Translation and validation of the Swedish version of the Self-Compassion Scale for Youth

ABSTRACT Objective Compassion-focused interventions for young people have started to emerge to treat depressive symptoms, and reliable and valid measures of the construct “self-compassion” is needed for this age-group in Swedish. This study aims to validate the Swedish translation of the Self-Compassion Scale for Youth (SCS-Y). Method Self-report questionnaires were collected from students (N = 316) aged 15–20 recruited from schools in Sweden, in a cross-sectional design. Confirmatory factor analyses, internal consistency, test-retest reliability, measurement invariance and convergent and divergent validity were calculated. Results A model with one general bi-factor and six specific factors had the best fit and confirmed the factor structure of SCS-Y. Internal consistencies were good, except for the subscale mindfulness for boys which was questionable. Three-week test-retest reliability was good. We found measurement invariance for age and no equivalence for sex. Evidence was found for convergent and divergent validity using correlations. Sex differences were found: girls scored higher on self-judgement, feelings of isolation and showed more over-identification, than boys. Conclusions The Swedish version of SCS-Y (SCS-Y-SE) is a reliable and valid self-report questionnaire, with some limitations, to assess self-compassion in clinical practice and research. Key Points What is already known about this topic: Compassion-focused interventions can potentially help young people overcome self-criticism and poor psychological health. Reliable and valid self-report questionnaires for compassion focused interventions are needed in Swedish. Self-Compassion Scale for Youths (SCS-Y) is a short, age-appropriate, valid and reliable instrument for adolescents in US populations. What this topic adds: We translated and adapted the SCS-Y to Swedish (SCS-Y-SE) and tested it in a school sample. The factor structure of SCS-Y-SE was established by confirmatory factor analyses, three-week test-retest reliability was good, and convergent and divergent validity were good. SCS-Y-SE can be considered a reliable and valid Swedish questionnaire for self-compassion in the age-range 15–20 years.


Introduction
Adolescence includes major developments in neurology, cognitive function, physical ability and emotional regulation (Susman & Dorn, 2009).Additionally, self-identity forms and relationship skills improve, and a stable and strong sense of identity and well-functioning relationships with peers are related to well-being in young people (Ragelienė, 2016).An absence of interpersonal connectedness (Caine et al., 2018) and self-compassion (e.g., Bluth & Blanton, 2015;Marsh et al., 2018;Zeller et al., 2015) is related to psychological problems and increased risk for suicide (Zeller et al., 2015).
Self-compassion is drawn primarily from Buddhist teaching in the Insight tradition (Brach, 2003) and has been defined as "compassion turned inward CONTACT Inga Dennhag inga.dennhag@.umu.seSupplemental data for this article can be accessed at https://doi.org/10.1080/00050067.2023.2217326.and refers to how we relate to ourselves in instances of perceived failure, inadequacy, or personal suffering" (Neff, 2015).Compassionate behaviours include self-compassion (being warm and understanding towards oneself), aspects of common humanity (sharing one's own limitations and imperfections with others) and mindfulness (being aware of the presently-experienced moment without being overwhelmed).Uncompassionate behaviours include selfjudgement (being hard and negative towards oneself), isolation (feeling alone when suffering) and over-identification with someone else's suffering.These components are conceptually distinct and tap into different ways that individuals attend to, respond to, and cognitively understand suffering.They represent various dimensions of selfcompassion, which interact as a system (Neff, 2015).
The result of two recent meta-analyses, one for adults (MacBeth & Gumley, 2012) and one for young people (Marsh et al., 2018), showed strong correlations between perceived self-compassion and psychological stress, anxiety and depression.High self-compassion in young people is related to increased well-being (Bluth & Blanton, 2015;Bluth et al., 2017;Henje et al., 2020).
Preliminary findings of compassion-focused therapy (CFT) (Bluth, Gaylord, et al., 2016;Boggiss et al., 2020;Bratt et al., 2020;Burke et al., 2019;Donovan et al., 2021) show that CFT can help young people overcome challenges during adolescence.However, there is a need for a reliable and valid self-report to assess the clinical outcomes of CFT, for clinical practice and in research.

