Development and validation of the Transgender Adolescent Stress Survey-Dysphoria

Sheree M Schrager; Jeremy T Goldbach; Jules K Wood; Rory P O'Brien; Shannon L Dunlap; Harmony Rhoades

doi:10.3389/fpsyg.2024.1448706

Development and validation of the Transgender Adolescent Stress Survey-Dysphoria

Front Psychol. 2024 Sep 19:15:1448706. doi: 10.3389/fpsyg.2024.1448706. eCollection 2024.

Authors

Sheree M Schrager^#¹, Jeremy T Goldbach^#², Jules K Wood², Rory P O'Brien³, Shannon L Dunlap⁴, Harmony Rhoades²

Affiliations

¹ Office of Graduate Studies and Research, California State University-Dominguez Hills, Carson, CA, United States.
² Sexuality, Health and Gender Center, George Warren Brown School of Social Work, Washington University in St Louis, Saint Louis, MO, United States.
³ School of Social Work, University of Michigan, Ann Arbor, MI, United States.
⁴ Luskin School of Public Affairs, University of California-Los Angeles, Los Angeles, CA, United States.

^# Contributed equally.

Abstract

Objective: Transgender and nonbinary adolescents (TNBA) may experience gender dysphoria arising from incongruities between their body and their gender. Prior dysphoria measures have largely focused on clinical diagnosis with little regard to comparability of forms for people assigned male or female at birth, overall psychometric performance, or applicability to nonbinary populations. This study develops and validates the Transgender Adolescent Stress Survey-Dysphoria (TASS-D), intended to address these gaps.

Methods: The current study recruited a U.S. national sample of TNBA (N = 444, aged 12-17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% nonbinary, 9.5% agender). The item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Scale development included factor analysis, item response theory modeling, measurement invariance testing, and reliability analyses. Associations were examined between the TASS-D and existing measures of gender dysphoria (convergent validity), gender minority stress (divergent validity), and behavioral health outcomes (criterion validity).

Results: TASS-D and its subscales (body distress and gender expression burden) were significantly and strongly associated with gender dysphoria; significantly but weakly associated with gender minority stress; and significantly associated with most indicators of psychological distress including depressive, anxiety, and posttraumatic stress symptoms, suicidal behaviors and nonsuicidal self-injury.

Conclusions: The TASS-D is a reliable and valid measure of gender dysphoria for TNBA, offering notable benefits over existing measures: It is psychometrically sound, inclusive of all gender identities, and does not assume that respondents identify binarily or desire medical transition as a terminal goal.

Keywords: adolescents; behavioral health; dysphoria; gender; nonbinary; transgender.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Institutes of Health Disparities under award numbers 5R21MD015945-02 and 1F31HD091981. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.