Excellent Internal Consistency Research Articles

Cross cultural adaptation and psychometric evaluation of the Turkish PedsQL™ Brain Tumor Module: Assessing health-related quality of life in children with brain tumors

Background Brain tumors are the most common type of pediatric cancer, significantly impacting children’s health-related quality of life (HRQoL). This study aimed to adapt the PedsQL™-BTM to Turkish culture and evaluate its psychometric properties, including reliability, validity, and cross-cultural consistency. Method A total of 108 children with brain tumors (mean age: 9.1 ± 4.99 years) and 120 parents participated in the study. The translation process included forward-backward translation, reconciliation, cognitive debriefing, and pilot testing. Internal consistency (Cronbach’s alpha), test-retest reliability (ICC), exploratory and confirmatory factor analysis were conducted to evaluate the psychometric properties. Correlations between the PedsQL™-BTM and the Generic Core Scales were examined for criterion validity. Results Cronbach’s alpha ranged from 0.83 to 0.97, indicating excellent internal consistency. Test-retest reliability was robust, with ICC values exceeding 0.80 for most subscales. EFA explained 84.2% of the variance in parent reports and 80.4% in child reports, while CFA confirmed the six-factor structure (child-reported outcomes: RMSEA = 0.069, 90% CI: 0.061–0.076; TLI = 0.862; NFI = 0.92; χ2 (147) = 1875, p < 0.001; and parent-reported outcomes: RMSEA = 0.063, 90% CI: 0.059–0.069; TLI = 0.858; NFI = 0.93; χ2 (153) = 1912, p < 0.001). Correlations between the BTM subscales and Generic Core Scales demonstrated strong criterion validity (e.g. Cognitive Problems correlated with School Functioning: r = 0.831, p < 0.05). Conclusions The Turkish PedsQL™-BTM is a reliable and valid tool for assessing HRQoL in children with brain tumors.

Validity and psychometric characteristics of the Duruöz Hand Index (DHI) with systemic sclerosis

Objective: The Duruöz Hand Index (DHI) is a self-report questionnaire originally developed to assess hand function in rheumatoid arthritis patients and validated for various rheumatic conditions. The aim of the study is to evaluate the validity and psychometric features of the DHI in patients with systemic sclerosis (SSc). Methods: SSc patients diagnosed using EULAR/ACR 2013 criteria were included in study. Hand functionality was assessed using the DHI, Hand Functional Index (HFI) and visual analog scales (VAS) for disability and handicap. Overall disability and quality of life were measured using the Health Assessment Questionnaire (HAQ) and Short Form-36 (SF-36). Reliability (Cronbach’s alpha and ICC) and validity (face, content, convergent and divergent) were also analyzed and correlations with other measures assessed for construct validity of the DHI were examined. Results: Seventy-three patients were included in the study, 78.1% were female. The baseline mean DHI score was 31.2 (SD: 20.2). Completion and calculation of the questionnaire were easy and took 5 min and 30 s, respectively. The Cronbach’s alpha coefficient for internal consistency was 0.973 and the ICC for test-retest reliability was 0.993 (95%CI 0.981–0.997), suggesting that the DHI has high internal consistency and a high degree of reliability. Cognitive debriefing showed that the DHI is clear, understandable, relevant, and covers many domains of daily life, indicating good face and content validity. The DHI demonstrated good to moderate correlations with functional measures indicating convergent validity and moderate to non-significant correlations with non-functional parameters that supported divergent validity. Cronbach’s alpha was 0.973, indicating excellent internal consistency. Conclusion: In SSc patients, specific tools for assessing hand function are lacking. The DHI is a practical, reliable and valid measurement tool for both clinical assessment and research in this disease affecting skin, tendons, subcutaneous tissue and arthritis.

Development of a caregiver-administered screening tool for language, speech, and attention in preschool Arabic-speaking children