Self-report questionnaires of self-compassion
One of the most studied self-compassion scales is the adult version of the Self-Compassion Scale (SCS; Neff, 2003), which is not optimal for youths due to its complex language (Neff et al., 2021).Neff et al. (2021) subsequently developed a youth version of the SCS (SCS-Y) adapted for 12-14 years olds.The 17-item SCS-Y was tested and analysed in an exploratory study, and two confirmative studies and a bifactor exploratory structural equation model (bifactor ESEM) supported the use of a general self-compassion score and six subscale scores.The validity and structure of Neff et al. (2021) SCS has been debated (Cleare et al., 2018;Ferrari et al., 2022;Muris & Petrocchi, 2017;Neff et al., 2021) and it has been questioned whether compassionate selfresponding (CSR) and uncompassionate self-responding (USR) are one single dimension or two semiindependent, unipolar dimensions (Ferrari et al., 2022).This debate is not yet resolved.Gilbert et al. (2017) biopsychosocial theory of compassion that investigates (in addition to self-compassion) how respondents give and receive compassion.Self-compassion was shown to be more important for psychological health (Henje et al., 2020) than the ability to give and receive compassion.At present, there is no Swedish self-report instrument that specifically targets self-compassion.

Sex differences in self-compassion
Studies about sex differences in self-compassion have shown mixed results for adults (Yarnell et al., 2015).In adolescent studies, girls scored lower overall on self-compassion than boys (Bluth & Blanton, 2015;Bluth et al., 2017;Henje et al., 2020), and interestingly, girls in late adolescence showed lower self-compassion than either boys or younger girls (Bluth & Blanton, 2015;Bluth et al., 2017).There may be several explanations for this pattern; for example, girls and boys are usually raised differently (Connell, 2009;Parpart et al., 2000).Furthermore, girls can suffer from sexual objectification and are more exposed to sexual harassment and abuse during adolescence than boys (Bradbury-Jones et al., 2019;Stahl & Dennhag, 2020).It is well known that these mechanisms can be internalised and affect self-confidence, self-worth and identity, and increase the risk for depressive symptoms e.g., (Dodd & Littleton, 2017).More self-objectification, body shame and negative eating attitudes have also been related to lower self-compassion (Liss & Erchull, 2015).

The objectives of the study
This study aimed to translate SCS-Y (Neff et al., 2021) to Swedish and validate it in a secondary school sample including age 15-20.The age span was a methodological necessity; it was the age of secondary school participants, which we intend to target with self-compassion interventions in a next phase.In this study, the term "young people" refers to 15-20 year olds (in other studies, "young people" has included ages 10-24, McDonagh et al. (2018)).In addition to confirming SCS-Y with regard to Neff's et al. (2021) single-bifactor model, we wanted to investigate whether CSR and USR are one single dimension or two semi-independent, unipolar dimensions.

Study setting and design
The study was cross-sectional and conducted in northern Sweden.Ethical approval for the research project was given by the Regional Ethical Review Board in Umeå, Sweden (number 2018/59-31)

Procedure
Permission for the translation process and for conducting the study was obtained from the author of the SCS and SCS-Y questionnaires (Neff et al., 2021).We used a back-translation method to obtain semantic and content equivalence across cultures (Hambleton, 2004).A professional translator was hired for backtranslation, and a few corrections were made after that.Four adolescent girls read and answered the questionnaire and confirmed the relevance and understandability of the items, before distribution.
All upper secondary schools in the region of Umeå were invited to participate, two of which agreed.Permission for conducting the study at the schools was granted by the principals.In total, 442 students received verbal and written information about the study from their teachers and the research assistants.Written consent was obtained from those who volunteered for participation (316, 71%).The students answered all questions on a web survey, and they were rewarded with a gift certificate worth around 20 US dollars.

