The Kessler Psychological Distress Scale (K6) is used as a self-report measure of nonspecific psychological distress. Although research documents higher K6 scores among lesbian, gay, bisexual, and transgender (LGBT) individuals relative to cisgender, heterosexual individuals, measurement invariance of the K6 has not been established between these groups. We used multigroup confirmatory factor analysis to examine factorial invariance of the K6 between 1,765 LGBT and 20,632 cisgender, heterosexual individuals who completed the Well-Being and Basic Needs Survey. The K6 exhibited configural, weak/metric, and strong/scalar measurement invariance between groups, suggesting that it operates equivalently for both groups. We then examined differences in latent mean K6 scores between groups and differences in the percentage of individuals in each group who met a threshold for serious psychological distress (scores ≥ 13). The latent K6 mean and the percentage of individuals who met the threshold for serious psychological distress were both significantly higher for LGBT than for cisgender, heterosexual individuals.
AkninL. B.De NeveJ. E.DunnE. W.FancourtD. E.GoldbergE.HelliwellJ. F.JonesS. P.KaramE.LayardR.LyubomirskyS.RzepaA.SaxenaS.ThorntonE. M.VanderWeeleT. J.WhillansA. V.ZakiJ.KaradagO.Ben AmorY. (2022). Mental health during the first year of the COVID-19 pandemic: A review and recommendations for moving forward. Perspectives on Psychological Science, 17(4). https://doi.org/10.1177/17456916211029964
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
3.
ArgyriouA.GoldsmithK. A.RimesK. A. (2021). Mediators of the disparities in depression between sexual minority and heterosexual individuals: A systematic review. Archives of Sexual Behavior, 50(3), 925–959. https://doi.org/10.1007/s10508-020-01862-0
4.
BentlerP. M. (2006). EQS 6 structural equations program manual. Multivariate Software.
5.
BentlerP. M.WuE. J. C. (2002). EQS for Windows user’s guide. Multivariate Software.
6.
BränströmR.StormbomI.BergendalM.PachankisJ. E. (2022). Transgender-based disparities in suicidality: A population-based study of key predictions from four theoretical models. Suicide and Life-threatening Behavior, 52(3), 401–412. https://doi.org/10.1111/sltb.12830
7.
BrooksV. R. (1981). Minority stress and lesbian women. Lexington Books.
8.
ByrneB. M. (2006). Structural equation modeling with EQS: Basic concepts, applications, and programming (2nd ed.). Erlbaum.
9.
ByrneB. M. (2008). Testing for multigroup equivalence of a measuring instrument: A walk through the process. Psicothema, 20(4), 872–882.
10.
ChenF. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504. https://doi.org/10.1080/10705510701301834
11.
CheungG. W.RensvoldR. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 9(2), 233–255. https://doi.org/10.1207/S15328007SEM0902_5
12.
DrapeauA.Beaulieu-PrévostD.MarchandA.BoyerR.PrévilleM.KairouzS. (2010). A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender. BMC Medical Research Methodology, 10(1), 68. https://doi.org/10.1186/1471-2288-10-68
FurukawaT. A.KesslerR. C.SladeT.AndrewsG. (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine, 33(2), 357–362. https://doi.org/10.1017/S0033291702006700
15.
GarbarskiD. (2021). The survey measurement of sexual orientation: Configurations of sexual identity and attraction and associations with mental health. LGBT Health, 8(4), 307–315. https://doi.org/10.1089/lgbt.2020.0270
16.
HarperL. A.BeckK. C.DrazdowskiT. K.LiC. (2023). Sex and sexual identity differences in poly-tobacco use and psychological distress in US adults: Results from the National Health Interview Survey. Nicotine & Tobacco Research, 25(1), 19–27. https://doi.org/10.1093/ntr/ntac180
17.
HendersonE. R.HotchkissM.LinC. A.BlosnichJ. R. (2025). Material hardship and use of social safety net programs among LGBT adults and their families. Analyses of Social Issues and Public Policy, 25(1). https://doi.org/10.1111/asap.12432
18.