BackgroundThe most rapid language development occurs between the ages of 2 and 5 years. Many parents of children with delayed language development appear to be unaware of their children’s difficulty with oral language. Increasing their awareness of typical language development milestones and the importance of early intervention is very important for minimizing the consequences of late intervention. This study aims to design an easily applicable reliable screening tool for language, speech, and attention that can be used by caregivers. It can identify cases of delayed language development. This can help ensure a proper referral time to the phoniatrician for detailed assessment and intervention.MethodsThe constructed simple language, speech, and attention screening tool was administered to 100 Egyptian Arabic-speaking children suspected to have delayed language development. Their ages ranged between 1.5 and ≤ 4 years. They were divided into 5 age groups, with a 6-month age interval. All the participants were subjected to the modified Preschool Language Scale-4 test, which was performed by the assessor only, and subjected to the designed test, which was carried out once by the assessor and was repeated by the caregiver after two weeks; in between, no language stimulation therapy was commenced.ResultsThe current study revealed that the highest scores in the simple language, speech, and attention screening tools were for the oldest age group, and the lowest scores were for the youngest age group. A total of 83% of the caregivers had a subjective impression that the test was easily applicable and took a short time. All the means of the subtests were significantly greater for the test performed by the caregivers than for the test performed by the assessor, except for the means of the articulation subtest. A significant positive correlation was found between the subtests and total language score of the modified Preschool Language Scale-4 and the Simple Language, Speech, and Attention test done by both the assessor and the caregivers.ConclusionThe designed SLSA screening tool showed excellent internal consistency reliability in the early identification of children with delayed language by both the assessor and the caregivers and showed concurrent validity with the PLS-4.

Psychometric validation of the Chronic Ocular Pain Questionnaire (COP-Q)

BackgroundThe Chronic Ocular Pain Questionnaire (COP-Q) is a newly developed patient-reported outcome (PRO) measure intended to assess symptoms and impacts associated with Chronic Ocular Surface Pain (COSP). This study assessed the psychometric properties of the COP-Q to determine the adequacy of the COP-Q as a ‘fit-for-purpose’ instrument to derive trial endpoints for future clinical studies in COSP.MethodsPatients with COSP completed the COP-Q daily for four weeks on an electronic, touch-screen, tablet device as part of a longitudinal, observational study in the United States (N = 124). Analyses were conducted to assess item properties, dimensionality and scoring, reliability and validity, and interpretation of scores. In addition, 4-hour and 24-hour recall period versions of the COP-Q Symptom Module were compared.ResultsItem responses were distributed across the full response scale for most COP-Q items. Inter-item correlations did not identify any redundant items (r > 0.90) and all items correlated at > 0.40 in their respective module. Confirmatory factor analysis (CFA) provided acceptable support for the unidimensional structure of the multi-item scales in the COP-Q and calculation of a total score for each module. However, CFA and Rasch analysis outlined potential redundant items for the COP-Q Visual Tasking Module (VTM), which were removed, resulting in a six-item VTM. The multi-item COP-Q modules had excellent internal consistency (α range = 0.91–0.96) and suggested fair to excellent test-retest reliability (ICC/Kappa range = 0.651–0.940) for all COP-Q modules. Construct validity for all COP-Q modules was supported by a logical pattern of correlations with concurrent measures and evidence of ability to distinguish between known-groups, with statistically significant differences between COSP severity groups. Paired t-tests, coefficient of determination (CoD) and concordance correlation coefficients (CCC) showed statistically significant differences between the two recall period versions of the Symptom Module, although the magnitude of the difference was small, and each version shares a high level of reproducibility in scores.ConclusionsFindings provide evidence that the COP-Q is a valid and reliable measure of patient-reported COSP symptoms and impacts for use in future clinical trials in COSP. Both 4-hour and 24-hour Symptom Module recall period versions are likely to yield consistent results and are equally robust.

Screening versions of the European Portuguese MacArthur-Bates Communicative Development Inventories Short Forms: development and preliminary validation

This study aimed to develop and validate the screening versions of the European Portuguese MacArthur-Bates Communicative Development Inventories Short Forms (EP CDI-SFs), intended to guide referrals for comprehensive language assessments in infants and toddlers. The first cohort, aged 8–18 months, included 1,293 typically developing children (Mage = 12.23, SD = 3.12, 50.2% male), 170 children at-risk for language impairments (Mage = 11.76, SD = 2.81, 45.9% male), and 39 children with Down syndrome (Mage = 12.28, SD = 3.40, 56.4% male), assessed using the EP CDI-SF Level I. The second cohort, aged 16–30 months, included 1,155 typically developing children (Mage = 23.45, SD = 4.07, 51.2% male), 181 children at-risk for language impairments (Mage = 23.23, SD = 4.31, 47% male), and 46 children with Down syndrome (Mage = 23.09, SD = 3.93, 69.6% male), assessed with the EP CDI-SF Level II. Through factor analysis, the 20 most psychometrically robust items from each form were identified and used to develop the new screening versions (EP CDI-Scr). Strong correlations between the EP CDI-SFs and EP CDI-Scr results for typically developing children, along with excellent internal consistency, supported the validity and reliability of the new tools. Furthermore, the EP CDI-Scr versions demonstrated excellent sensitivity and moderate specificity. They effectively distinguished between typically developing children, those at-risk for language impairments, and those with Down syndrome, confirming strong discriminant validity. These findings establish the preliminary validity, reliability, and effectiveness of the EP CDI-Scr, supporting timely referrals for comprehensive language evaluations.

