Sex Roles (2012) 67:528543 DOI 10.

1007/s11199-012-0202-y

ORIGINAL ARTICLE

Agentic and Communal Personality Traits: Their Associations with Depression and Resilience among Transgender Women
Cesar A. Gonzalez & Walter O. Bockting & Linda J. Beckman & Ron E. Durn
Published online: 30 August 2012 # Springer Science+Business Media, LLC 2012

Abstract Research reports the perpetuation of communal traits by transgender women, possibly to affirm their core gender identity. Transgender women in the United States are nearly 6 times more likely than the general population to experience significant depressive symptoms. Studies among non-transgender individuals in the United States demonstrate that agentic traits are associated with less depressive symptoms, while studies on communal traits are more inconsistent in their association with indicators of depression. Our studys central objective was to examine the associations of agency and communion with depression and resilience (i.e., personal competence and acceptance of self and life) among transgender women living part-time and full-time in the female gender role. Participants in the United States were recruited through online and offline purposive sampling. One hundred and twenty-two transgender women (primarily Caucasian; ages ranging from 22 to 75) completed a webbased questionnaire. Results indicated that agentic and communal traits were significantly associated with decreased symptoms of depression and increased levels of resilience. One component of resilience acceptance of self and life
C. A. Gonzalez (*) : W. O. Bockting Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South 2nd Street, Suite 180, Minneapolis, MN 55454, USA e-mail: CesarGonzalezPhD@gmail.com W. O. Bockting e-mail: bockt001@umn.edu L. J. Beckman : R. E. Durn California School of Professional Psychology at Alliant International University, Los Angeles, CA, USA L. J. Beckman e-mail: lbeckman@alliant.edu R. E. Durn e-mail: rduran@alliant.edu

mediated the relationship between agentic/communal traits and depression, however, for communal traits this pattern was only found for transgender women living in the female role full-time. There were no significant differences on depressive symptoms and one component of resilience - personal competence among transgender women living full-time compared to transgender women living in the female role parttime. Transgender women living full-time in the female gender role reported higher levels of agentic/communal traits and acceptance of self and life compared to those living part-time in the female gender role. Our findings are discussed in the context of mental health among transgender women. Keywords Transgender . Agency . Communion . Depression . Resilience . Mental health

Introduction The estimated prevalence of depression among transgender women in the U.S. ranges from 42 to 64 % (Clements-Nolle et al. 2006; Shipherd et al. 2011; Sugano et al. 2006). These rates are at least 5 times higher than the 8.7 % estimated prevalence of depression for the U.S. general population (Angold et al. 1998; Hankin et al. 1998; Nolen-Hoeksema et al. 1991, 1992; Strine, et al. 2008; Weissman et al. 1996; Wichstrom 1999). Despite these statistics, most research on the mental health of transgender people in the U.S. has been the secondary focus of epidemiological studies that instead emphasized prevalence rates for other illnesses such as HIV/ AIDS (e.g., Bockting et al. 2005; Clements-Nolle et al. 2001). Knowledge is particularly limited on the individuallevel risk and protective factors for psychological wellbeing in the transgender population. This knowledge gap is a significant barrier to the development of targeted, evidence-based interventions to promote mental health in this population.

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The primary purpose of this cross-sectional study was to examine the effect of agency and communion personality traits posited to be essential elements of psychological wellbeing (Helgeson 1994) on levels of depression and resilience among transgender women in the U.S. We also tested whether resilience (as a single construct and as two specific factors) would mediate any observed relationship between these personality traits and depression. Lastly, we compared these relationships for transgender women who lived full time and part time in the female gender role. All research cited in this article are based on U.S. samples, unless otherwise stated, and must be considered in that sociocultural context. Our study has a basis in prior research. As described and cited below, there is some evidence from non-transgender samples that agency is associated with lower levels of depression, whereas findings on communion and depression are more inconsistent. Some literature and our clinical experience suggest that many transgender women strongly endorse communal traits; we believe that doing so affirms their gender identity and expression. In other words, by adopting a gender role that embodies how women are supposed to be in the dominant U.S. culture, transgender women validate their internal sense of feeling female and feel more congruent in their gender; this in turn may decrease their gender role conflict and increase their own self-acceptance and connection to other transgender affirming people and environments. However, only one previous study (Strain 2006) has attempted to quantitatively assess these personality traits and their relationship to mental health among transgender women. Thus, additional research is needed to clarify the relationship between agency, communion, resilience, and depressive symptoms in transgender women, for whom the prevalence of depression is alarmingly high. If significant relationships are found, this information could be applied in clinical and community health interventions for transgender women to affirm or challenge the adoption of particular personality traits or increase resiliency in order to promote mental health and well-being. Our work would also provide a foundation for future research in other countries, where gender role traits may differ by culture. As background, we first provide an overview of literature on some other potential contributors to the high rates of depression among transgender women, followed by salient literature on agency and communion and their relationship to resilience and depression in non-transgender populations. We conclude the introduction by articulating the specific hypotheses tested in our analyses. Limited Knowledge of Risk/Protective Factors for Mental Health among Transgender People Contributors to mental health are an understudied area of transgender health. Meyer s model of minority stress (1995,

2003; Meyer et al. 2008) proposes that experiences of stigma such as discrimination and harassment reported to be high among transgender women (Lombardi et al. 2002; Meyer 2003; Shipherd et al. 2011; Stotzer 2009) may contribute to the high rates of mental illness among sexual minorities. In addition, experiences of transphobia defined as enacted stigma and societal discrimination of individuals who do not conform to traditional concepts of gender (Hill and Willoughby 2005) have been linked to lower levels of self-esteem among transgender women (Sugano et al. 2006). Transgender people also experience increased social isolation, a risk factor for depression and suicide (Fitzpatrick et al. 2005; Haas et al. 2011; Nemoto et al. 2011). Yet on the whole, we have limited knowledge on the individual-level risk and protective factors for psychological well-being in this population. Specific to our research, no studies have directly assessed agency and communion and their relationship to depressive symptoms among transgender women. Agency and Communion and Their Relationship to Well-Being Agency and communion are personality traits that are posited to be essential elements of psychological well-being (Helgeson 1994). Agency refers to personality characteristics that are related to an individual focusing on the self; it is manifested through self-confidence, self-assertiveness, and self-direction and is associated with individualistic thinking (Woike 1994). Individuals oriented toward agency experience life fulfillment through individual accomplishments and a sense of independence (Guisinger and Blatt 1994; Helgeson 1994; Spence, and Helmreich 1978). Communion is associated with collectivistic thinking (Woike 1994) and refers to personality characteristics that are related to an individual connecting with others through emotions, nurturance, empathy, and cooperation. Individuals oriented toward communion experience life fulfillment through relationships with others and a sense of belonging (Guisinger and Blatt 1994; Helgeson 1994; Spence, and Helmreich 1978). Agency and communion were found to represent desirable stereotypical characteristics of men and women, respectively; however, both unmitigated agency (e.g., being arrogant) and unmitigated communion (e.g., being overly involved with others) are considered to be undesirable gender traits (Diehl et al. 2004; Helgeson 1994; Twenge 1997). Helgesons (1994, 2003) conceptual model of agency, communion, and well-being suggests that agency and communion are unrelated constructs and that both are needed to maintain physical and mental well-being. Helgeson posits that agency promotes positive mental health, whereas communion promotes interpersonal relationships, and together the balance of these two culminate in a sense of overall well-being.

