Table 4.

Study results from measures of psychological outcomes, effect size and findings

Reference/outcome measure	Effect size (Cohen’s d)	Main findings
Fisher et al. (32)		Adjusted P - values between HC and KS were:
AQ	0.822	<0.001
GIDYQ-AA	0.872	<0.001
SCL 90- R (GSIS)	0.69	Positive symptom distress index: 0.03, obsession-compulsive: 0.04, somatization 0.03.
Herlihy et al. (21)		Significant difference for all psychosocial outcomes measured, when compared with population normative data (P < 0.001).
MBSRQ-AS	0.75
Appearance evaluation	1.143
Appearance orientation
RSE	2.022
K10	–	K10 found 43% of KS had high/very high psychological distress compared to the general population 10%.
SIS	–
Sorensen (27)
Behaviour rating scale	–	P-values between KS and controls were (P < 0.005) in subscales; intelligence, attention, level of activity. (P < 0.05); drive, liveliness. (P < 0.025) endurance and interest.
Skakkebaek et al. (34)		KS expressed significantly more neuroticism, less extraversion, conscientiousness, and openness to experience (P - values ≤ 0.01), controls scored higher on attention switching, imagination, communication, and social skills, while the scores of patients with KS were more evenly distributed across these scales. Differences between KS and controls for attention switching, imagination, communication, and social skills (P< 0.01). Attention-to-detail scores were comparably and normally distributed for both patients with KS and controls (P >0 .75)
NEO PI-R
Neuroticism	1.15
Extraversion	0.73
Openness	0.60
Agreeableness	0.018
Conscientiousness	0.40
AQ
Attention to detail	0.06
Attention switching	0.58
Imagination	0.65
Communication	0.42
Social skills	0.52
Van Rijn et al. (7)		Total ADI-R score for KS participants was (24.3 ± 15.4), showing that the overall range of ASD symptoms was increased in children with KSe.
ADI-R	–
Van Rijn et al. (26)		AQ score and all subscales were significantly different between controls and KS. KS reported to less frequently display negative assertion, significant difference was (P = 0.01).
SIB
Distress during ‘SI’	1.002
Frequency during ‘SI’	0.167
AQ	2.111
Liberato et al. (22)
SCID-II	–	Detected personality disorders in 31% of the KS sample vs a mean of 10.7% obtained from different community samples.
MMPI-2	–	Showed four altered scales, corresponding to Social Responsibility, Dominance, Ego Strength and Repression, in more than 40% of patients. Twenty-four of 34 MMPI scales were pathological in at least 10% of patients.
SPM	–	The mean raw score was 44 ± 10.8 (10–58), with a maximum score of 60.
Nielsen & Pelsen (24)
Mental illness diagnosis		There were no significant differences between controls and KS regarding mental illness. However, at the initial examination 41% of KS participants had a mental illness and which was significantly higher than controls (P < 0.0021).
Fabrazzo et al. (30)		There were statistical differences favouring controls over patients with KS following 1-year TRT in measures of; obsessive-compulsive, anger-hostility, phobias, psychoticism, GSI, PSDI. While MMSE had a much larger statistical difference (P = 0.0001). Measures: interpersonal sensitivity, depression, anxiety, PST and TCI-R showed no significant differences between groups.
SCL-90 subscales
Somatization	0.197
Obsessive-compulsive	0.870
Interpersonal sensitivity	0.209
Psychoticism	0.796
Anxiety	0.028
Anger-hostility	0.709
Phobias	0.675
Paranoid	0.475
SCL-90 global- indices
PST	0.509
GSI	0.724
PSDI	1.0
MMSE	1.490
TCI-R	–

AQ, Autism Spectrum Quotient (62); ADI-R, Autism diagnostic interview – Revised (73); GIDYQ-AA, Gender Identity/Dysphoria Questionnaires for Adults and Adolescents (63); K10, Kessler Psychological Distress Scale (66), MMPI-2, Minnesota Multiphasic Personality Inventory 2 (70); MMSE, Mini-mental State Examination; MBSRQ-AS, Multidimensional body-self relations questionnaire (64); NEO PI-R, Revised NEO personality inventory (67); QRI, Qualitative reading inventory (67); RSE, Rosenberg self-esteem test (65); SIB, Scale for interpersonal behaviour (69); SIS, Sexual Identity scale (68); SPM, Standard Progressive Matrices (74); SCID-II, Structured Clinical Interview for Axis II Disorders (71); SLC-ANX/DEP, Subscales of Symptoms checklist 90 Anxiety/Depression (72); SCL-90-R, Symptom Checklist-90-R; TCI-R, Temperament and Character Inventory-Revised.