Translation and validation of the Swedish version of the early-onset scoliosis 24-item questionnaire.

Translation and validation of the Swedish version of the early-onset scoliosis 24-item questionnaire.

Psychometric properties of the Persian version of Self-Injurious Thoughts and Behaviors Questionnaire-Nonsuicidal (SITBQ-NS) in an Iranian outpatient sample.

Psychometric properties of the Persian version of Self-Injurious Thoughts and Behaviors Questionnaire-Nonsuicidal (SITBQ-NS) in an Iranian outpatient sample.

Family reaction to coming out (FRCO): A Spanish adaptation and validation of perceived parental reactions scale.

Family reactions to coming out can affect the mental health of individuals who disclose their sexual orientation or gender identity. Therefore, it is important to have an appropriate tool to assess them. The Perceived Parental Reactions Scale (PPRS) assessed perceived parental reactions to the disclosure of gay, lesbian, or bisexual sexual orientation by their children. We adapted the PPRS so that it can be answered by any individual belonging to a sexual or gender minority, and can be answered regarding any member of the family, not just parents. A total of 2627 individuals from Spain participated in this study, with a mean age of 31.59 (SD = 11.26). Participants completed the adapted PPRS questionnaire, now named the Family Reaction to Coming Out (FRCO). The FRCO assessed family reactions when disclosing their sexual orientation or gender identity. The majority of participants identified as cisgender men (47.5%) or cisgender women (44.9%), and as gay/lesbian (51.9%). A one-factor model emerged through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The FRCO displayed excellent internal consistency and demonstrated good levels of invariance for participants' gender (male vs female vs nonbinary gender), family member's gender (male vs female), and type of family member (parents vs other family member). Supporting convergent validity, the FRCO has shown a positive correlation with fear of family reaction to coming out. These findings support the validity and reliability of the FRCO tool in assessing the reactions of any family member within the Spanish context.

Psychometric properties of the Spanish Multidimensional Fatigue Inventory in people with heart diseases.

Psychometric properties of the Spanish Multidimensional Fatigue Inventory in people with heart diseases.

Indonesian Translation and Adaptation of Social Appearance Anxiety Scale (SAAS) for Early Adolescent Girls in Indonesia.

During adolescence, the attention of individuals has been observed to increasingly shift toward respective appearances, and this is primarily influenced by the various stages of puberty. Previous studies have reported that early body image disturbances may have long-term mental health impacts that persist into adulthood. This study aimed to translate and validate Social Appearance Anxiety Scale (SAAS), developed by Hart et al, for use among early adolescent girls in Indonesia. In order to achieve the stated objective, an adaptation process, guided by the International Test Commission (ITC) Guidelines for Adapting Tests was carried out. The process consisted of three stages including 1) forward and backward translations, 2) testing of reliability coefficients, and 3) collecting validity evidence through content-based and construct-based testing using Confirmatory Factor Analysis (CFA). Data were collected online from respondents in Bandung, Indonesia, who were then asked to participate in a retest 1 month later. The final sample comprised 197 girls aged 10-14 years. The obtained results showed that content validity achieved an agreement rate exceeding 90%, and SAAS was observed to possess excellent internal consistency (Cronbach's α = 0.932). Accordingly, test-retest reliability was stable (ICC (95% CI) = 0.850), convergent validity between SAAS and Social Anxiety Scale for Adolescents (SAS-A) was significantly positive (r = 0.439; p < 0.001), and CFA signified an acceptable model fit after modification (Model Chi-Square, p > 0.05; RMSEA = 0.036 < 0.08; CFI = 1 ≥ 0.90; GFI = 0.94 ≥ 0.90; Loading Factors > 0.3). SAAS-Indonesia was observed to be sufficiently reliable and valid for use among early adolescent girls in Indonesia.

Psychometric properties, factor structure, and functional correlates of the PTSD checklist for DSM-5 in a U.S. national sample of older veterans.

Psychometric properties, factor structure, and functional correlates of the PTSD checklist for DSM-5 in a U.S. national sample of older veterans.