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Several studies among the general, non-transgender U.S. population have examined the relationship between agency and/or communion and depression and add empirical support for Helgesons model. In large part, studies from the U.S. indicate that agency serves as a protective factor and is associated with lower levels of depression, whereas communion is sometimes (though not always) associated with higher levels of depression. In three meta-analyses (Bassoff and Glass 1982; Taylor and Hall 1982; Whitley 1985), moderate effect sizes were found between agency and lower levels of depression. Similarly, Markstrom-Adams (1989) found that possession of agentic (stereotypically masculine-associated) traits was associated with decreased symptoms of depression, anxiety, and hostility in males and females. In another study, agency was found to shield against the effects of hardship on psychological functioning (Nezu and Nezu 1987; Nezu et al. 1986; Towbes et al. 1989; Lam and McBride-Chang 2007). However, one study found that, after controlling for self-esteem, the effects of agency on depression in men and women were no longer significant (Feather 1985). Research by Carlson and Baxter found that people with a higher degree of communion (i.e., stereotypically feminineassociated traits such as emotional, submissive, passive) reported more symptoms of depression (Carlson and Baxter 1984). In other U.S. studies, communion was associated with higher interpersonal and marital functioning (Aube et al. 1995; Kurdek and Schmitt 1986a, b; Zeldow et al. 1985). Moreover, findings on communion are more inconsistent compared to agency, with studies finding minimal to no association with depressive symptoms (Bassoff and Glass 1982; Helgeson 1994; Kreiger and Dumka 2006; Mosher and Danoff-Burg 2008; Whitley 1985). All of these studies looked at agency and communion in the U.S. general population, without considering participants sexual orientation or people with a transgender identity. Agency and Communion among Non-Transgender LGB Individuals Sexual orientation and gender identity are distinct constructs; sexual orientation refers to a persons sexual attraction, whereas gender identity refers to a persons internal sense of being a man and/or woman (Israel et al. 2001). However, non-transgender gay, lesbian, and bisexual individuals are similar to transgender individuals in that many experience minority stress because of the stigma attached to their identity (Meyer 2003; Snchez and Vilain 2009). Therefore, in the absence of studies (except one, described below) that quantitatively examined the relationship between agency, communion and depression among transgender people, we reviewed relevant studies from the U.S. that included non-transgender, gay-identified individuals to

assess whether the effects of agency and communion on depression were similar to those found in the general population. Carlson and Baxter (1984) found that, among nontransgender gay men, higher levels of communion and lower levels of agency were associated with higher levels of depression. In a study by Carlson and Steuer (1985), agentic traits were associated with psychological well-being in both gay and heterosexual, non-transgender men and women; communal traits had no significant effect on psychological well-being. A more recent study tested and confirmed a causal model that linked communal traits to depressive symptoms among non-transgender gay men (Josephson and Whiffen 2007). Together, these results indicate that in the U.S., agency is more consistently associated with increased psychological well-being among non-transgender men and women, across sexual orientations, than is communion. This finding may be a result of the cultural values placed on agency across social groups in the U.S. (Schwartz and Rubel 2005). For example, among gay men in the U.S., agentic traits are more socially valued than communal traits (Snchez et al. 2009); and as suggested by research, the less an individual holds the more valued traits, the greater the psychological distress (Josephson and Whiffen 2007; Szymanski & Carr 2008). Among transgender women, the perpetuation of communal traits may lessen gender role conflict because of the association that society has among communal traits and being female/woman, thus validating transgender womens internal sense of being female. This guides our hypotheses that transgender women who live full-time in the female role will have less levels of depression because their gender identity is, theoretically, validated throughout their daily lives. Unlike non-transgender gay men, transgender women are shown to value communal traits, as described next. Agency and Communion among Transgender Women Among transgender women in the U.S., findings suggest that transgender women strongly endorse communal traits (Herman-Jeglinska et al. 2002; Lippa 2001; Lothstein 1984; Melendez and Pinto 2007; Rodriguez-Madera and ToroAlfonso 2005). To our knowledge, however, only one study in the U.S., a doctoral thesis (Strain 2006), quantitatively examined the relationships between agency, communion, and depression among transgender women (N 0 105). In that study, communion was significantly associated with lower levels of depression and higher levels of self-esteem. Similarly, the results of qualitative research by Nuttbrock and colleagues (2002, 2009) suggest that among transgender women, there is a positive relationship between being acknowledged as female and mental health. These findings which suggest that communion may be a protective factor for depression in transgender women is contrary to most

