Exploring Gender Bias in the Dual Continua of Mental Health Measurement: Differential Item Functioning Analysis

Rahmat Aziz; Retno Mangestuti; Nada Ibrahim Alribdi; Maqdisi Firdaus Ali

doi:10.15408/jp3i.v15i1.45690

Authors

Rahmat Aziz Department of Psychology, Universitas Islam Negeri Maulana Malik Ibrahim Malang, Indonesia
Retno Mangestuti Department of Psychology, Universitas Islam Negeri Maulana Malik Ibrahim Malang, Indonesia
Nada Ibrahim Alribdi College of Education and Human Development, Princess Nourah bint Abdulrahman University, Saudi Arabia
Maqdisi Firdaus Ali Master of Public Health, Monash University, Victoria, Melbourne, Australia

DOI:

https://doi.org/10.15408/jp3i.v15i1.45690

Keywords:

differential item functioning, dual continua model, gender bias, mental health assessment, psychological distress

Abstract

Gender differences in mental health are widely reported, yet few studies have examined whether commonly used assessment instruments function equivalently across gender at the item level, particularly within the Dual Continua Model of Mental Health. The present study addresses this gap by evaluating gender-related measurement bias using regression-based Differential Item Functioning (DIF) analysis. A total of 1,674 university students from 32 Indonesian institutions completed the Azira Mental Health Scale (AMHS-24), which measures psychological well-being and psychological distress. DIF was assessed by controlling for latent trait levels to determine whether males and females respond differently to items at equivalent levels of psychological functioning. Results indicate that most well-being items exhibited no DIF, suggesting structural stability across gender for positive emotion, social relationship, and life satisfaction domains. In contrast, several distress items demonstrated uniform and nonuniform DIF, with one item showing strong magnitude. These findings suggest that the distress dimension may be more sensitive to gender-related response tendencies than the well-being dimension. By integrating the dual-continua framework with item-level psychometric analysis, this study clarifies whether observed gender differences reflect construct-relevant variance or differential item functioning, thereby contributing to the theoretical refinement and measurement fairness of mental health assessment.

References

American Educational Research Association, A. P. A. & N. C. on M. in Education. (2014). The Standards for Educational and Psychological Testing. American Educational Research Association.

Anjara, S. G., Brayne, C., & Van Bortel, T. (2021). Perceived causes of mental illness and views on appropriate care pathways among Indonesians. International Journal of Mental Health Systems, 15(1), 74. https://doi.org/10.1186/s13033-021-00497-5

Aziz, R., & Mangestuti, R. (2023). Profiling and action plan strategies for teachers’ mental health. Cyprus Turkish Journal of Psychiatry and Psychology, 5(2), 121–128. https://doi.org/10.35365/ctjpp.23.2.04

Aziz, R., & Mangestuti, R. (2025). Validating psychometric properties of dual-continua models for university student mental health assessment. International Journal of Public Health Science, 14(1), 425–433. https://doi.org/10.11591/ijphs.v14i1.24601

Bacigalupe, A., Martín, U., Triolo, F., Sjöberg, L., Sterner, T. R., Dekhtyar, S., Fratiglioni, L., & Calderón-Larrañaga, A. (2024). Is the diagnosis and treatment of depression gender-biased? Evidence from a population-based aging cohort in Sweden. International Journal for Equity in Health, 23(1), 252. https://doi.org/10.1186/s12939-024-02320-2

Boone, W. J., Staver, J. R., & Yale, M. S. (2014). Rasch Analysis in the Human Sciences. Springer Netherlands. https://doi.org/10.1007/978-94-007-6857-4

Bruce, M., & Weinraub, D. (2023). Implicit gender bias in the clinical judgment of psychopathy and personality disorders among licensed psychologists in the USA. Journal of Personality Assessment, 105(6), 763–769. https://doi.org/10.1080/00223891.2023.2178928

Christiansen, D. M., McCarthy, M. M., & Seeman, M. V. (2022). Where sex meets gender: How sex and gender come together to cause sex differences in mental illness. Frontiers in Psychiatry, 13, 856436. https://doi.org/10.3389/fpsyt.2022.856436

Diener, E., Oishi, S., & Tay, L. (2018). Advances in subjective well-being research. Nature Human Behaviour, 2(4), 253-260. https://doi.org/10.1038/s41562-018-0307-6

Elizabeth, A., Hutton, J. L., Skues, J. A., Sullivan, L. Z., & Wise. (2022). Mental health research in the global construction industry: A scoping review using a dual-continuum model of mental health. Mental Health and Prevention, (28), 200249. https://doi.org/10.1016/j.mhp.2022.200249