Development and validation of the eHealth Literacy and Use Scale (eHLUS) to measure medical app literacy.

This study aimed to develop and validate the eHealth Literacy and Use Scale (eHLUS), a German assessment tool designed to measure health literacy in the context of using medical apps. This scale enhances traditional eHealth literacy tools by focusing on the unique requirements of medical app use, such as integration into everyday life, and self-efficacy. This study employed a mixed-method design. The development of the eHLUS involved a thorough literature review, expert interviews, and psychometric evaluation in a real-world environment. The eHLUS, consisting of 14 items across three dimensions, was designed for a nuanced assessment of eHealth literacy in medical apps. Psychometric evaluation data were gathered from 127 participants at two time points (nt1=117; nt2=62). The scale demonstrated excellent internal consistency, with a Cronbach's alpha of 0.913 and a McDonald's omega of 0.911. A mean completion time of 2.2min underscores its practical applicability. Retest reliability was confirmed in 52 matched cases, affirming the scale's stability. Principal component analysis revealed three dimensions: autonomous use and technical access, eHealth engagement, and eHealth literacy. The findings demonstrate the suitability of eHLUS for assessing individuals' abilities to effectively use medical apps, highlighting its importance in research and healthcare. The evaluation of the scale, along with expert interviews, underscores both its necessity and feasibility. The eHLUS captures eHealth literacy and its associated determinants within the context of medical app use, contributing to the optimization of patient care.

THE RELATIONSHIP BETWEEN STRESS AND ACADEMIC PROCRASTINATION AMONG PRIVATE UNIVERSITY STUDENTS IN KLANG VALLEY

The research examines the relationship between stress and academic procrastination among private university students in Klang Valley. A total of 280 university students were selected for this study through convenience sampling. An online questionnaire was distributed to students in four private universities in Klang Valley by using a Google form. The questionnaire was adapted to the Perceived Stress Scale (PSS-10) to measure an individual's subjective experience of stress over the past month. Meanwhile, The Academic Procrastination Scale-Short Form (APS-S) was used to measure the tendency to delay or postpone academic tasks. The reliability analysis for the pilot test is Cronbach's alpha of 0.96, which indicates excellent internal consistency and reliability. For data analysis, Pearson's correlation coefficient was performed to analyse the relationship between stress and academic procrastination. These variables are predicted to have a high positive correlation. The findings of this study predict a significant correlation between perceived stress and academic procrastination, indicating that higher stress levels were associated with increased procrastination tendency.

Is it about substituting an addiction with another? development and initial psychometric properties of the first heated tobacco products addiction questionnaire (HeaTPAQ)

BackgroundPublic health experts currently agree that heated tobacco products (HTPs) pose a significant health risk for their consumers. The same concentrations and speed of delivery of nicotine found for HTPs and conventional combustion cigarettes make it necessary to consider the addictiveness of HTPs, and provide precise diagnostic instruments to serve as the basis for effective treatment plans. Therefore, the main objectives of this study were to design a questionnaire for HTPs addiction called “Heated Tobacco Products Addiction Questionnaire (HeaTPAQ)” and to examine its psychometric properties.MethodsAdults from the general population of Lebanon (n = 754) were administered the HeatPAQ, along with the Fagerström test for nicotine dependence (FTND), the Caffeine Use Disorder Questionnaire, the Generalized Anxiety Disorder 7-item, and the Patient Health Questionnaire-9. We split the main sample into two subsamples; subsample 1 consisting of 33% of the participants used for the exploratory factor analysis (EFA) (n = 246; mean age 27.82 ± 9.38 years) and subsample 2 consisting of 67% of the participants used for the confirmatory factor analysis (CFA) (n = 508; mean age 27.81 ± 8.80 years).ResultsEFA then CFA analyses revealed a one-factor model consisting of 13 items with acceptable fit to the data. The HeaTPAQ reached excellent internal consistency coefficients, with both Cronbach’s α and McDonald’s ω values of 0.96. The one-dimensional structure of the HeaTPAQ was found to be invariant across sex groups. Convergent validity was demonstrated through significant positive correlation with FTND scores. Furthermore, HeaTPAQ scores correlated positively with measures of caffeine addiction, anxiety and depression, which suggests the adequate concurrent validity of the scale.ConclusionFindings suggest that the HeatPAQ is a specific, short and simple-to-use self-report questionnaire to assess HTPs addiction reliably and validly. Pending future studies confirming our results, we hope that the HeatPAQ will facilitate routine screening for HTPs addiction, which is an essential step towards appropriate prevention and intervention efforts and to inform policy makers.

