Does androgyny have psychoprotective attributes? A cross-sectional community-based study.

BACKGROUND: In our society, adherence to feminine traits by the female gender had been culturally promoted and socially desired. A few studies, however, entertained the possibility that healthy men and women have some common attributes in their gender orientation. Androgyny and masculinity were found related to positive mental health.
MATERIALS AND METHODS: A cross-sectional study was conducted to assess the level of masculinity and femininity and its relationship with the perception of stress and various psychopathology including anxiety and depression.
RESULTS: Masculinity scores of the participants negatively correlated while femininity scores positively correlated with the scores on General Health Questionnaire, Beck's Depressive Inventory, Beck's Anxiety Inventory, and Perceived Stress Scale.
CONCLUSION: Androgyny is psychoprotective. Empowerment-oriented psychological approaches aimed to encourage psychological androgyny, and masculinity might be therapeutic.

Before one discusses about sex differences, it is important to understand the term ‘sex’ and its relation to the term ‘gender’. Broadly, ‘gender’ denotes the sexual distinction between males and females that is an amalgamation of biological, cultural, historical, psychological, and social factors, although the word is often used deliberately to exclude biological factors. In terms of gender, ‘sex’ refers to just those biological factors that distinguish males and females, and ‘sex differences’ are factors (biological, cultural, etc.) related to sex. It is important to emphasize that a sex difference is not necessarily biological, although it does rest on an assumed common understanding of a biological distinction between men and women.[1] The 1970s brought forth a new concept in masculinity and femininity research: the idea that healthy women and men could possess similar characteristics. Androgyny emerged as a framework for interpreting similarities and differences among individuals according to the degree to which they described themselves in terms of characteristics traditionally associated with men (masculine) and those associated with women (feminine). The term ‘androgyny’ has its roots in classical mythology and literature.[2] ‘Androgyny’ comes from the Greek word andros meaning ‘man’ and gyne meaning ‘woman’. An androgynous person is, therefore, one who has both masculine and feminine characteristics. Androgyny refers to sex-role flexibility and adaptability. The major underlying assumption of this perspective of sex roles is that the individual may act in either a traditionally masculine or a traditionally feminine manner, depending on situation constraints and needs. Research indicates that the gender-role identity is a good predictor of psychological adjustment. Masculine and androgynous children and adults have a higher sense of self-esteem, whereas feminine individuals often think poorly of themselves. Feminine women seem to have adjustment difficulties.[3] The Bem Sex Role Inventory was designed to facilitate empirical research on psychological androgyny. A sex-typed woman is one who is cooperative, dependent, and yielding, whereas a sex-typed man is one who acts as a leader and is aggressive and assertive. An androgynous person is characterized as having both high masculine and high feminine traits without employing a gender schema; circumstances dictate which trait – feminine or masculine – is exhibited by an androgynous person. Thus, she defined masculinity and femininity in terms of sex-linked social desirability.[2] An individual can adhere strictly to one role (masculine or feminine), weakly to both roles (androgynous), or strongly to both (undifferentiated) or to neither (ambiguous). Although the definition of a particular role may be culturally dependent, we can presume that because gender roles are self-perpetuating through processes of socialization they are rarely subject to substantial change. In gender role theory, the feminine style of coping is to deal with the emotion associated with the stressor (emotion focused) whereas the masculine style is to deal directly with the stressor (problem focused).[4] Feminine, emotion-focused coping is associated with higher levels of depression than masculine problem-focused coping.[1] Compared with women who identify with more flexible gender roles, women who adopt traditional feminine gender roles appear to have lower self-esteem, find stressful events more aversive than women who also show some masculine-type traits, are less capable of bouncing back from failure experiences, are more likely to believe that women are to be seen and not heard, and are more likely to conform to group pressure.[5] Individuals with desirable assertive qualities, including both masculine and androgynous individuals, are proposed to experience higher levels of psychological well-being than do their feminine counterparts.[67] Results from meta-analyses revealed that desirable assertive qualities are stronger predictors of psychological well-being than are desirable communal qualities, thus providing further support for the masculinity model. When a range of real-life stressful situations was examined, androgynous people differed from masculine and feminine participants in three major ways. First, androgynous people tend to be more sensitive to subtle differences among distinct stressful events, as reflected by their flexible deployment of different strategies and their ability to distinguish situational effectiveness of coping strategies. Second, their flexible pattern of strategies does not just represent an array of random behaviors, but rather a meaningful pattern. Specifically, they endeavor not only to change the situation (e.g., direct action) when encountering stressors perceived as controllable but to change themselves (e.g., acceptance) when encountering stressors perceived as uncontrollable. Third, androgynous individuals experience a lower depression level in a stressful period of life transition than do others, thus providing support for the androgyny model[8] Findings indicate that well-being is primarily a subjective phenomenon that is based on people's internal predispositions. That is, current thinking in the field has shifted toward a view of well-being as a product of internal or subjective processes (e.g., goals, temperament, and coping, i.e., problem based or emotion focused) rather than of objective external factors (e.g., education).[9] Individuals who endorsed androgynous traits reported significantly lower levels of social anxiety than did participants who were feminine or undifferentiated. As identification with a traditionally masculine gender role orientation increased, reported levels of social anxiety decreased; conversely, femininity was not a significant predictor of social anxiety. This finding supports the masculinity model that asserts that the relationship between mental health and androgyny is primarily due to the masculinity component of androgyny. According to this model, femininity exerts no significant impact on mental health; rather, psychological well-being is maximized by the extent to which one possesses a masculine gender-role orientation, irrespective of gender.[10] On the basis of the above paradigm, the authors began with the hypothetical paradigm that androgynous or masculine females are more psychologically healthy than sex-typed females. Our objective was to see whether their psychological gender orientation influenced the presence of psychopathology, depression, anxiety, and perceived stress in these female participants.

