BACKGROUND: The three-item Sexual Distress Scale (SDS-3) has been frequently used to assess distress related to sexuality in public health surveys and research on sexual wellbeing. However, its psychometric properties and measurement invariance across cultural, gender and sexual subgroups have not yet been examined. This multinational study aimed to validate the SDS-3 and test its psychometric properties, including measurement invariance across language, country, gender identity, and sexual orientation groups. METHODS: We used global survey data from 82,243 individuals (Mean age=32.39 years; 40.3 % men, 57.0 % women, 2.8 % non-binary, and 0.6 % other genders) participating in the International Sexual Survey (ISS; https://internationalsexsurvey.org/) across 42 countries and 26 languages. Participants completed the SDS-3, as well as questions regarding sociodemographic characteristics, including gender identity and sexual orientation. RESULTS: Confirmatory factor analysis (CFA) supported a unidimensional factor structure for the SDS-3, and multi-group CFA (MGCFA) suggested that this factor structure was invariant across countries, languages, gender identities, and sexual orientations. Cronbach's α for the unidimensional score was 0.83 (range between 0.76 and 0.89), and McDonald's ω was 0.84 (range between 0.76 and 0.90). Participants who did not experience sexual problems had significantly lower SDS-3 total scores (M = 2.99; SD=2.54) compared to those who reported sexual problems (M = 5.60; SD=3.00), with a large effect size (Cohen's d = 1.01 [95 % CI=-1.03, -0.98]; p < 0.001). CONCLUSION: The SDS-3 has a unidimensional factor structure and appears to be valid and reliable for measuring sexual distress among individuals from different countries, gender identities, and sexual orientations.

Artois University Arras France

Auckland University of Technology Auckland New Zealand

Austrian Public Health Institute Vienna Austria

Biostatistics Consulting Center National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan

Center for Excessive Gambling Addiction Medicine Lausanne University Hospitals Lausanne Switzerland

Center on Alcohol Substance use and Addictions University of New Mexico Albuquerque New Mexico United States

Centre de recherche interdisciplinaire sur les problèmes conjugaux et les agressions sexuelles Montréal Canada

Centre for Advanced Research Excellence in Public Health Savar Dhaka Bangladesh

Centre of Excellence in Responsible Gaming University of Gibraltar Gibraltar United Kingdom

Chuncheon Addiction Management Center Republic of Korea

College of Education Psychology and Social Work Flinders University Adelaide Australia

College of Healthcare Sciences James Cook University Queensland Australia

Connecticut Council on Problem Gambling Wethersfield CT USA

Decentralized Big Data Team RIKEN Center for Advanced Intelligence Project Tokyo Japan

Departamento de Psicología Básica Clínica y Psicobiología University Jaume 1 Castelló Spain

Departamento de Psicología y Filosofía Facultad de Ciencias Sociales Universidad de Tarapacá Arica Arica y Parinacota Chile

Département de Psychologie Université de Montréal Montréal Canada

Département de Psychologie Université du Québec à Trois Rivières Trois Rivières Canada

Department of Addictology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Addictology General University Hospital Prague Prague Czech Republic

Department of Clinical Pharmaceutical and Biological Sciences University of Hertfordshire Hertfordshire United Kingdom

Department of Educational Psychology and Psychology of Health Pavol Jozef Safarik Universit y in Kosice Kosice Slovakia

Department of Educational Psychology and Psychology of Health Pavol Jozef Safarik University in Kosice Kosice Slovakia

Department of Neuropsychiatry Graduate School of Medicine Kyoto University Kyoto Japan

Department of Pediatrics National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan

Department of Personality Assessment and Psychological Treatments University of Valencia Valencia Spain

Department of Psychiatry All India Institute of Medical Sciences New Delhi India

Department of Psychiatry College of Medicine Hallym University Chuncheon Republic of Korea

Department of Psychiatry Faculdade de Medicina Universidade de São Paulo São Paulo Brazil