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of the literature for non-transgender women and men, in which communion was found to have minimal to no association with depressive symptoms (Bassoff and Glass 1982; Helgeson 1994; Kreiger and Dumka 2006; Mosher and Danoff-Burg 2008; Whitley 1985). Resilient Personalities Resilience is a broad concept defined by Masten and Reed (2002) as a reliable positive adjustment despite hardships or risks. Resilience has also been described as the presence of cumulative protective factors or processes that buffer the effects of adversity among individuals (Hjemdal et al. 2006). Wagnild and Young (1993) described resilience as a positive personality characteristic that augments adaptation, lessens the negative effects of stress, and restores equilibrium despite overwhelming adversity. Wagnild and Young conceptualized two specific components to resilience: (1) personal competence and (2) acceptance of self and life. Personal competence relates to self-reliance, independence, determination, mastery, and resourcefulness and perseverance; whereas acceptance of self and life relates to adaptability, balance, flexibility, and a balanced perspective of life (Wagnild and Young 1993). Interestingly, the definitions for resilient personalities reflect some of the definitions of agency and communion. For example, resilient personalities have been characterized by traits that reflect both a strong, well-differentiated/integrated sense of self (similar to agency), and traits that facilitate interpersonal relationships with others (similar to communion; Shiner 2000). In our study, we adopted Wagnild and Youngs description of resilience to evaluate its association with agency and communion in transgender women, and to assess whether resilience mediated any observed relationship between agency, communion, and depression. In a study of adult resiliency as a predictor in the development of psychiatric symptoms, Hjemdal and colleagues (2006) found that individuals who reported higher levels of resiliency had virtually unchanged levels of psychiatric symptoms after being faced with stressful life events; further, individuals with lower levels of resiliency had higher levels of psychiatric symptoms after being faced with stressful life events than before they were faced with the stressful events. Ong, Bergeman, Bisconti, and Wallace (2006) concluded that individuals with high levels of resilience have more positive emotions and that, over time, those positive emotions help individuals in their ability to effectively rebound from hardships. These researchers also found that individuals with lower levels of resilience tended to have difficulty regulating negative emotions and were significantly more reactive to daily stressful life events. Only a few studies, all in the U.S., have examined resilience characteristics among transgender individuals, making

resilience perspectives under-studied in transgender health. A qualitative study on the resilience strategies of 21 transgender individuals found five common themes with respect to resiliency: a sense of knowing their own identity; embracing self-worth; awareness of societal oppression; connection with a supportive community; and fostering hope for the future (Singh et al. 2011). Similarly, another qualitative study of 55 transgender youth found similar themes (e.g., self-esteem, a sense of personal mastery) associated with less mental health problems (Grossman et al. 2011). A quantitative study conducted by Strain and Shuff (2011) among 105 transgender women found that self-acceptance and being out about ones transgender status were associated with decreased depression. Together, these results suggest that acceptance of self and connections to others are important factors associated with resiliency and decreased depression. Given the high level of stigma and traumatic life events reported by transgender women, resilience may be an important characteristic for maintaining positive mental health. Study Objective and Hypotheses The overall objective of our study was to acquire new knowledge and examine the associations of agency and communion with levels of depression and resilience (i.e., personal competence and acceptance of self and life) among transgender women living part-time and full-time in the female gender role in the U.S. Our specific hypotheses, informed by the literature outlined above, were as follows: 1. Agency among transgender women will be associated with (a) lower levels of depression and (b) higher levels of resilience. 2. Communion among transgender women will also be associated with (a) lower levels of depression and (b) higher levels of resilience. 3. Resilience (i.e., personal competence and selfacceptance) will mediate the relationship between agency and communion. In other words, communion/agency is associated with decreased depression; however, it is the increased resilience that explains the relationship between communion/agency and decreased depression (Fig. 1). 4. Transgender women who reported living full-time in the female gender role will have (a) higher levels of both agency and communion; (b) lower levels of depression; and (c) higher levels of resiliency compared to transgender women who reported living part-time in the female gender role. Further, (c) there will be no differences in the hypothesized mediational models and paths for combined sample compared to transgender women living in the female role full-time or part-time.

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Agency/ Communion c

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Depression

Resilience a Agency/ Communion + c'

b Depression

Fig. 1 Hypothesized model and path directions

Method This study received Institutional Review Board approval before it was implemented. Participant Characteristics The sample consisted of 122 transgender women, all of whom reported being from the United States. Sixty-four percent of the sample reported presenting full-time in the female role. Demographic information on the total sample and by time living in the female role (full-time and part-time) is in Table 1. The mean age of all participants was 46.77 years old (SD 0 12.15; range 2275). The majority (83.6 %) self-identified as Caucasian. Forty percent of participants reported having a high school education or less, while approximately 59 % reported having a college degree. The majority (44.3 %) of participants reported earning over $50,000 in annual income, whereas 27.9 % reported earning $20,000 or less. In terms of sexual orientation, 42.4 % identified as bisexual, 29.7 % as heterosexual, and 27.9 % as gay/homosexual. With respect to relationship status, 56.6 % reporting in a relationship, and 24.6 % were separated or divorced. Measures Participants completed a web-based survey that assessed demographics, agency and communion, symptoms of depression, and resilience. Time spent living in the female role was assessed with one-item, How much of the time do you present yourself as a woman? Participants were able to select part-time or full-time. The effects of hormone therapy on mood among transgender people are inconsistent. A study from the Netherlands found increased depressive symptoms with hormone therapy (Asscheman et al. 1989), while a recent study from France found an increased quality of life (GorinLazard et al. 2012) associated with hormonal treatment among transgender people. Because of these inconsistencies we assessed current hormone use and subsequently tested it as a potential confounding variable. Participants were asked about

current hormone therapy on the questionnaire through the following question: Are you currently taking hormones? Participants were able to select yes or no. Agency and communion were assessed with the 24-item (5point Likert scale; 04) Personal Attributes Questionnaire (PAQ; Spence and Helmreich 1978). Responses on the PAQ range from not at all to very. Examples of items are: Not at all aggressive. . . Very aggressive and Not at all emotional. . . Very emotional. Two subscale (agency and communion) scores were computed by summing their respective items. Agency in the PAQ is recognized as masculinity (PAQ-M; 8 items; score range 0 032), and communion, as femininity (PAQ-F; 8 items; score range 0 032). For our sample, the internal consistency reliability estimates (Cronbachs alpha) for these subscales were .74 and .75, respectively. Resilience was assessed with the 25-item (7-point Likert scale; 17) Resilience Scale (RS; Wagnild and Young 1993). Response options range from 1disagree to agree. Authors of the RS report two factors, Personal Competence (RS-PC; 17-items; e.g., When Im in an emergency, I can usually find my way out of it, I am determined) and Acceptance of Self and Life (RS-ASL; 8-items; e.g., My life has meaning, Its okay if there are people who dont like me). The total score for the RS, the RS-PC subscale, and the RS-ASL were obtained by summing their respective items, with higher scores indicating higher levels of resilience. For our sample, the internal consistency reliability estimates (Cronbachs alpha) were .91for the total scale, .89 for the RS-PC subscale, and .80 for the RS-ASL subscale. Depression was assessed with the 20-item (4-point Likert scale; 03) Center for Epidemiology Studies Depression scale (CES-D; Radloff 1977). The CES-D asks participants to selfreport how they felt during the past week. Examples of items are: I was bothered by things that usually dont bother me and I felt depressed. Total scores for the CES-D range from 0 to 60, with higher scores indicating higher levels of depression; a total scale score of 16 or greater is considered indicative of depression. The internal consistency reliability estimate (Cronbachs alpha) for the CES-D in our sample was .91. Procedures Participants were recruited through purposive sampling in 2007 through transgender-related Internet sites and list-servs; email; authors personal and professional contacts; and flyers posted at a transgender friendly medical clinic in San Francisco, California. Upon reaching the survey website, potential participants were asked whether they were 18 years of age or older and whether they self-identified as transgender male-to-female. If both questions were answered yes, then respondents were forwarded to a consent form. After completion of the consent process they were forwarded to the survey. The instruments administered in the survey were in the

