Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS): Construct validity among transgender,nonbinary, and LGBQ samples

Abstract

Background: Researchers combined both versions of the original Utrecht Gender Dysphoria Scale (UGDS) to create a single gender spectrum version (UGDS-GS) which measures dissatisfaction with gender identity and expression over time as well as comfort with affirmed gender identity.

Aim: This study examined the construct validity of the newly revised, UGDS-GS.

Method: Tests of measurement invariance were conducted in stages to assess measurement invariance of the UGDS-GS across three groups: cisgender, binary transgender, and nonbinary/genderqueer.

Results: Findings indicate that the UGDS-GS functions acceptably in all three gender groups (configural and metric invariance). Also, across binary transgender and nonbinary/genderqueer groups, the measure functions very similarly with all four types of invariance. Item level findings highlight the specificity of the measure to distinguish experiences of binary transgender and nonbinary/genderqueer persons differently from cisgender LGBQ individuals.

Conclusions: The UGDS-GS demonstrates a large degree of invariance across binary transgender, nonbinary/genderqueer, and cisgender LGBQ subgroups; and therefore, findings indicate this revision to be a substantial improvement. This 18-item self-report, Likert-type scale measure is a) inclusive of all gender identities and expressions (e.g., transfeminine spectrum, transmasculine spectrum, genderqueer, nonbinary, cisgender); b) appropriate for use longitudinally from adolescence to adulthood; and c) administered at any point in the social or medical transition process, if applicable, or in community-based research focused on gender dysphoria that examines cisgender and transgender persons.     

The Gender Identity Reflection and Rumination Scale: Development and Psychometric Evaluation

The authors describe the development of the Gender Identity Reflection and Rumination Scale (GRRS), which measures rumination in the context of gender identity among transgender persons. GRRS items were formulated taking into account previous research on rumination, stigma stress, and identity processing. Two national U.S. samples were collected to investigate the psychometric properties of the GRRS, resulting in 3 factors of gender identity rumination: Reflection, Rumination, and Preoccupation With Others’ Perceptions.     

The Gender Congruence and Life Satisfaction Scale (GCLS): Development and validation of a scale to measure outcomes from transgender health services

Background: It is vital that the treatment offered at transgender health services can be evaluated to ensure a high quality of care. However, the tools currently used to evaluate treatment at transgender health services are limited by mainly focusing on mental health or because they have been developed for binary transgender people only. This study therefore aimed to develop and validate a tool that addresses these limitations. The Gender Congruence and Life Satisfaction Scale (GCLS) was developed through reviewing the literature, conducting interviews with transgender people, and holding discussions with experts working in transgender healthcare. An initial pool of items was developed and feedback on these was obtained. The tool was then validated.

Method: For the validation of the tool, a total of 789 participants (451 transgender [171 transgender females, 147 transgender males, 133 people identifying as non-binary], and 338 cisgender [254 females, 84 males]) were recruited from the United Kingdom to test the factor structure and validity of the GCLS.

Results: Exploratory factor analysis retained 38 items which formed seven subscales (psychological functioning; genitalia; social gender role recognition; physical and emotional intimacy; chest; other secondary sex characteristics; and life satisfaction). These seven subscales were found to have good internal consistency and convergent validity. The GCLS was also found to be capable of discriminating between groups (e.g., people who have and have not undergone gender affirming medical interventions). Transgender and cisgender subscale norms are provided for the GCLS.

Conclusion: The GCLS is a suitable tool to use with the transgender population to measure health-related outcomes for both clinical and research purposes.     

Dimensions of Identity Development Scale (DIDS): A test of longitudinal measurement invariance in Greek adolescents

Identity is one core developmental task of adolescence. Although Marcia’s model, comprising of the dimensions of exploration and commitment, has dominated identity research for decades new models have recently been proposed. Luyckx and colleagues’ model poses that identity is a process consisting of five aspects: Exploration in Breadth, Commitment Making, Ruminative Exploration, Exploration in Depth and Identification with Commitments. The Dimensions of Identity Development Scale (DIDS) is a 25-item instrument developed to assess those five aspects. The goal of this study is: (a) to test the applicability of DIDS in a sample of Greek adolescents, and (b) to investigate the longitudinal measurement invariance of the scale. The results support the use of DIDS in Greek context and show that strong measurement invariance holds longitudinally in the course of 12 months. Echoing recent studies, the six-factor model showed significantly better fit, with Exploration in Depth splitting to Exploration in Depth and Reconsideration of Commitment. The scale is suitable for studies of longitudinal change in identity development.     