HoltzmanD. (2004). The behavior risk factor surveillance system. In BlumenthalD. S.DiClementeR. J. (Eds.), Community-based health research issues and methods (pp. 115–131). Springer.
19.
HuL.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
20.
KarpmanM. (2021). Well-Being and Basic Needs Survey, United States, 2021. Inter-University Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR38759.v1
21.
KarpmanM. (2022). Well-Being and Basic Needs Survey, United States. Inter-University Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR38975.v1
KesslerR. C.AndrewsG.ColpeL. J.HiripiE.MroczekD. K.NormandS.-L. T.WaltersE. E.ZaslavskyA. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. https://doi.org/10.1017/S0033291702006074
24.
KesslerR. C.BarkerP. R.ColpeL. J.EpsteinJ. F.GfroererJ. C.HiripiE.HowesM. J.NormandS. L. T.ManderscheidR. W.WaltersE. E.ZaslavskyA. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184
25.
KesslerR. C.GreenJ. G.GruberM. J.SampsonN. A.BrometE.CuitanM.FurukawaT. A.GurejeO.HinkovH.HuC.LaraC.LeeS.MneimnehZ.MyerL.Oakley-BrowneM.Posada-VillaJ.SagarR.VianaM. C.ZaslavskyA. M. (2010). Screening for serious mental illness in the general population with the K6 screening scale: Results from the WHO World Mental Health (WMH) survey initiative. International Journal of Methods in Psychiatric Research, 19(S1), 4–22. https://doi.org/10.1002/mpr.310
26.
KingM.SemlyenJ.TaiS. S.KillaspyH.OsbornD.PopelyukD.NazarethI. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 70. https://doi.org/10.1186/1471-244X-8-70
27.
KirakosianN.StantonA. M.McKetchnieS. M.KingD.DolotinaB.O’CleirighC.GrassoC.PotterJ.MayerK. H.BatchelderA. W. (2023). Suicidal ideation disparities among transgender and gender diverse compared to cisgender community health patients. Journal of General Internal Medicine, 38(6), 1357–1365. https://doi.org/10.1007/s11606-022-07996-2
28.
LefevorG. T.Boyd-RogersC. C.SpragueB. M.JanisR. A. (2019). Health disparities between genderqueer, transgender, and cisgender individuals: An extension of minority stress theory. Journal of Counseling Psychology, 66(4), 385–395. https://doi.org/10.1037/cou0000339
29.
LehmannJ.PilzM. J.HolznerB.KemmlerG.GiesingerJ. M. (2023). General population normative data from seven European countries for the K10 and K6 scales for psychological distress. Scientific Reports, 13(1), 18389. https://doi.org/10.1038/s41598-023-45124-0
30.
LiuR. T.SheehanA. E.WalshR. F. L.SanzariC. M.CheekS. M.HernandezE. M. (2019). Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Clinical Psychology Review, 74, 101783. https://doi.org/10.1016/j.cpr.2019.101783
31.
MahonC. P.Lombard-VanceR.KiernanG.PachankisJ. E.GallagherP. (2022). Social anxiety among sexual minority individuals: A systematic review. Psychology & Sexuality, 13(4), 818–862. https://doi.org/10.1080/19419899.2021.1936140
32.
MarchiM.ArcolinE.FioreG.TravascioA.UbertiD.AmaddeoF.ConvertiM.FiorilloA.MirandolaM.PinnaF.VentriglioA.GaleazziG. M. (2022). Self-harm and suicidality among LGBTIQ people: A systematic review and meta-analysis. International Review of Psychiatry, 34(3–4), 240–256. https://doi.org/10.1080/09540261.2022.2053070
MeyerI. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
36.
PellicaneM. J.CieslaJ. A. (2022). Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis. Clinical Psychology Review, 91, 102113. https://doi.org/10.1016/j.cpr.2021.102113
37.