Sex Roles (2012) 67:528543 Table 1 Participant demographic characteristics Total sample (N 0 122) M (SD) 46.77 (12.15) n (%) 5 (4.1) 30 (24.6) 15 (12.3) 72 (59.1) n (%) 19 (15.6) 15 (12.3) 10 (8.2) 13 (10.7) 11 (9.0) 54 (44.3) n (%) 8 (6.6) 3 (2.5) 6 (4.9) 3 (2.5) 102 (83.6) n (%) 23 (18.9) 69 (56.5) 30 (24.6) n (%) 35 (29.7) 50 (42.4) 33 (27.9)

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Living in female role Part-time (n 0 41) M (SD) 49.44 (11.43) n (%) 2 (4.9) 11 (26.8) 5 (12.2) 23 (56.1) n (%) 2 (4.9) 5 (12.2) 1 (2.4) 7 (17.1) 4 (9.8) 22 (53.7) n (%) 2 (4.9) 0 (0) 0 (0) 0 (0) 41 (95.1) n (%) 6 (14.6) 28 (68.3) 7 (17.1) n (%) 15 (38.5) 17 (43.6) 7 (17.9) Full-time (n 0 72) M (SD) 45.27 (12.37) n (%) 3 (4.2) 19 (26.4) 8 (11.1) 42(58.3) n (%) 17 (23.6) 9 (12.5) 9 (12.5) 4 (5.6) 6 (8.3) 27 (37.5) n (%) 5 (6.9) 1 (1.4) 5 (6.9) 3 (4.2) 58 (80.6) n (%) 13 (18.1) 36 (50 %) 23 (31.9) n (%) 16 (22.9) 31 (44.1) 23 (32.8)

Age Education Less than high school High school Vocational training (No degree) College degree Income Less than $10,000 $10,000$20,000 $20,001$30,000 $30,001$40,000 $40,001$50,000 $50,001 + Primary race/Ethnic identification Asian American African American Latina/Hispanic Native American Caucasian (not Latino/Hispanic) Marital/Relationship Status Single; Not in a relationship In a relationship Divorced/separated Sexual orientation Heterosexual/straight Bisexual Homosexual/gay

following order: demographics questionnaire, PAQ, CES-D, and RS. Participants were given a choice to decline answering any survey question. The survey did not ask for any identifying information. Participants did not receive any compensation for their involvement in the study. Data Preparation All data were transferred securely from the study website to the study database by a Secure Sockets Layer protocol that encrypted the data and facilitated secure communication over the Internet. Participants were excluded from the analyses if they did not complete the three standardized instruments; if they scored three standard deviations from the mean on any measure, indicating an extreme response-style; or if there were any duplicated cases. Data were cross-validated by comparing Internet protocol (IP) addresses. Participants completed a total of 191 surveys. Sixty-six participants did not complete all instruments and had multiple non-responses to items, these

cases were deleted; this resulted in no missing data among the studys main variables (i.e., agency, communion, depression, and resiliency). An additional six cases were removed from the dataset for scoring three standard deviations from the mean on the PAQ and Resilience Scale. Thus, the final sample size was 122 self-identified transgender women. All predictor and covariate variables were assessed to determine if they met the statistical assumptions for subsequent analyses (Tabachnick and Fidell 2007). Scores for the communion (PAQ-femininity) subscale had a moderate negative skew, and scores for the CES-D had a moderate positive skew. Therefore, appropriate transformations (e.g., logarithmic, square root) were performed on these data and parametric tests were performed. We tested for associations between the two groups (living full-time and part-time in female role) on demographic and outcome variables (depression and resilience, including self-competence, and acceptance of self and life) to determine whether they were confounding variables. A significant positive association was found between age and the

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agency subscale score (r 0 .28, p <.01). Therefore, age was statistically controlled for in all subsequent analyses that incorporated the agency (PAQ-M) subscale. Whether or not the participant was on hormone therapy was not associated with depression or length of time as living in the female role. Age and living in the female gender role part-time or full-time gender role were not correlated.

Hypothesis 2a: Communion will be negatively associated with depression Results of a Pearsons productmoment correlation indicated that communion is negatively associated with depression (r 0 .24, p <.01) and explained approximately 6 % of the variance in depression scores. Hypothesis 2b: Communion will be positively associated with resiliency factors Pearsons productmoment correlation results indicated that communion scores were positively associated with personal competence (r 0 .34, p <.001) and self-acceptance (r 0 .33, p <.001). Communion scores explained 12 % of the variance in personal competence and 11 % of the variance in selfacceptance. Hypothesis 3: Resilience will mediate any observed relationship between hypotheses 1a and 2a To test the hypothesis that resilience will mediate the relationship between agency/communion and depression, we used the Preacher and Hayes (2004, 2008) SPSS macro. This is a bias-corrected and accelerated bootstrapping method (non-parametric; Preacher and Hayes 2004, 2008). Compared to Baron and Kennys (1986) steps for mediation analysis, the Preacher and Hayes (2004, 2008) approach provides greater statistical power and precision when calculating confidence intervals for indirect effects despite sample size, effect size, or level of statistical significance (MacKinnon et al. 2004; Mallinckrodt et al. 2006; Preacher and Hayes 2004, 2008). In our analysis we employed bootstrapping (continuous resampling; 20,000 times) of our dataset to estimate the indirect effect. Interpretation of the bootstrapping procedures involved assessing whether the 95 % confidence interval (lower and upper) for the mediation effect included zero; confidence intervals that did not include