Psychometric characteristics of the Transgender Identity Survey in an Italian sample: A measure to assess positive and negative feelings towards transgender identity

Transgender people experience systematic oppression due to societal endorsement of binary notions of gender. As a result, they are at risk for self-stigmatization via the internalization of negative attitudes about being transgender. Thus, researchers need instruments to assess the multilayered nature of transgender identity and its role in the experience of mental health and well-being. This study evaluated the psychometric characteristics of the Transgender Identity Survey (TIS) in an Italian sample of 149 transgender people. The TIS assesses levels of pride, shame, alienation, and passing in transgender populations, providing researchers and clinicians with an instrument that can evaluate both positive aspects of transgender identity and internalized transphobia. Confirmatory factor analyses showed that the original four-factor model had adequate fit to the data obtained from the Italian sample, with the exception of one item. Both convergent and predictive validity were assessed and partially confirmed, indicating that the TIS is significantly correlated with some of the enacted stigma and mental health outcome measures (perceived stress, depression, and anxiety). This study provides both clinicians and researchers with a tool to assess positive and negative aspects of identity in transgender populations.     

The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients

Abstract

Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals.

Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired).

Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals.

Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.     

Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples

This study investigated the psychometric properties of a newly developed 20-item instrument that assesses one's anticipation of being able to change anxiety: the Anxiety Change Expectancy Scale (ACES). Study 1 evaluated the ACES in undergraduate university students, self-identified as experiencing difficulties with anxiety. Study 2 examined the ACES in a community sample of persons with anxiety difficulties. Study 3 tested the utility of the ACES in predicting treatment change in a group of individuals with generalized anxiety disorder participating in group cognitive behavioral therapy for anxiety. Across these samples, the ACES demonstrated excellent internal reliability (coefficient alphas=.89–.92) as well as good convergent, divergent, and factorial validity. The ACES was also significantly predictive of treatment-related changes in somatic anxiety symptoms and worry. The results of these studies provide strong support for the ACES as a reliable and valid measure of expectancies for changing anxiety.     

Measurement invariance of the Multigroup Ethnic Identity Measure (MEIM) across Bulgarian,Dutch and Greek samples

The Multigroup Ethnic Identity Measure (MEIM; Phinney, 1992) is a widely used instrument to quantify the way people think, feel, and behave regarding their ethnic origin. This instrument is commonly used to compare groups of people from different ethnic and/or cultural backgrounds. However, in order for these comparisons to be accurate, measurement invariance between groups needs to be tested and this is what has been done in the current study. First, confirmatory factor analyses were conducted separately for data sets with Bulgarian, Dutch, and Greek adolescents. Second, configural and scalar invariance were tested. Finally, comparisons between Bulgarian, Dutch, and Greek adolescents were made on their scores on MEIM.     

The Development of the Universal Ethnic Identity Scale (UEIS) for use in an Australian context

The aim of the present research was to develop a measure that assessed the level of ethnic identification of adults from diverse ethnic backgrounds, as well as individuals' level of ethnic identification with a host culture following migration. In the first study, an ethnically diverse sample of 275 people (138 males and 137 females) responded to a range of new items, as well as items drawn from related scales. Factor analysis revealed three dimensions of ethnic identity that were labelled, “Pride in Ethnic Background and Language,”“Liking for Traditional and Social Activities of my Ethnic Group,” and “Sense of Belonging to This (host) Country.” This factor structure was evaluated in a second study with 1,007 (552 males, 455 females) adults from culturally and linguistically diverse backgrounds. A two‐factor structure provided the most parsimonious fit to the data but further investigation of the factor structure within ethnically diverse samples was recommended. The results are discussed in relation to theories of social identity as well as research on ethnic identification and adaptation.     