Participants
Participants (N = 316), of which 213 were girls (67%), constituted a convenience sample from two upper secondary schools.The age ranged from 15 to 20 years (M = 17.07,SD = 1.36).The distribution was as follows: six participants were 15 years old, 91 were 16 years old, 108 were 17 years old, 86 were 18 years old, 20 were 19 years old and 5 were 20 years old.Most participants were born in Sweden (90%) and all of them spoke Swedish fluently.A majority of the participants lived with both parents (67%), the socioeconomic status of whom were classified according to a Swedish socioeconomic classification system made by Statistics Sweden (Statistiska Centralbyrån, 1984, 2019).The distribution was as follows: 17.60% manual workers, 32.6% clerical or office workers, 32.60% professionals, higher civil servants and executives, 7.60% self-employed of various kinds and 11.10% unknown.A subset of the sample (119 girls and 36 boys, mean age 16.91 (SD = 0.84)) filled in the same questionnaires three weeks later to obtain data on test-retest reliability.

Self-report questionnaires
All self-report questionnaires were administered in Swedish.

Self-Compassion Scale for youths -Swedish version (SCS-Y-SE)
SCS-Y-SE was translated from the original SCS-Y (Neff et al., 2021) comprising17 items divided into six subscales that can be used separately or combined for a total score.The items of self-kindness, common humanity and mindfulness were rated on a 5-point Likert scale from 1 (almost never) to 5 (almost always).Self-judgement, isolation and over-identification were reversely graded.Psychometrics were satisfactory in the English version by Neff et al. (2021), who found internal consistency to be questionable to excellent (ω = .93for the total scale; Cronbach's alphas for the subscales: .85 for self-compassion, .71for selfkindness, .80 for self-judgement, .72 for common humanity, .78 for isolation, .67 for mindfulness, .73 for overidentification) and test-retest reliability was satisfactory (r = .51to .71,total score .83).

Self-Compassion Scale (SCS)
SCS (Neff, 2003) is a 26-item instrument that measures responses to difficult life circumstances and inner triggers.Compassionate responses include self-kindness, common humanity and mindfulness, and uncompassionate responses include self-judgement, isolation and over-identification.The items were rated on a 5-point Likert scale from 1 (almost never) to 5 (almost always) with higher scores indicating more selfcompassion.A total mean score was calculated after reversing the items of the negative subscales (selfjudgement, isolation and over-identification).The Swedish version of SCS (Norrbottens läns landsting, 2013) has been validated in a sample of students (Nicolaidis, 2018).Internationally, SCS has been validated in a large adolescent sample, ages 12-19 (Cunha et al., 2016).Internal consistency in the current sample was .88(95% CI = [0.86,0.90]).
A 6-point Likert scale from 0 (not present) to 5 (constantly present) was used with higher scores meaning better well-being (Blom et al., 2012).The total sum score was calculated (range from 0 to 25), and the percentage value was calculated by multiplying the score by 4 and thus obtaining a scale from 0 (worst imaginable wellbeing) to 100 (best imaginable well-being).WHO-5 was found psychometrically valid in a Swedish adolescent psychiatric sample (ages 14-18) (Blom et al., 2012).Internal consistency in the current sample was .89(95% CI = [.87,.91]).

Revised Child Anxiety and Depression Scale (RCADS)
RCADS long scale (Chorpita et al., 2005) measures anxiety and depression symptoms.The 47-item scale was rated on a 4-point Likert scale, from 0 (never) to 3 (always).Here, we used the total anxiety scale (37 items) and the total depression scale (10 items).Total sum scores were calculated.The Swedish version was retrieved from a homepage for RCADS (Chorpita & Spence, 1998), which was found valid in a Danish sample age 8-16 (Esbjørn et al., 2012).The internal consistencies were excellent (α = .94and .91) in the present study.