Results To test hypotheses 13 the total sample (N 0 122) was utilized. Hypothesis 4 compared transgender women living in the female role full-time to transgender women living in the female role part-time. Intercorrelations of study variables by time spent living in the female role are presented in Table 2. Hypothesis 1a: Agency will be negatively associated with depression Nearly half (46 %) of participants scored 16 or higher on the CES-D (M 0 16.44, SD 0 10.89). A Pearsons productmoment correlation coefficient (two-tailed) was calculated to test for associations between agency and depression. When controlling for age, a statistically significant negative relationship was found between agency and depression in the total sample (r 0 .54, p <.001), suggesting that agency explained approximately 29 % of the variance in depression. Hypothesis 1b: Agency will be positively associated with resiliency factors A statistically significant positive correlation was found between agency and personal competence (r 0 .63, p <.01; adjusted for age), and acceptance of self and life (r 0 .59, p <.01). Agency scores explained approximately 40 % of the variance in personal competence, and 35 % of the variance in acceptance of self and life.

Table 2 Intercorrelations of study variables for transgender women living in the female role full-time and part-time Construct (Scale) 1. 2. 3. 4. 5. Agency (PAQ-M) Communion (PAQ-F) Personal Competence (RS-PC) Acceptance of Self and Life (RS-ASL) Depression (CES-D) 1 .42** .70*** .56** .46** 2 .12 .14 .53 .08 3 .52*** .36** .73*** .69*** 4 .61*** .36** .78*** .73*** 5 .53*** .24* .54*** .64***

Intercorrelations for transgender women living full-time in the female role (n 0 63) are presented above the diagonal, and intercorrelations for transgender women living part-time (n 035) are presented below the diagonal. For all scales, higher scares are indicative of endorsement of the respective construct. PAQ-M Personal Attributes Questionnaire, Masculinity subscale (theoretical score range: 032); PAQ-F Personal Attributes Questionnaire, Femininity subscale (theoretical score range: 032); RS-PC Resilience Scale, Personal Competence subscale (theoretical score range: 17119); RS-ASL Resilience Scale, Acceptance of Self and Life subscale (theoretical score range: 856); CES-D Center for Epidemiologic Studies Depression Scale (theoretical score range: 060). * p <.05. ** p <.01. *** p <.001

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zero indicated that a mediation effect was statistically significant (Preacher and Hayes 2004, 2008). The 95 % CI of the total indirect effect of agency (adjusting for age) on depression through overall resilience (both personal competence and acceptance of self and life) in the total sample was estimated within [1.29, .51] and indicated that the combination of the two resilience constructs was a significant mediator. When evaluating the components of resilience among the total sample, the indirect effect of agency on depression through personal competence was not significantly different from zero [ .55, .42]. However, the 95 % CI of the indirect effect of agency on depression through acceptance of self and life was significantly different from zero, and estimated within [ 1.28, .35]. The overall mediation model for the total sample was significant, F(4, 104) 0 26.26, p <.0001, and accounted for approximately 50 % of the variance in depressive symptoms. In the total sample, the 95 % CI of the total indirect effect of communion on depression through overall resilience (both personal competence and acceptance) of self and life was estimated within [ 1.05, .36] and indicated that the combination of the two resilience components was a significant mediator. In specifically evaluating each of the resiliency components among the total sample, it was determined that the specific indirect effect of communion on depression through personal competence was not significantly different from zero [ .46, .07]. The indirect effect of communion on depression through acceptance of self and life was significantly different from zero and was estimated within [ .91, .22]. The overall meditation model was significant in the total sample, F(3, 118) 0 36.46, p <.0001 and accounted for approximately 48 % of the variance in depressive symptoms. Hypothesis 4

Hypothesis 4a: Transgender women living full-time in the female gender role will have higher levels of both agency and communion There were significant differences between living full-time and part-time in the female role and agency scores, F(2, 97) 0 6.54, p 0 .002, partial 2 0 .12; adjusting for age) and communion scores ( F (1, 111) 0 12.71, p 0 .001, partial 2 0 .10; Table 3). Scores on agency and communion were significantly higher for transgender women living in the female role full-time compared to transgender women living part-time in the female gender role (see Table 3 for means and standard deviations). Hypothesis 4b: Transgender women living full-time in the female gender role will have lower levels of depression Results indicated that there were no significant differences on depression scores between transgender women living in the female gender role full-time versus part-time, F(1, 111) 0 2.50, p 0 .12, partial 2 0 .02. Hypothesis 4c: Transgender women living full-time in the female gender role will have higher levels of resilience (i.e., personal competence and acceptance of self and life) compared to transgender women living in the female role part-time There were no significant differences on scores of personal competence, F(1, 111) 0 4.88, p 0 .03, partial 2 0 .04, between transgender women living full-time in the female role
Table 3 Summary of means and standard deviation for transgender women living in the female role full-time and part-time Construct (Scale) Time living in female role Part-timea M 1. Agency (PAQ-M) 2. Communion (PAQ-F) 3. Personal Competence (RS-PC) 4. Acceptance of Self and Life (RS-ASL) 5. Depression (CES-D)
a

Intercorrelations comparing transgender women who live in the female role full-time versus part-time are presented in Table 2. To examine hypotheses 4a4c, related to differences on study variables between transgender women living fulltime and part-time in the female role, we utilized Hotellings Trace multivariate test. The multivariate effect of living in the female role full-time compared to part-time was significant [Hotellings T 0.20, F(5, 107) 0 4.22, p 0 .002], with the effect of time living in the female role (full-time compared to part-time) on agency/communion, depression, and resilience being large (partial 2 0 .17). To assess the specific hypotheses on the effect of living in the female gender role full-time versus part-time on agency/communion, depression, and resilience (i.e., self competence and acceptance of self and life) subsequent univariate tests were conducted. To reduce Type I error (due to multiple dependent variables being analyzed) we utilized a reduced 0 .05/5 0 .01 to indicate significance.

