Study on the development and reliability and validity of Transsexualism Screening Questionnaire
10.3760/cma.j.cn113661-20240821-00285
- VernacularTitle:易性症筛查问卷的编制及信效度研究
- Author:
Na LIU
1
;
Jingyi BAI
;
Junjuan ZHU
;
Nan HUANG
;
Yi XU
;
Jing CHEN
;
Jie ZHANG
;
Zheng LU
Author Information
1. 上海交通大学医学院附属精神卫生中心，上海200030
- Publication Type:Journal Article
- Keywords:
Screening questionnaire;
Sensitivity and specificity;
Transsexualism;
Reliability test;
Validity test
- From:
Chinese Journal of Psychiatry
2025;58(5):365-372
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aims to develop a questionnaire for transsexualism screening and validate its reliability and validity, to provide a culturally adapted screening tool for Chinese clinicians.Methods:Referencing internationally validated instruments related to transsexualism, items closely aligned with the diagnostic criteria of the International Classification of Diseases, 10th Revision (ICD-10) for transsexualism were extracted. Items reflecting Chinese family cultural characteristics were integrated. The overall structure of the questionnaire was refined through expert consultations. A total of 111 patients diagnosed with transsexualism according to ICD-10 diagnostic criteria (78 male-to-female (MtF), 33 female-to-male (FtM)) were recruited from the outpatient clinic of Shanghai Mental Health Center between June 2021 and April 2024. Additionally, 232 cisgender participants, whose self-reported gender identity aligned with their birth sex, were recruited via the Wenjuanxing platform from June 14 to 22, 2022, comprising 64 heterosexual males, 16 non-heterosexual males, 120 heterosexual females, and 32 non-heterosexual females. Both the transsexual and cisgender groups completed the screening questionnaire. The internal consistency reliability was assessed using Cronbach′s α coefficient, and the corrected item-total correlation (CITC) was employed to measure the relationship between individual items and the total score. Structural validity was verified through structural equation modeling (SEM) using AMOS software. The receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal screening cutoff value, with the area under the curve (AUC) used to evaluate diagnostic accuracy. Effect sizes (Cohen's d) were calculated to compare the average scores of the questionnaire across groups. Results:The Transsexualism Screening Questionnaire consists of 15 items including 4 reverse-scored questions, rated on a 5-point Likert scale. The Cronbach′s α coefficient was 0.953 and the CITC for all items exceeded the recommended threshold of 0.3. After rotation based on eigenvalues>1, one principal component explained 61.67% of the total variance. Confirmatory factor analysis indicated acceptable model fit (χ2/ df = 3.887, standardized root mean square residual (SRMR) = 0.064, root mean square error of approximation (RMSEA)=0.092, comparative fit index (CFI)=0.952, normed fit index (NFI)=0.936, Tucker-Lewis index (TLI)=0.943, incremental fit index (IFI)=0.952). Factor loadings for each item ranged from 0.435 to 0.914. ROC curve analysis revealed that the optimal cutoff values were a mean score of 2.83 and a total score of 42.5, achieving 100% sensitivity and 98.7% specificity, with a Youden index of 0.987. Effect size comparisons showed a Cohen′s d of 6.112 between MtF individuals and cisgender heterosexual males, and a Cohen′s d of 9.287 between FtM individuals and cisgender heterosexual females. Conclusion:The Transsexualism Screening Questionnaire exhibits acceptable reliability, validity, sensitivity, and specificity, and is suitable for screening transsexualism in the Chinese population.