PinnaF.ParibelloP.SomainiG.CoronaA.VentriglioA.CorriasC.FrauI.MurgiaR.El KacemiS.GaleazziG. M.MirandolaM.AmaddeoF.CrapanzanoA.ConvertiM.PirasP.SupraniF.ManchiaM.FiorilloA.CarpinielloB. (2022). Mental health in transgender individuals: A systematic review. International Review of Psychiatry, 34(3–4), 292–359. https://doi.org/10.1080/09540261.2022.2093629
38.
PoteatT. C.DivsalarS.StreedC. G.FeldmanJ. L.BocktingW. O.MeyerI. H. (2021). Cardiovascular disease in a population-based sample of transgender and cisgender adults. American Journal of Preventive Medicine, 61(6), 804–811. https://doi.org/10.1016/j.amepre.2021.05.019
39.
RoodB. A.ReisnerS. L.SuraceF. I.PuckettJ. A.MaroneyM. R.PantaloneD. W. (2016). Expecting rejection: Understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgender Health, 1(1), 151–164. https://doi.org/10.1089/trgh.2016.0012
40.
RossL. E.SalwayT.TarasoffL. A.MacKayJ. M.HawkinsB. W.FehrC. P. (2018). Prevalence of depression and anxiety among bisexual people compared to gay, lesbian, and heterosexual individuals: A systematic review and meta-analysis. Journal of Sex Research, 55(4–5), 435–456. https://doi.org/10.1080/00224499.2017.1387755
41.
RostoskyS. S.RichardsonM. T.McCurryS. K.RiggleE. D. B. (2022). LGBTQ individuals’ lived experiences of hypervigilance. Psychology of Sexual Orientation and Gender Diversity, 9(3), 358–369. https://doi.org/10.1037/sgd0000474
42.
SalwayT.RossL. E.FehrC. P.BurleyJ.AsadiS.HawkinsB.TarasoffL. A. (2019). A systematic review and meta-analysis of disparities in the prevalence of suicide ideation and attempt among bisexual populations. Archives of Sexual Behavior, 48(1), 89–111. https://doi.org/10.1007/s10508-018-1150-6
43.
SatorraA.BentlerP. M. (1994). Corrections to test statistics and standard errors in covariance structure analysis. In von EyeA.CloggC. C. (Eds.), Latent variable analysis in developmental research (pp. 285–305). Sage.
44.
SatorraA.BentlerP. M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66(4), 507–514. https://doi.org/10.1007/BF02296192
SunderlandM.HobbsM. J.AndersonT. M.AndrewsG. (2012). Psychological distress across the lifespan: Examining age-related item bias in the Kessler 6 Psychological Distress Scale. International Psychogeriatrics, 24(2), 231–242. https://doi.org/10.1017/S1041610211001852
47.
TwengeJ. M.JoinerT. E. (2020). Mental distress among U.S. adults during the COVID-19 pandemic. Journal of Clinical Psychology, 76(12). https://doi.org/10.1002/jclp.23064
48.
VandenbergR. J.LanceC. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3(1), 4–70. https://doi.org/10.1177/109442810031002
49.
WittgensC.FischerM. M.BuspavanichP.TheobaldS.SchweizerK.TrautmannS. (2022). Mental health in people with minority sexual orientations: A meta-analysis of population-based studies. Acta Psychiatrica Scandinavica, 145(4), 357–372. https://doi.org/10.1111/acps.13405
50.
ZuckermanS. (2018). Well-Being and Basic Needs Survey, United States, 2018. Inter-University Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR37653.v2
51.
ZuckermanS. (2018). Well-Being and Basic Needs Survey, United States, 2019. Inter-University Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR38044.v1
52.
ZuckermanS. (2018). Well-Being and Basic Needs Survey, United States, 2020. Inter-University Consortium for Political and Social Research [distributor]. https://doi.org/10.3886/ICPSR38388.v1
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