Full-timeb SD 4.93 4.25 14.86 8.40 11.18 M 22.14 27.29 116.13 38.31 15.24 SD 4.96 3.71 17.27 7.42 11.04

20.39 24.56 109.03 33.01 18.67

n 0 41; b n 0 72; PAQ-M Personal Attributes Questionnaire, Masculinity subscale (theoretical score range: 032); PAQ-F Personal Attributes Questionnaire, Femininity subscale (theoretical score range: 032); RSPC Resilience Scale, Personal Competence subscale (theoretical score range: 17119); RS-ASL Resilience Scale, Acceptance of Self and Life subscale (theoretical score range: 856); CES-D Center for Epidemiologic Studies Depression Scale (theoretical score range: 060). Higher scores on each of the scales indicate higher endorsement of the respective construct

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compared to those living part-time in the female role. However, there were significant differences in respect to acceptance of self and life, F(1, 111) 0 12.08, p 0 .001, partial 2 0 .10, between transgender women living full-time in the female gender role compared transgender women living parttime in the female role, with transgender women living in the female role full-time scoring significantly higher (see Table 3 for descriptive statistics). Hypothesis 4d: Living in the female role full-time, compared to part-time, will not have any effect on the hypothesized mediational model (hypothesis 3) We examined the effect of living in the female role full-time compared to part-time on the hypothesized meditational model. The indirect effects of the components of resilience on agency and depression for transgender women living in the female role full-time and part-time are presented in Fig. 2. The 95 % CI of the total indirect effect of agency (adjusting for age) on depression through both personal competence and acceptance of self and life for transgender women living full-time and part-time in the female gender role indicated that agency was related to increased personal competence and acceptance of self and life. Personal competence did not mediate the relationship between agency and depression for both groups. However, acceptance of self and life was found to mediate the relationship between agency and depression among both groups. The 95 % CI of the total indirect effect of communion on depression through both personal competence and acceptance of self and life for transgender women living full-time compared to part-time in the female gender role indicated that communion was only related to increased personal
Fig. 2 Indirect effects of the components of resilience on agency and depression among transgender women living in the female role a full-time and b part-time Note. Coefficients are unstandardized. CI 0 95 % confidence interval. 20,000 Bootstrap iterations. Significant mediator. Model summary for full-time sample (adjusting for age), R2 0 .44, p 0 .001, n 0 64. Model summary for part-time sample (adjusting for age), R2 0 .60, p 0 .001, n 0 36. *p <.01. **p <.001. ***p <.001

competence and acceptance of self and life for transgender women living in the female role full-time but not for those living in the female role part-time (Fig. 3). Further, unlike the other models, personal competence was the only variable associated with decreased depression among transgender women living part-time in the female role.

Discussion Our study of transgender women was primarily designed to acquire new knowledge and examine the associations of agentic and communal traits with levels of depression and resilience (i.e., personal competence and acceptance of self and life) among transgender women living part-time and full-time in the female gender role in the U.S. In our sample of transgender women, agency was negatively associated with depression. This result supported our hypothesis and is consistent with previous research showing that agency may serve as a protective factor against depression among non-transgender women and men (Antill and Cunningham 1979; Bassoff and Glass 1982; Carlson and Baxter 1984; Carlson and Steuer 1985; Josephson and W h i ff e n 2 0 0 7 ; L a m a n d M c B r i d e - C h a n g 2 0 0 7 ; Markstrom-Adams 1989; Nezu and Nezu 1987; Nezu et al. 1986; Taylor and Hall 1982; Towbes et al. 1989; Whitley 1985). Agentic characteristics and traits (e.g., being independent, active, competitive, self-confident) are commonly valued in our society (Helgeson 1994). For transgender women, agentic characteristics may help to cope with the minority stress that may result from stigma experienced as a result of being gender nonconforming and a member of a minority group (Lombardi et al. 2002; Meyer 2003; Stotzer

(a) Full-time
a1 1.81***

Personal Competence [-.50, .63]

b1 - .03

c -1.20***
Agency a2 .90***

c'

-.51 -.71*

Depression

Acceptance of Self and Life

b2

(b) Part-time
a1 2.47***

Personal Competence [-1.67, .27]

b1 - .20

c
Agency a2 1.08** *

-1.22* -.13 -.79 * Depression

c'

Acceptance of Self and Life

b2

Sex Roles (2012) 67:528543 Fig. 3 Indirect effects of the components of resilience on communion and depression among transgender women living in the female role a full-time and b part-time Note. Coefficients are unstandardized. CI 0 95% confidence interval. 20,000 Bootstrap iterations. Significant mediator. Model summary for full-time sample, R2 0 .41, p <.001, n 0 72. Model summary for part-time sample, R2 0 .59, p 0 .001, n 0 41. *p <.01. **p <.001. *** p <.001

537

(a) Full-time
a1 1.66**

Personal Competence [-.51, .40]

b1 - .07

c
Communion a2 .72**

-.71* -.01 -.82*** Depression

c'

Acceptance of Self and Life

b2

(b) Part-time
a1 .49

Personal Competence [-.68, .08]

b1
- .25*

c
Communion a2 .20

-.20 -.05 -.54** Depression

c'

Acceptance of Self and Life [-.66, -.42]

b2

2009; Wylie et al. 2010). The minority stress stemming from such stigma and discrimination has been postulated to contribute to the disproportionate rates of depression in this population (Bockting 2009; Clements-Nolle et al. 2006). Agentic characteristics may aid in coping with minority stress, thereby ameliorating the negative effects of stigma and discrimination on mental health (Helgeson 1994). In the general U.S. population, agentic traits are associated with lower levels of rumination about sadness, which in turn is associated with lower levels of depression (Wupperman and Neumann 2006), this may be what is facilitating the reduction of depressive symptoms among transgender women. Similar to agency, communion was also associated with lower levels of depression in our sample of transgender women; however, communion was significantly correlated to less depressive symptoms among transgender women living in the female role full-time. This result differs from some of the previous findings for non-transgender women and men, which found communion/femininity to be associated with higher levels of depression and decreased selfesteem (Barrett and White 2002; Marsh et al. 1987; Orlofsky and OHeron 1987; Wupperman and Neumann 2006), but is consistent with our hypothesis and results from the doctoral thesis (Strain 2006) examining the relationship between communion and depression among transgender women. Communion may be especially salient for transgender women seeking to affirm their cross-gender identity, serving as an important source of gender validation that contributes to (rather than compromises) self-esteem (Nuttbrock et al. 2002, 2009; Singh 2010). Indeed, we found that transgender women who lived full-time in the female gender role had higher communion scores than those of transgender women living part-time in the female gender