MATERIALS AND METHODS

Hundred married females from an urban area of Pune city were taken for this study by random sampling. After due consent, each participant was subjected to psychosocial performa designed for this study (pretested and validated), personal attribute questionnaire (a 24-paired-item scale, each pair describing contradictory characteristics in which scoring brings out the masculinity and the femininity response of each individual), General health questionnaire 12 (GHQ, a self-administered standardized 12-item screening test sensitive for the presence of psychiatric disorders in individuals that is not designed to detect symptoms that occur with specific psychiatric diagnosis), Beck's depressive inventory (BDI, a self-administered standardized 21-item instrument to assess the presence and severity of depression with a reliability of 0.73–0.92 in nonpsychiatric samples), Beck's anxiety inventory (BAI, a self-administered standardized 21-item instrument to assess the presence and severity of anxiety), and Perceived stress scale (PSS, a most widely used 10-item psychological instrument to measure the degree to which situations in an individual's life are appraised as stressful, which measures the perceived stress over last 1-month duration). Standard cutoff scores were taken for GHQ, BDI, BAI, and PSS.

The participants were subsequently analyzed on the basis of their presence of masculinity and femininity scores and compared and correlated with various sociodemographic and outcome variables. Data were statistically interpreted by using SPSS version 14.

RESULTS

Tables 1 and 2 depict details of sociodemographic and personal data. Mean masculinity and femininity scores were as shown in Table 2. Table 3 shows the mean and median scores of the population on GHQ, BDI, BAI, and PSS. Psychopathology was found in 30%, while proportions of anxious, depressed, and stressful were 25, 23, and 36%, respectively [Table 4]. There was no statistically significant association between age, income, occupation of the spouse, and education of the participants with scores on psychopathology (GHQ), depression (BDI), anxiety (BAI), and perceived stress (PSS). Table 5 shows that the number of years since marriage and masculinity and femininity scores were found to have statistically significant association with all these scores. Table 6 shows that masculinity scores of the participants were negatively correlated while femininity scores were positively correlated with the scores on GHQ, BDI, BAI, and PSS – all these were statistically significant. Furthermore, a multivariate analysis (logistic regression) was done to assess the impact of independent variables (masculinity and femininity) and others such as education of the wives, family structure, and occupation of the spouse that are likely to confound the results [Table 7]. The analysis revealed that after controlling for all the variables, masculinity had a protective effect on scores of GHQ (psychopathology), BDI (depression), BAI (anxiety), and PSS (perceived stress) whereas raised femininity scores corresponded with increased scores on general psychopathology and depression. The same was statistically significant. Figure 1 depicts the relationship between the masculinity score and the score on GHQ.