The Negative Physical Self Scale: Initial development and validation in samples of Chinese adolescents and young adults

This research presents four studies on the initial development and validation of the 48-item Negative Physical Self Scale (NPS), a multidimensional measure of body image concerns for use with Chinese samples. In Study 1 (N = 1095), exploratory factor analyses identified five dimensions underlying the NPS (General Appearance, Facial Appearance, Shortness, Fatness, Thinness). In Study 2 (N = 1057), confirmatory factor analyses replicated this factor structure. In Studies 3 and 4, the validity of all NPS dimensions except Thinness Concern was supported via their patterns of relation with both objective physical characteristics/behaviors and other self-report measures of body image and general self worth. Because Chinese adolescents and young adults expressed relatively more concerns about General Appearance, Shortness, and Facial Appearance than about Fatness, the NPS may have greater utility for assessing body image disturbances in China than existing measures that focus exclusively on general body satisfaction and body size/weight.     

The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation

Measurements of subjective quality of life (QoL) are an important complement to symptom ratings in clinical research and practice. Despite there being several established QoL self-rating scales, we identified a need for a freely accessible, easy-to-use inventory, validated for use with both clinical and non-clinical samples, based on the overall life satisfaction conceptualization of QoL. The Brunnsviken Brief Quality of life scale (BBQ) was designed to meet these requirements. Items were selected by performing a factor analysis on a large data-set of QoL ratings collected previously. Six life areas (Leisure time, View on life, Creativity, Learning, Friends and Friendship, and View of self) were identified as important for overall QoL and were included in the BBQ. A psychometric evaluation was performed using two independent samples: healthy undergraduate students (n = 163), and a sample seeking treatment for social anxiety disorder (n = 568). Results suggested a unifactorial structure, with good concurrent and convergent validity, high internal and test-retest reliability, and accurate classification ability. We conclude that the BBQ is a valid and reliable measure of subjective QoL for use in clinical and research settings. The BBQ is presently available in 31 languages and can be freely downloaded from www.bbqscale.com.     

Age of anxiety and depression revisited: A meta-analysis of two European community samples (1964-2015)

Background/Objective: Based on studies using established psychometric scales, Twenge and coworkers have shown substantial increases in trait anxiety, depressive symptoms and neuroticism in North American population samples since the 1950s. Similar analyses for European samples have not yet been conducted. Our study therefore examined whether similar secular trends exist in German-speaking and British non-clinical samples together with possible connected societal factors. Method: A literature search identified 131 studies (N = 63,269) using the STAI, BDI or EPI in non-clinical samples between 1964 and 2015. Seven societal factors from national statistics were included. We conducted meta-analyses with displayed means and moderation analyses of publication year for all scales. Results: In contrast to North America results, anxiety, depression and neuroticism showed no increase in the two European populations. Publication year correlated negatively with and moderated trait anxiety (GER) and neuroticism (UK). Most societal factors were highly correlated with year of publication. Trait anxiety and neuroticism were significantly predicted by age at marriage and unemployment rate in German-speaking countries. Conclusion: The difference in secular trends between European and North American samples may indicate society specific developments connected to different societal factors.     

Construct validity of the Sivik Psychosomaticism test and test of Operational style: Correlations with four Minnesota Multiphasic Personality Inventory (MMPI) subscales

To evaluate the construct validity (convergent and divergent) of the Sivik Psycho Somaticism test (SPS) and test of Operationality (OPER), Pearson correlation coefficients between SPS scales and subscales, OPER and Minnesota Multiphasic Personality Inventory (MMPI) subscales Hypochondria (Hs), Depression (D), Hysteria (Hy) and Alexithymia (Al) were calculated. Eighty-eight healthy individuals and 285 psychosomatic patients completed the SPS and OPER tests and MMPI; Hs, D, Hy and Al. The results show that most of the SPS subscales and OPER are significantly correlated to several MMPI subscales in both a normal and a psychosomatic population. The results are in concordance with the theoretical hypotheses and confirm the validity of the SPS and OPER constructs.     

The Portuguese version of the Basic Empathy Scale (BES): Dimensionality and measurement invariance in a community adolescent sample

Empathy is the heightened ability to cognitively perceive and/or affectively share the emotions of others, which has been consistently associated with desirable social interactions. This paper aimed to test the bi-factorial structure of a Portuguese version of the Basic Empathy Scale and examine its variation by gender and age using a large community sample (n = 1029) of adolescents. The two-factor model, originally developed and supported by other cross-cultural validations, presented good fit indicators which was similar across genders and adolescent age groups. Girls were more empathic than boys and younger adolescents were more empathic than the older ones. Further support for the validity of the new scale comes from its relations to measures of social skills and aggression which were similar to theoretical predictions. In conclusion, the Portuguese version of the BES is a consistent and valid instrument for the assessment of empathy in samples of adolescents aged 12–18 years old in Portugal, which can now be used in cross-cultural studies of this important psychological construct.     