role. This may also result in less gender role conflict; otherwise, their internal sense of their gender was validated through the associated gender traits, in this case communal traits. Overall, for transgender women living in the female role full-time, communion may function differently for transgender and non-transgender women in the U.S. because of the sociocultural context. In a patriarchal-centered sociocultural context, communion in women who were assigned female at birth and raised as girls/women may be perceived as a negative trait with connotations of submission, oppression, and being tooother-directed, whereas for transgender women who were assigned male at birth and raised as boys/men, communion may have a positive connotation because it affirm their femininity and core female gender identity. Communal traits may function differently for transgender women living in the female role part-time due to gender transitioning stage or the need to present both male and female attributes to others. Qualitative research is needed to identify potential differences in how femininity is experienced, perceived, and expressed among transgender and non-transgender women, and to what extent certain aspects of communion/feminine traits are experienced as limiting versus empowering in specific sociocultural contexts. Among transgender women, such research could inform positive interpretations and expressions of communion and femininity to promote resilience. Moreover, nontransgender women who are oriented toward communion might be able to benefit from a deeper understanding of the positive, potentially validating and empowering aspects of communion. In other words, if communion can work in a positive way for transgender women living in the female role full-time, perhaps there is a way for both transgender

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women living in the female role part-time and nontransgender women to reclaim communion/femininity in a way that is also empowering and can enhance resilience. With only a few published research reports on transgender people and resilience to guide us, we hypothesized based on clinical experience, Helgeson s model, and Wagnild and Youngs conceptualization of resilience that the relationships between agentic/communal traits and depression would be mediated by resilience (specifically, the components of personal competence and acceptance of self and life), which in turn would be associated with lower levels of depression. Our findings partly supported our hypotheses. Our hypothesis that transgender women living full-time in the female gender role would score lower on depression was not supported. Our findings indicated that depression symptoms were not associated with time living in the female role full-time or part-time. This finding is unlike that found by Shipherd and colleagues (2011) who found a small effect of more time dressed in the female role on levels of depression; with those who spent less time dressed in the female role scoring higher on the CES-D. This inconsistent finding may be a result of how groups were compared. In Shipherds study, groups were binned into more time dressed versus less time dressed, whereas in our study we dichotomized the groups based on whether they reported living in the female gender role full-time or part-time. Further, the results may also be due to low statistical power, given the relatively smaller sample sizes. Most importantly, our findings suggests that time spent living in the female gender role may be an important factor to considered in future studies and that other variables may need to be examined when comparing transgender women living in the female role full-time compared to part-time. For example, from clinical experience we know that not all transgender women have the goal to live in the female role full-time. Further, our analyses did not find significant differences among transgender women living in the female role full-time, compared to part-time, in regards to one component of resilience - personal competence (i.e., self-reliance, independence, determination, mastery, and resourcefulness and perseverance) - whereas we did find significantly higher scores on acceptance of self and life (i.e., adaptability, balance, flexibility, and a balanced perspective of life). Societal stigma and discrimination around being transgender may contribute to these findings. For example, research that compares transgender to nontransgender individuals suggests that transgender individuals report feeling different early in life and may lead to suppression of their own expression in order to avoid coercion and rejection from others (Simon et al. 2011). Further, research indicates that transgender women report increased feelings of defectiveness, social isolation, and have underlying beliefs that others may

not meet their emotional needs, all of which may be related to early social adversity (Simon et al. 2011). This in turn may lead transgender women to have strong beliefs that they need to solely rely on themselves because others will not be able to support them. The higher levels of acceptance of self and life found in the group of transgender women living full-time in the female gender role may be the result of psychotherapy, which is associated with increased resilience among non-transgender individuals (Heilemann et al. 2011) and is encouraged for transgender individuals before living full-time in the gender opposite to their sex (World Professional Association for Transgender Health 2011). The overall goal of psychotherapy for transgender people is to integrate their gender identity and maximize well-being, quality of life, and self-fulfillment (Fraser 2009; Bockting 2008). In addition to resilience, other mechanisms may be influencing gender traits and symptoms of depression. We suggest that future research be conducted to replicate our findings with a larger and more diverse sample of transgender women and to identify mediating and moderating variables between gender traits and depressive symptomatology in this population. For example, a study of people with unmitigated agency and communion may yield further information into the dynamic between agency and communion on depression and resilience. Clinical and Research Implications Altogether resilience was a significant mediator among the hypothesized models; however, only acceptance of self and life, a component of resilience was the only mediator between agency and depression among transgender women living in the female role full-time and part-time; personal competence did not have an indirect effect. Unexpectedly, acceptance of self and life was a not a significant mediator between communion and depression among transgender women living in the female-role part-time. Acceptance of self and life, which relates to adaptability, balance, flexibility, and a balanced life perspective (particularly when it comes to life changes), may indicate a tendency toward self-compassion and flexibility, constructs associated with healthy psychological functioning (Neff 2003; Neff et al. 2007; Vettese et al. 2011). It may be that transgender women who live in the female role part-time are less likely to have integrated their gender identity and may also experience increased minority stress, leading to increased emotional inhibition and reduced cognitive resources and abilities that exercise elements of resilience (Hatzenbuehler 2009). Unlike transgender women living in the female role part-time, communal traits among transgender women living in the female role full-time may serve as a vehicle for transgender womens own self-acceptance of their gender identity, as well as increased opportunities to be validated for their gender by others. Similar results were reported in other studies