Fitriana, T. S., Purba, F. D., Stolk, E., & Busschbach, J. J. V. (2023). Indonesia youth population norms for EQ-5D-Y-3 L, EQ-5D-Y-5 L and the PedsQL generic core scale: lower health related quality of life relates to high economic status and stress. BMC Public Health, 23(1), 1124. https://doi.org/10.1186/s12889-023-16003-0

Garb, H. (2021). Race bias and gender bias in the diagnosis of psychological disorders. Clinical Psychology Review, 90, 102087. https://doi.org/10.1016/j.cpr.2021.102087

Garcia, J., Gallagher, M., O’Bryant, S., & Medina, L. (2021). Differential item functioning of the Beck Anxiety Inventory in a rural, multi-ethnic cohort. Journal of Affective Disorders, 293, 36–42. https://doi.org/10.1016/j.jad.2021.06.005

García-Fernández, M., Fuentes-Sánchez, N., Escrig, M. A., Eerola, T., & Pastor, M. C. (2025). Gender, emotion regulation, and cognitive flexibility as predictors of depression, anxiety, and affect in healthy adults. Current Psychology, 44(7), 5685–5694. https://doi.org/10.1007/s12144-024-07240-6

Hennein, R., Poulin, R., Gorman, H., & Lowe, S. R. (2023). Gender Discrimination and Mental Health Among Health Care Workers: Findings from a Mixed Methods Study. Journal of Women’s Health (2002), 32(7), 823–835. https://doi.org/10.1089/jwh.2022.0485

Hermann, V., Söderqvist, F., Karlsson, A. C., Sarkadi, A., & Durbeej, N. (2024). Mental health status according to the dual-factor model in Swedish adolescents: A cross sectional study highlighting associations with stress, resilience, social status and gender. PLoS ONE, 19(3), 1–22. https://doi.org/10.1371/journal.pone.0299225

Huang, T.-W., Wu, P.-C., & Mok, M. (2022). Examination of gender-related differential item functioning through poly-BW indices. Frontiers in Psychology, 13, 821459. https://doi.org/10.3389/fpsyg.2022.821459

Jane, J. S., Oltmanns, T. F., South, S. C., & Turkheimer, E. (2007). Gender bias in diagnostic criteria for personality disorders: an item response theory analysis. Journal of Abnormal Psychology, 116(1), 166–175. https://doi.org/10.1037/0021-843X.116.1.166

Jodoin, M. G., & Gierl, M. J. (2001). Evaluating type I error and power rates Using an effect size measure with the logistic regression procedure for DIF eetection. Applied Measurement in Education, 14(4), 329–349. https://doi.org/10.1207/S15324818AME1404_2

Jones, R. N. (2019). Differential item functioning and its relevance to epidemiology. Current Epidemiology Reports, 6(2), 174–183. https://doi.org/10.1007/s40471-019-00194-5

Keyes, C. L. M. (2017). The dual continua model: The foundation of the sociology of mental health and mental illness. In T. L. Scheid & E. R. Wright (Ed.), A handbook for the study of mental health: Social contexts, theories, and systems (pp. 66–81). Cambridge University Press. https://doi.org/https://doi.org/10.1017/9781316471289.007

Keyes, C. L. M., Eisenberg D, Perry GS, Dube SR, Kroenke K, & Dhingra SS. (2012). The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students. Journal of American College Health, 60(2), 126–133. https://doi.org/10.1080/07448481.2011.608393

Kwon, J.-Y., & Sawatzky, R. (2017). Examining gender-related differential item functioning of the Veterans Rand 12-item Health Survey. Quality of Life Research, 26, 2877–2883. https://doi.org/10.1007/s11136-017-1638-x

Lee, J., Lim, Y., Seo, D. G., Lee, M. K., Schalet, B. D., Fischer, F., Rose, M., Kang, D., & Cho, J. (2025). A multinational comparison study of the patient‐reported outcomes measurement information system anxiety, depression, and anger item bank in the general population. International Journal of Methods in Psychiatric Research, 34(1), e70012. https://doi.org/10.1002/mpr.70012

Levkovich, I., Yatzkar, U., & Shenaar-Golan, V. (2025). Age and gender differences in emotional and behavioral functioning among youth referred to a psychiatric outpatient clinic at a public hospital. Children, 12(6), 683. https://doi.org/10.3390/children12060683