Exploring the Role of Social Support in Postpartum Well-Being with a Psychometric Approach

Abstract The Czech version of the Social Support Survey Instrument (CZ-SSSI) was developed and validated to assess social support among postpartum women, a crucial factor in mitigating mental health challenges during the perinatal period. This cross-sectional study recruited 486 Czech postpartum women via online platforms focused on motherhood and childcare. The CZ-SSSI was translated using a forward and backward method, with psychometric validation conducted through confirmatory factor analysis, internal consistency testing (Cronbach’s alpha and McDonald’s Omega), and validity assessments using the Depression, Anxiety, and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS). The results demonstrated excellent internal consistency (Cronbach’s alpha &gt; 0.9 across subscales), confirming the robustness of the four-factor model. Convergent validity was established through significant correlations with mental health measures, and the instrument effectively distinguished between groups with differing levels of depression and infant health status. The CZ-SSSI is a reliable and valid tool for assessing postpartum social support, with potential applications in both clinical assessment and perinatal mental health research. By providing a standardized measure, this instrument can contribute to a better understanding of the role of social support in postpartum well-being and inform targeted interventions to support maternal mental health.

Validity and reliability of the Turkish version of the Spinal Cord Independence Measure (SCIM III) self-report.

A cross-sectional validation study. The aim of the study was to create a Turkish version of the Spinal Cord Independence Measure Self-Report (SCIM-SR) scale and verify its validity and reliability. Rehabilitation Department at Istanbul Physical Medicine and Rehabilitation and Training Research Hospital. The Turkish version of SCIM-SR was translated from English using forward and backward translation in accordance with standard guidelines and 90 participants completed the SCIM-SR Turkish form. At the same time, a Spinal Cord Independence Measure III (SCIM III) was administered to the participants by a health professional through observation. Cronbach's alpha, Pearson and Spearman correlation coefficients were used to evaluate the internal consistency and concurrent validity. The Cronbach's α coefficients for the total scale was 0.883. For the subscales, it was 0.929 for self-care, 0.571 for respiration and sphincter management and 0.885 for mobility. Test-retest reliability after two weeks yielded Spearman coefficients above 0.92 for the total scale and all subscales. When analyzing the correlation between SCIM-SR and SCIM III, the intraclass correlation average and its lower and upper bound values were as follows: 0.984 (0.976-0.990) for self-care; 0.970 (0.955-0.980) for respiration and sphincter management; 0.968 (0.951-0.979) for mobility and 0.980 (0.969-0.987) for the total. There was good agreement between SCIM-SR and SCIM III when evaluating the total score in Bland-Altman graphs. The Bland-Altman analysis revealed no significant proportional bias (0.76; 95% CI [-21.34, 22.87]), but a significant fixed bias was observed. The Turkish version of SCIM-SR demonstrated excellent internal consistency and good validity in Turkish individuals with spinal cord injury.

Utility of the Modified Anxiety Dimensional Observation Scale in Autistic Preschoolers with Varying Intellectual Functioning

ABSTRACT Objective Co-occurring anxiety affects 40–80% of autistic individuals; however, little is understood about how anxiety manifests in young autistic children, especially those with intellectual disability (ID), partly due to the paucity of measures designed to assess anxiety symptoms in this population. The present study examined the utility of the Modified Anxiety Dimensional Observation Scale (M-Anx-DOS), an observational measure of anxiety-related behaviors, in preschool-aged autistic children with and without ID. Method This study included 48 autistic children (Mean age = 43.96 months; 81.3% with ID) and 30 non-autistic (NA) controls (Mean age = 43.66 months). Anxiety-related behaviors were measured during the M-Anx-DOS. Parent-reported anxiety symptoms were assessed via the Preschool Anxiety Scale-Revised (PAS-R). Results Groups exhibited comparable scores on both the M-Anx-DOS and PAS-R. Within the autism group, a subset of M-Anx-DOS scores were related to age, autistic features, or IQ. The M-Anx-DOS exhibited excellent inter-rater reliability and acceptable internal consistency. Convergent validity was promising, with specific M-Anx-DOS scores correlated with parent-reported social, separation, and overall anxiety symptoms. M-Anx-DOS scores were not correlated with parent-reported ADHD or externalizing symptoms, suggesting strong discriminant validity. Conclusions This study provides preliminary evidence of the reliability and validity of the M-Anx-DOS. These findings are promising given the importance of observational measurement of anxiety and lack of existing measures for this critical developmental period. Given the sample size and the complexity of identifying prodromal signs of anxiety in young autistic preschoolers with ID, future longitudinal work is essential to replicate and extend this work.