Measuring illness representations in breast cancer survivors (BCS) prescribed tamoxifen: Modification and validation of the Revised Illness Perceptions Questionnaire (IPQ-BCS)

Objective: The Revised Illness Perceptions Questionnaire (IPQ-R), widely used to assess illness perceptions, may fail to measure unique characteristics of different illnesses. This study modified and validated the IPQ-R for breast cancer survivors to provide detailed understanding of the specific illness perceptions held by these patients.

Design: Initial modifications were made following qualitative interviews and were revised in a think-aloud study. The modified scale was tested in 753 breast cancer survivors prescribed tamoxifen. Modifications included adding a tamoxifen consequences scale and adapting the timeline scales to measure beliefs around risk of recurrence and cure. A confirmatory factor analysis was conducted on the modified questionnaire and an exploratory factor analysis on the causal beliefs scale. Test–retest reliability, internal consistency and construct validity were also examined.

Results: The proposed eight-factor structure showed acceptable model fit, with high loadings and good reliability for all subscales. Correlations between subscales were consistent with theory and previous research.

Conclusions: The IPQ-BCS is valid and reliable, and provides unique understanding of specific perceptions held by this population, including beliefs surrounding risk of recurrence and consequences of ongoing hormonal treatment. Identifying these perceptions will aid development of interventions targeting depression, fear of recurrence and medication non-adherence.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

A rating measure of ADHD-related neuropsychological impairment in children and adolescents: Data from the Cognition and Motivation in Everyday Life (CAMEL) Scale from population and clinical samples

A new parent-completed questionnaire, the Cognition and Motivation in Everyday Life (CAMEL) scale, was developed to provide a comprehensive assessment of neuropsychological impairment in children related to attention-deficit/hyperactivity disorder (ADHD) across diverse cognitive, motivational and energetic domains. Its psychometric properties were investigated. A total of 60 items were generated to cover a wide range of putative ADHD-related neuropsychological processes. A clinical (n = 142) and community (n = 810) sample of parents with children between 6 and 16 years of age completed the questionnaire. Data on ADHD symptoms were also collected with a commonly-used, validated parent rating scale to explore the associations between CAMEL scores and dimensional measures of child ADHD and conduct problems. Factor analysis identified six factors which we labeled (i) Cognition, (ii) Self-Direction and Organization, (iii) Effort Engagement, (iv) Arousal Regulation, (v) Motivational Responsiveness, and (vi) Cautiousness. Self-Direction and Organization and Arousal Regulation were the strongest predictors for ADHD symptomatology. Self-Direction and Organization was strongly associated with inattention and Arousal Regulation with hyperactivity-impulsivity symptoms. Parents distinguished between broad neuropsychological domains in reliable and plausible ways, making distinctions between key aspects of functioning. However, the boundaries between these domains did not map directly onto the distinctions drawn within traditional models of ADHD deficits. Further research is required to examine the predictive validity and cost-effectiveness of the CAMEL scale compared to direct objective testing using laboratory measures in predicting prognosis and treatment outcome.     

Perceived discrimination amongst young people in socio‐economically disadvantaged communities: Parental support and community identity buffer (some) negative impacts of stigma

There is increasing acceptance that children are not unaware of when they are targets of discrimination. However, discrimination as a consequence of socio‐economic disadvantage remains understudied. The aim of this study was to examine the impact of perceived discrimination on well‐being, perceptions of safety and school integration amongst children growing up within socio‐economically disadvantaged communities in Limerick, Ireland. Mediation analysis was used to explore these relationships and to examine the potential role of parental support and community identity in boys and girls in the 6th to 9th year of compulsory education (N = 199). Results indicate perceived discrimination contributed to negative outcomes in terms of school integration, perceptions of safety and levels of well‐being. Age and gender differences were observed which disadvantaged boys and younger children. All negative outcomes were buffered by parental support. Community identity also protected young people in terms of feelings of school integration and risk but not in terms of psychological well‐being. Findings are discussed in terms of the different role of family and community supports for children negotiating negative social representations of their community.