Nie, Y.-Z., Zhang, X., Hong, N.-W., Zhou, C., Huang, Q.-Q., Cao, S.-Y., & Wang, C. (2024). Psychometric validation of the PERMA-profiler for well-being in Chinese adults. Acta Psychologica, 246, 104248. https://doi.org/10.1016/j.actpsy.2024.104248

Nila, S., Webb, C., Suryobroto, B., & Carter, A. (2025). Cultural differences in self-reported empathy in Indonesia. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-16075-5

Ogunola, A. A. (2022). Quality of Work-Life and Work-Life Balance as Predictors of Employee Job Satisfaction. TAZKIYA Journal of Psychology, 10(1), 74-84 https://journal.uinjkt.ac.id/tazkiya/article/view/22499/pdf

Özel, B., Karakaya, E., Köksal, F., Altinoz, A. E., & Yilmaz-Karaman, I. G. (2024). Gender bias of antisocial and borderline personality disorders among psychiatrists. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-024-01519-0

Putnick, D. L., & Bornstein, M. H. (2016). Measurement invariance conventions and reporting: The state of the art and future directions for psychological research. Developmental Review, 41, 71–90. https://doi.org/10.1016/j.dr.2016.06.004

Ramli, S. A., Zaremohzzabieh, Z., Idris, K., Bolong, J., & Abdullah, H. (2024). Psychometric validity, and measurement invariance of the PERMA model among youth in Malaysia. Cogent Psychology, 11(1), 2316419. https://doi.org/10.1080/23311908.2024.2316419

Renshaw, T. L., Bolognino, S. J., & Clark, K. N. (2024). Exploring a dual-factor mental health screening model with children in grades 5–10. School Psychology. https://doi.org/10.1037/spq0000669

Restar, A., Jin, H., Breslow, A., Reisner, S. L., Mimiaga, M., & ... (2020). Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. SSM Popul Health, 11(100595). https://doi.org/10.1016/j.ssmph.2020.100595

Sholichatun, Y., Aziz, R., Baharuddin, B., Mulyadi, M., & Muhid, A. (2025). Building resilience to promote mental health in university students. Health Education and Health Promotion, 13(2), 257–263. https://doi.org/http://dx.doi.org/10.58209/hehp.13.2.257

Simon, R. W. (2020). Gender, emotions, and mental health in the United States: Patterns, explanations, and new directions. Society and Mental Health, 2(10), 97–111. https://doi.org/10.1177/2156869320926236

Syafitri, N., Lubis, R., Indrawan, Y. F., & Choong, T. C. (2024). Self-compassion: Unveiling mental health through emotion regulation in high-school students. TAZKIYA Journal of Psychology, 12(1), 1–16. https://doi.org/10.15408/tazkiya.v12i1.37794

Tsaousis, I., Alahmandi, M. T., & Asiri, H. (2023). Uncovering Differential Item Functioning effects using MIMIC and mediated MIMIC models. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1268074

Velten, J., Brailovskaia, J., & Margraf, J. (2022). Positive mental health scale: Validation and measurement invariance across eight countries, genders, and age groups. Psychological Assessment, 34(4), 332–340. https://doi.org/10.1037/pas0001094

Verdam, M., Oort, F., & Sprangers, M. (2016). Item bias detection in the hospital anxiety and depression scale using structural equation modeling: Comparison with other item bias detection methods. Quality of Life Research, 26(6), 1439–1450. https://doi.org/10.1007/s11136-016-1469-1

Vigod, S. N., & Rochon, P. A. (2020). The impact of gender discrimination on a woman’s mental health. EClinicalMedicine, 20(19), 100311. https://doi.org/https://doi.org/10.1016/j.eclinm.2020.100311

Watkinson, R. E., Linfield, A., Tielemans, J., Francetic, I., & Munford, L. (2024). Gender-related self-reported mental health inequalities in primary care in England: a cross-sectional analysis using the GP Patient Survey. The Lancet Public Health, 9(2), e100–e108. https://doi.org/10.1016/S2468-2667(23)00301-8

Weiss, S. J., Nagle-Yang, S., Flynn, H., Cooper, B., Muzik, M., Simeonova, D. I., & Ozerdem, A. (2025). Gender differences in symptom profiles of individuals being treated for mood disorders. Journal of Mood & Anxiety Disorders, 12, 100152. https://doi.org/10.1016/j.xjmad.2025.100152

Zumbo, B. D. (2007). Three generations of DIF analyses: Considering where it has been, where it is now, and where it is going. Language Assessment Quarterly, 4(2), 223–233. https://doi.org/10.1080/15434300701375832