate support for the idea that trait mindfulness buffers theassociation between gender nonconformity and psychologicalhealth. In particular, people high on trait mindfulness demon-strated a weaker association between being gender atypicaland psychological symptoms; whereas those low on traitmindfulness demonstrated a stronger (positive) associationbetween gender nonconformity and psychological symptoms.Further, higher trait mindfulness predicted a more positiveassociation between gender nonconformity and subjectivewell-being. Analyses at the level of individual facets of mind-fulness suggest that these relationships were driven primarilyby the ability to act with awareness and/or the ability to relateto one’s experiences nonjudgmentally. These abilities likelyenable individuals to respond to prejudice-related stressorsmore effectively, by disengaging from maladaptive rumina-tion and self-judgment or avoidance of negative experiences(Robins et al. 2012). Interestingly, the observing facet of traitmindfulness predicted a negative association between gendernonconformity and well-being. The finding suggests beinghighly observant of one’s experiences (in the absence of em-bodying core attitudes of mindfulness, such as being nonjudg-mental) may render one vulnerable to the negative effects ofbeing gender nonconforming. This finding is consistent withprevious research showing that the observe facet of the FFMQeither correlated positively or did not correlate with psycho-logical symptoms in nonmeditating samples, presumably dueto a lack of training in observing one’s moment-to-momentexperiences in a non-biased or nonjudgmental manner (Baeret al. 2008).

Overall, the findings point to the potential of mindfulnesstraining in helping gender atypical individuals cope more ef-fectively with stress or psychological symptoms resultingfrom a lack of acceptance or prejudice related to their gender

expression. Within the larger literature, mindfulness-based in-terventions have been shown to ameliorate a variety of psy-chological symptoms (Baer 2003; Keng et al. 2011) Whilelittle work has examined the efficacy of mindfulness-basedinterventions in the Singaporean context, such interventionsmay be received favorably given the compatibility betweenmindfulness practice and Buddhist worldviews (withBuddhism being the second largest religion in Singapore) aswell as preliminary research demonstrating the benefits ofmindfulness-based interventions among older adults inSingapore (Rawtaer et al. 2015).

The study also demonstrated self-compassion to be a factorthat attenuates the negative association between gender non-conformity and subjective well-being. Analyses at the level ofsubscales showed that the moderation effect was driven bykey aspects of self-compassion, including self-judgment,over-identification, and isolation. Having lower self-judgments and not over-identifying with one’s emotions likelyenable gender atypical individuals to respond to their difficul-ties in a more gentle way, as opposed to internalize thesedifficulties and perceive them as reflective of their ownfailures or shortcomings. Further, understanding that one isnot alone in experiencing such difficulties likely decreasesfeelings of alienation that could result from beingstigmatized. These results extend the work of Chandler(2013) and Crews (2012) by demonstrating the protective ef-fect of self-compassion in a general population, beyond a sex-ual minority sample. The findings also shed light on the utilityof self-compassion training for individuals struggling withstress related to their gender expressions. Existing researchhas demonstrated the efficacy of mindfulness- and self-compassion-based interventions in enhancing self-compassion and other well-being-related outcomes in the gen-eral population (Keng et al. 2012; Neff and Germer 2013;Shapiro et al. 2007). More broadly speaking, in the culturalcontext of Singapore, interventions aiming at enhancing self-compassion may be especially relevant, given the influence ofConfucian values emphasizing shame and self-criticism asavenues to self-improvement. It is possible that Singaporemay be a culture prone to low self-compassion, as suggestedby previous research demonstrating that Taiwanese (whomSingaporeans are culturally more similar to among the sub-samples of the study) reported the lowest level of self-compassion compared to Thais and Americans (Neff et al.2008). Future research should explore the utility of self-compassion training in cultures prone to high self-criticismor shame.

There are several strengths to the present study. The studyis among the first that has examined psychological correlatesof gender nonconformity in an Asian context. Also, we re-cruited a sample that is relatively diverse in terms of sexualorientation (e.g., 66.5% heterosexual; the rest identifying asLGBTQ). This supports the generalizability of the findings to

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individuals of a variety of sexual orientations. The ethnic com-position of the sample also corresponds to the demographicsof Singapore (i.e., majority Chinese, followed by Malays,Indians. and other ethnicities such as Eurasians). Further, thestudy conceptualized psychological health-related outcomesbroadly, in terms of not only (the absence of) psychopatholog-ical symptoms, but also subjective well-being. The analysesalso controlled for demographic variables that may serve asconfounding factors of the association between gender non-conformity and psychological health. Lastly, analyses of traitmindfulness and self-compassion both at the level of the over-all scale and subscales contribute to a more fine-tuned under-standing of potential pathways through which these variablesbuffer the negative association between gender nonconformityand psychological health.

Limitations

This study is not without limitations. First, several of the mea-sures administered in this study have not been formally vali-dated in Singapore, even though all the measures demonstrat-ed relatively high levels of internal consistency. Also, theCGIS was originally developed for male-identified individ-uals, and therefore, needed to be adapted for female-identified participants in this study. The cross-sectional natureof the study also precludes causal conclusions regarding therelationships between gender nonconformity and psychologi-cal health, as well as the moderating role of trait mindfulnessand self-compassion. Future research should experimentallyassess the causal role of mindfulness and self-compassion inbuffering the negative effects of gender nonconformity onwell-being. Use of self-report measures also raises concernsrelated to demand characteristics and social desirability, al-though effort was made to ensure the anonymity of partici-pants’ responses. Future studies could utilize multiple modesof assessment (e.g., observer-rated levels of gender noncon-formity and physiological measures of stress) to assess theassociation between gender nonconformity and well-beingmore objectively.

Acknowledgements The authors would like to thank the OogachagaCounseling Center in Singapore for their assistance with publicity of thisstudy within the LGBT community. The authors are grateful to all theparticipants who volunteered their time to participate in this study.

Compliance with Ethical Standards

Funding This study did not receive any funding.

Ethical Approval All procedures performed in the studies involvinghuman participants were in accordance with the ethical standards of theinstitutional and/or national research committee and with the 1964Helsinki declaration and its later amendments or comparable ethicalstandards.

Informed Consent Informed consent was obtained from all the indi-vidual participants included in the study.

Conflict of Interest The authors declare that they have no conflict ofinterest.

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