Table 1

Sociodemographic profile of the study participants

Table 2

Distribution of various sociodemographic and individual characteristics

Table 3

Distribution of various dependent variables

Table 4

Distribution of participants regarding dependent variables of psychopathology, depression, anxiety, and stress

Table 5

Association of masculinity and femininity scores in family and years of marriage with various dependent variables

Table 6

Correlation of masculinity and femininity scores in family to various dependent variables

Table 7

Multivariate analysis (logistic regression) of the dependent and independent variables

Figure 1

Graphical representation of the relationship between GHQ and masculinity scores

DISCUSSION

This study attempts to understand the role of optimal mix of psychological aspect of masculinity and femininity on the psychopathology of the participants, depressive symptoms, anxiety, and stress perceived by the individual. This study looks into the participants in their third to fifth decades of life. The median masculinity score of 32 ranging from 24 to 42 is more than the median femininity score ranging from 18 to 26. These suggest, in general, the societal acceptance of psychological androgyny with a stronger emphasis on the masculine pattern in the female population today. The mean score of the participants on the outcome variables was skewed; however, the median scores on general psychopathology (GHQ), depression (BDI), anxiety (BAI), and perceived stress (PSS) were well below the cutoff in all [Table 3]. The cutoff-based evaluation of these scales revealed that around one fourth to one third of the sample population was psychologically distressed, which is in accordance with the findings by other researchers in similar population[1112] [Table 4]. The absence of any significant relationship between age, income, occupation of the spouse, and education of the participants on one side with scores on psychopathology (GHQ), depression (BDI), anxiety (BAI), and perceived stress (PSS) on another side lay emphasis on the more stronger role of individual's intrinsic factor than extrinsic factors. These findings go in favor of the top-down approach in coping as suggested by Watson et al.[7] The number of years since marriage was significantly associated with scores of GHQ, BDI, BAI, and PSS, which had statistically significant negative correlation with these. This implied that as the number of years of married life increased, the scores on psychopathology, anxiety, depression, and perceived stress decreased. This reflects increasing pattern of adaptability in people and more specifically female participants over the years in marital life. Our findings are in accordance with those by De Vaus.[13] Masculinity scores of the participants were found to be significantly associated with various outcome variables (i.e., psychopathology, depression, anxiety, and perceived stress.) This again emphasizes the role of individual intrinsic factors (i.e., top-down model) in coping with life events. Correlation analysis revealed that people with higher masculinity scores tend to have less psychopathology, were less depressed and anxious, and had reduced perception of stress. On the other hand, femininity scores of the participants were found to be significantly affecting the various outcome variables (i.e., psychopathology, depression, anxiety, and perceived stress) reiterating the role of individual intrinsic factors (i.e., top-down model) in coping with life events. Correlation analysis revealed that people with higher femininity scores tend to have more psychopathology, get more depressed and anxious, and have increased perception of stress. These findings lead to a construct where masculinity is positively associated with better mental health and coping and wherein increased amount of femininity in the female made them vulnerable manifesting with stress and psychopathology. The finding of similar nature came out in multivariate analysis wherein masculinity was found to have a psychoprotective effect and that of femininity detrimental. Similar findings have been shown by various researchers who advocate greater emphasis on intrinsic factors in increasing psychological resilience in people.[358] Our findings do find androgyny with more emphasis toward masculinity having psychoprotective attributes in our female participants.

CONCLUSION

To conclude, our study revealed that a strong component of psychological masculinity in feminine individuals increase their resilience and coping and makes them less vulnerable to psychopathology in general, depression, anxiety, or the perception of stress. The role of intrinsic individual factors cannot be ignored and fostering the same may lead to better mental health. However, the replication and validation of these findings is a continuous process and should move parallel with simultaneous constructive intervention.

Recommendation

Our findings establish the point that targeting the individual's own intrinsic factor during psychotherapeutic sessions might improve therapeutic outcome and empowerment-oriented approach would be more valuable in effective preventive and remediation strategies rather than mere stress reduction or environmental manipulation. This study does not attempt to underplay the role of stress reduction or environmental manipulation but wants to make a conscious effort to understand individual vulnerabilities and empowering them, such as with more psychological masculine attributes in a feminine individual.

Limitation of the study

The study aimed to target only the female gender and to study the protective value of masculine traits in them. The male population was not included. Whether the prominence of masculine trait is effective or the optimal androgynic trend could have been generalized cannot be commented upon, as it did not involve both the genders. There could be a varied number of extrinsic and intrinsic factors that may affect the outcome variable; the exclusion of the same in a general population is impractical. This study has just attempted a cross-sectional analysis in a normative sample of the female population for the role of gender orientation in psychological distress. This study generates an insight into this direction, and more research, especially longitudinal studies, in this dimension would be further conclusive.