Department of Psychology and Cognitive Science University of Trento Trento Italy

Department of Psychology and Neuroscience Auckland University of Technology Auckland New Zealand

Department of Psychology College of Humanity and Social Science Fuzhou University Fuzhou Fujian province China

Department of Psychology Faculty of Education Charles University Prague Czech Republic

Department of Psychology Faculty of Humanities and Social Sciences University of Zagreb Zagreb Croatia

Department of Psychology Nottingham Trent University Nottingham United Kingdom

Department of Psychology Sharda University Greater Noida Uttar Pradesh India

Department of Psychology University of Nevada Las Vegas NV USA

Department of Public Health and Informatics Jahangirnagar University Savar Dhaka Bangladesh

Department of Sociology Faculty of Humanities and Social Sciences University of Zagreb Zagreb Croatia

Doctoral School of Psychology ELTE Eötvös Loránd University Budapest Hungary

Experimental Pathophisiology Post Graduation Program Faculdade de Medicina Universidade de São Paulo São Paulo Brazil

Facultad de Ciencias de la Salud Universidad Privada del Norte Lima Perú

Facultad de Medicina Universidad Científica del Sur Lima Perú

Facultad de Psicología Universidad de Talca Talca Talca Region del Maule Chile

Faculty of Philosophy University of Ss Cyril and Methodius in Trnava Trnava Slovakia

Florida State University Panama Republic of Panama

Health Promotion Research Centre University of Galway Galway Ireland

HELP University Kuala Lumpur Malaysia

Institute for Behavioural Addictions Sigmund Freud University Vienna Austria

Institute for Neural Computations University of California San Diego CA USA

Institute for Sex Research Sexual Medicine and Forensic Psychiatry University Medical Center Hamburg Eppendorf Hamburg Germany

Institute of Allied Health Sciences College of Medicine National Cheng Kung University Tainan Taiwan

Institute of Forensic Psychiatry and Sex Research Center for Translational Neuro and Behavioral Sciences University of Duisburg Essen Essen Germany

Institute of Legal Psychiatry Lausanne University Hospitals Lausanne Switzerland

Institute of Psychology Cardinal Stefan Wyszynski University Warsaw Poland

Institute of Psychology ELTE Eötvös Loránd University Budapest Hungary

Institute of Psychology Polish Academy of Sciences Warsaw Poland

Institute of Psychology University of Lausanne Lausanne Switzerland

International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health Babeș Bolyai University Cluj Napoca Romania

Laboratory of Behavioral Medicine Neuroscience Institute Lithuanian University of Health sciences Kaunas Lithuania

Leuven School For Mass Communication KU Leuven Leuven Belgium

Macedonian Academy of Sciences and Arts Skopje Republic of North Macedonia

Public Health Institute Faculty of Health Liverpool John Moores University Liverpool Merseyside United Kingdom

SAMRC Unit on Risk and Resilience in Mental Disorders Department of Psychiatry and Neuroscience Institute University of Cape Town Cape Town South Africa

SAMRC Unit on Risk and Resilience in Mental Disorders Department of Psychiatry Stellenbosch University Cape Town South Africa

School of Psychology University of Southampton Southampton United Kingdom

School of Social Work Faculty of Social Welfare and Health Sciences University of Haifa Haifa Israel

Section of Sexual Psychopathology Department of Dynamic and Clinical Psychology and Health Studies Sapienza University of Rome Rome Italy

Sistema Nacional de Investigación SENACYT Panama Republic of Panama

Universidad Pedagógica y Tecnológica de Colombia Colombia

Universidad Privada de Santa Cruz de la Sierra Santa Cruz Bolivia

University of Baghdad College of Medicine Baghdad Iraq

University of Cuenca Azuay Ecuador

Virtual Teaching and Cyberpsychology Laboratory School of Psychology National Autonomous University of Mexico Mexico Mexico

William James Center for Research Department of Education and Psychology University of Aveiro Aveiro Portugal

Yale University School of Medicine New Haven CT USA

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