Sex Roles (2012) 67:528543

539

on transgender people and resilience that found that selfacceptance and knowing ones identity and being secure about being transgender and being out as transgender was related to increased well-being (e.g.,Grossman et al. 2011; Singh et al. 2011; Strain and Shuff 2011). Research demonstrates that increased resilience mitigates psychiatric symptoms after stressful life events (Hjemdal et al. 2006). The high prevalence of psychological distress among transgender people (Clements-Nolle et al. 2006; Shipherd et al. 2011; Sugano et al. 2006) may be reduced by increasing resilience, particularly acceptance of self and life. Increasing resilience may also lead to increased self-esteem through the feeling connected and accepted by others who are transgender-identified (Snchez and Vilain 2009). Together, these elements may play a key role in fostering resilience in the face of stigma and suggest that the centerpiece of mental health interventions should focus on increasing resilience, particularly acceptance of self and life. Our data suggested that there are no significant differences between levels of depression among transgender women who live full-time versus those who live part-time. Given the high rates of depression found in our sample, and in other studies (e.g.,, Clements-Nolle et al. 2006; Shipherd et al. 2011; Sugano et al. 2006), it should not be assumed that transgender women living in the female role part-time or full-time is associated with levels of depression. Our findings suggests that gender transitioning may alleviate gender dysphoria but may not address mental health concerns (as a result of minority stress) and may require specific focus during and after the gender transition process, even when transgender women are living full-time in the female role. Our data suggested that treatment for depression should be targeted to both groups (those living full-time and part-time in the female gender role) of transgender women. Further, in our sample we found those who were living full-time in the female gender role had higher levels of acceptance of self and life, one component of resilience. This may be indicative of the positive effects of transgender clients gender transitioning on self-acceptance and having an understanding of ones identity. Further, understanding the function of gender-associated personality traits in transgender individuals is an important element for clinicians, particularly because transgender people commonly endorse communal traits (Herman-Jeglinska et al. 2002; Lippa 2001; Lothstein 1984; Melendez and Pinto 2007; RodriguezMadera and Toro-Alfonso 2005). In assessing agentic and communal traits among transgender individuals, clinicians may have a better understanding of their clients and the variables that influence not only mental distress but also resiliency. This does not mean that in clinical practice one should only affirm communion-related behaviors, but rather, that some level of discussion of what it means to hold agentic/communal traits is important for transgender women

to consider and perhaps that one can still be other-focused through communal traits and yet still get core needs met by being assertive through agentic traits. Qualitative research should investigate what mechanisms of aspects of communion and agency is important. Our findings suggest that it may be worthwhile to explore how transgender women perceive agency/masculinity and communion/femininity and how these stereotypical traits can be empowering to the individual if they are viewed in terms of agency and communion. Future research to explore what parts of communion adds to resilience versus what parts may be maladaptive may add to the literature. Further, our sample was primarily Caucasian, thus our results capture a primarily white perspective of agency and communion. It is recommended that future research evaluate agency and communion among ethnic/racial diverse samples to assess whether agency and communion, and time living as female among transgender people from diverse backgrounds have the similar associations on levels of depression. Previous arguments on communal traits and their associations to negative health outcomes (e.g., decrease condom negotiation; Melendez and Pinto 2007; Rodriguez-Madera and Toro-Alfonso 2005) may still be valid, however, because of a potentially new understanding of how sociocultural context (e.g., valued gender traits for a particular culture) impact well-being, we can leverage off this to positively influence resilience and thus the focus of interventions should be on specific aspects of the constructs (e.g., increasing self-esteem, assertiveness, and negotiation) rather than admonishing the concepts of agency or communion. Study Limitations and Strengths A limitation of our study is that we only measured agency and communion to study gender-related characteristics. Researchers have argued that agency and communion are multifactorial constructs and should be assessed not only through gendered personality traits but must also through behavioral traits (Aube et al. 1995; Saragovi et al. 1997). While this may be a limitation of our study, a substantial amount of research has been conducted with the traditional conceptualization of gender role; this may be beneficial for group comparisons. Nevertheless, researchers evaluating gender traits among transgender women in future research could incorporate the more modern conceptualization of unmitigated communion and agency and assess how it is related to mental health outcomes. Another limitation is that we assessed only one mediating variable (resilience), on the relationship between agency/ communion and depression. Future work might examine the influence of other variables, such as gender dysphoria. It is conceivable that agentic traits are associated with

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decreased symptoms of depression among transgender women due to gender validation and expression, in other words, those who endorsed communal traits may have felt as though they did not have to conceal their feelings of femininity and therefore had less symptoms of depression. Our data also suggested that endorsement of communal traits by transgender women is related to living full-time in the female role. However, living full-time in the female role is not associated with significantly less depression compared to transgender women living part-time. A direct assessment of gender dysphoria is recommended for future studies as it has been found that gender dysphoria is independent from psychopathology (Bockting 2009; Meyer-Bahlburg 2010) and may explain our findings. Our study utilized a non-random sample and cross sectional design. Because our survey was web-based, our results may not be generalizable to participants without access to the Internet. Individuals who use the Internet and participate in online surveys may respond differently than non-users or users who do not respond to online surveys. However, there is some evidence that Internet surveys are comparable to paper surveys in both quality and quantity of responses and may aid in lessening social desirability bias, because participants are completely anonymous (Gosling et al. 2004). Ethnic/racial minorities were under-represented in our study; most participants self-identified as Caucasian, were in their mid-thirties to late fifties, and reported high levels of socioeconomic status, therefore our study may have captured a racialized conceptualization of agency and communion. As a result, the external validity of the results is limited and interpretations of the findings should be made with caution. These biased sample characteristics are common among Internet-based samples (Gosling, et al. 2004). Further, our study had moderate power to detect medium effect sizes when comparing transgender women living in the female gender role full-time versus part-time. Future research may want to combine both offline and online data collection to achieve an increased sample size and diversity to achieve higher overall power. Our study had several strengths: This is one of the first studies to explore protective factors among this minority population that appears to be at higher risk for developing depression as a result of the negative impact of stigma attached to their gender variance on their mental health and well-being (Clements-Nolle et al. 2006; Lombardi et al. 2002). It incorporated standardized measures of gender traits (i.e., agency/communion), depression, and resilience. Further, the use of bootstrap estimation procedures to assess mediation provided a more rigorous statistical analysis for hypothesis testing and increased statistical power and the precision of the reported confidence intervals (i.e., Baron and Kenny 1986; Hayes 2009; Mallinckrodt et al. 2006; Preacher and Hayes 2004, 2008; Pituch et al. 2006).

Conclusions In summary, both agentic and communal traits were associated with lower levels of depression and higher levels of resiliency in our sample of transgender women. Further, we found that transgender women living fulltime (compared to part-time) in the female gender role scored higher on one component of resilience acceptance of self and life that also mediated the relationship between agency and depression. This meditational pattern was also found between communion and depression but only for transgender women living in the female role full-time. No significant differences on depressive symptoms were found between transgender women living in the female role full-time compared to part-time.
Acknowledgments Our gratitude goes out to the women who participated in this research and to those who assisted in recruitment. The authors gratefully acknowledge Anne Marie Weber-Main, PhD for her thoughtful and rigorous review of our manuscript.

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