Psychometric assessment of the breastfeeding self-efficacy scale-short form: An alternative german translation.

Psychometric assessment of the breastfeeding self-efficacy scale-short form: An alternative german translation.

Validation of Malayalam Translation of the Sydney Swallow Questionnaire (MSSQ): A Prospective Cross-Sectional Study.

The study aimed to cross-linguistically adapt the Sydney Swallow Questionnaire in Malayalam (MSSQ) and to determine its psychometric properties. The objectives of our study were to document the test-retest reliability, internal consistency, and discriminant validity of MSSQ. The SSQ was translated from English to Malayalam, and was administered to 55 Malayalam-speaking participants with oropharyngeal dysphagia and 55 age- and gender-matched Malayalam speakers with normal swallowing ability. The Kolmogorov-Smirnov normality test was performed to check the normality of the data. Cronbach's alpha was used to measure the test-retest reliability. Internal consistency was measured through split-half reliability using the Spearman-Brown correlation coefficient. The discriminant validity was documented using the Mann-Whitney U-test. The Cronbach's alpha value for the total MSSQ scores was 0.99, indicating a strong positive correlation between the test and retest scores. The Spearman-Brown correlation coefficient was 0.97, indicating that the MSSQ had excellent internal consistency. Mann-Whitney U-test revealed that Group 1 participants had significantly higher MSSQ scores than Group 2 participants, exhibiting excellent discriminant validity. It was concluded that the MSSQ was a valid and reliable tool to assess the symptoms of dysphagia among Malayalam speakers.

Unveiling mental health challenges: Investigating depression, anxiety and stress among transgender individuals in Sindh, Pakistan

Purpose Transgender individuals are more susceptible to psychological distress and mental health issues. The purpose of this study is to determine the prevalence and associated factors of depression, anxiety and stress among individuals from the transgender community. Design/methodology/approach This cross-sectional study was conducted from March to December 2022 among the transgender community in Karachi and Hyderabad. A standardized, self-administered DASS-42 questionnaire was used, and a non-probability convenient sampling technique was used. The frequency and percentages of variables were calculated. The Cronbach’s alpha coefficient was used to evaluate the internal consistency of the items within the subscale. The impact of socio-demographic factors on depression, anxiety and stress levels was assessed using multivariate ordinal logistic regression. Findings Out of total 352 transgender individuals, the majority of them were experiencing extremely severe depression with 187 (53.1) affected. Additionally, 267 (75.9) individuals were dealing with extremely severe anxiety and 167 (47.4) facing severe stress. The mean depression score was 26.3 ± 8.6, with stress following closely at 26.2 ± 7.9 and anxiety at 23.5 ± 8.3. The scale had excellent internal consistency, as shown by a Cronbach’s alpha of 0.93. Male sex had a 3.48 (95% C.I: 1.34–9.05) fold higher likelihood of experiencing anxiety compared to females. Research limitations/implications One of the limitations of this study is the use of a non-probability convenient sampling technique and the collection of data exclusively from two cities of Pakistan (Karachi and Hyderabad). Practical implications The study identified specific mental health challenges faced by transgender individuals in Sindh, enabling mental health professionals and policymakers to develop targeted interventions and counseling services. This includes advocating for mental health programs and anti-discrimination laws that address the unique stressors experienced by transgender individuals. Community awareness and support programs aimed at educating the public, reducing stigma and fostering acceptance of transgender individuals should be implemented to achieve better outcomes. Social implications he research can help raise awareness about the challenges faced by transgender individuals, fostering greater empathy and understanding among the general public. This may contribute to reducing societal stigma, prejudice and discrimination against the transgender community. The study can encourage efforts to create a more inclusive society where transgender individuals feel valued and accepted in family, educational and workplace settings. Thich research can also serve as a tool for advocacy, empowering transgender individuals to voice their concerns and demand their rights, which could lead to greater self-confidence and a stronger sense of community among transgender people. Originality/value This study revealed a significant prevalence of depression, anxiety and stress among transgender individuals. Regular assessment and implementation of appropriate measures should be conducted to promote their mental well-being. By actively engaging with transgender individuals, we can develop more effective strategies to meet their mental health needs and foster social integration and acceptance.