Screening adolescent transgender-related distress: Gender preoccupation and stability questionnaire demonstrates excellent criterion validity with multi-disciplinary, pediatric gender specialist assessment

Abstract

Objective To assess the psychometric properties of a gender-related distress questionnaire in adolescents questioning or experiencing gender incongruence and/or gender dysphoria, aged under 18 years, with multi-disciplinary, specialist pediatric gender assessment. Design & Setting : Prospective cohort study at state-wide tertiary children’s hospital gender clinic (2017–2021). Participants N = 299, aged 11–17 years referred for support with gender identity. Main outcome measure: The Gender Preoccupation and Stability Questionnaire (GPSQ) was designed for adults to assess gender dysphoria and intervention suitability. This study examined the psychometric properties of the GPSQ in an adolescent population and screening utility against the criterion of specialist assessment of gender dysphoria in a pediatric gender service. Results GPSQ demonstrated a univariate construct ‘gender dysphoria’ (α = 0.77) via factor analysis. It moderately correlated with outdated gender measure GIDYQ-AA (r = −0.31, p < .001) and strongly predicted specialist assessment outcomes (99% positive predictive power). However, negative predictive power or false negatives were high at 27%. Conclusions GPSQ is a reliable, valid tool for Australian adolescents under 18 years of age with excellent positive predictive power with a specialist pediatric gender dysphoria assessment. Caution is needed due to a high false-negative rate. General practitioners, pediatricians, psychiatrists, mental health professionals, school nurses and youth workers may benefit from the use of a reliable screening tool for gender-related distress to inform primary care planning, referrals, mental health formulation, psycho-education and conversations with young people and their parents. This is the first study to establish a reliable and valid screening tool for gender related distress in Australian minors with utility across all genders and criterion validity against multi-disciplinary, pediatric gender clinic assessment.