Strength and Difficulties Questionnaire (SDQ)
SDQ (Goodman, 2001;Hagquist, 2007) measures the psychological adjustment of children and youth.Here, we used only the SDQ-impact subscale, which is considered a measure of global functioning.The five-item SDQ-impact subscale uses a 5-point Likert scale from 1 (Not at all) to 5 (All the time) to assess how much psychological problems interfere with daily life.The sum score was calculated.The internal consistency was acceptable (α = .69)(95% CI = [.61,.75]) in the present study.The SDQ has been found psychometrically valid in a Swedish adolescent sample (ages 12-18, Hagquist, 2007).

Statistical analysis
Descriptive analyses were conducted using SPSS, Version 27.0.We analysed corrected item-total correlations (r it c ) and the cut-off for removing items was set to less than .30(Field, 2018).
SCS-Y-SE's dimensionality was tested using the Lavaan R package for structural equation modelling version 0.60-3.00(BETA); (Rossell, 2018).Two confirmative models of SCS-Y were analysed using confirmatory factor analysis (CFA).First, a bifactor model with one global factor was estimated: items loaded on a selfcompassion global (G) factor and on their corresponding six specific factors.No cross-loadings were allowed between G and specific factors (Model 1), but specific factors were allowed to correlate.Second, a twobifactor model was calculated and no cross-loading was allowed between G and specific factors.The two global factors (compassionate and uncompassionate self-responding) were allowed to correlate with one another.Specific factors were allowed to correlate (Model 2).We tested whether CSR and UCS were single dimension or semi-independent by a Chi-square test between the models (Figure 1).
Construct validity was calculated by Pearson's correlations (r) between subscales (convergent and divergent validity).
Measurement equivalence or invariance across groups was used to assess measurement invariance across sex and age groups.As recommended by Svetina et al. (Svetina et al., 2019), we estimated the models in the following order: initial baseline models (configural invariance models), a test of invariant factor loadings (metric invariance) and invariant factor covariance (scalar invariance).A CFI change (ΔCFI) equal to or less than −0.01 is evidence of measurement invariance, even with a small sample (e.g., 150 per group) (Cheung & Rensvold, 2002;Finch et al., 2018).An RSMEA change (ΔRSMEA) of ≤0.01 can be interpreted as an excellent fit (close fit, 0.01-0.05;fair fit, 0.05-0.08;mediocre fit, 0.08-0.10;poor fit, >0.10) (Finch et al., 2018), categories from Svetina et al. (2019).A significant Satorra-Bentler test indicates that there is a difference between the models (Svetina et al., 2019).Sex differences were measured by independent t-tests (p = .05).Age differences were tested with an independent t-test.

Descriptive statistics of the items
See Tables 1 and 2 for descriptive statistics of the items.

Correlations between the SCS-Y-SE subscales
As expected, we found high correlations between the subscales.The highest correlations (medium to large) were within the compassionate subscales (selfkindness, common humanity and mindfulness) and within the uncompassionate subscales (selfjudgement, isolation and overidentified) (Table 3).
α-i 1.I try to be kind and supportive to myself when I'm having a hard time.

Reliability
The corrected item-total correlations (r it c ) were higher than 0.30 in the total sample, and in the subsamples of girls and boys, except for one item (17 in the subscale "over-identification" was lower for boys (r it c = .25)).We still decided to keep all items for holding the scale theoretically intact.
The analysis of divergent validity, between SCS-Y-SE scales, and the scales measuring SDQ-functioning composite (r = −.14, p = .060to −.29, p < .010)and PROMIS Pain interference (r = .00,p = .99to −.21.p < .010),showed no to small associations, supporting the divergent validity of the scales (descriptive statistics of the validity scales and the Pearson correlations appear in Table 5).

Measurement invariance for sex
The configural invariance model demonstrated a good fit to the data indicating that the factor structure of SCS-Y-SE was equivalent for boys and girls.The metric invariance model showed an acceptable fit.Two goodness-of-fit tests ΔCFI and the Satorra-Bentlers test indicated inequality for Configural vs. Metric and Metric vs.   Scalar invariance model.The scalar invariance model showed a good fit indicating that there were no observable sex differences between the intercepts in the models (Table 6).We concluded there was an ambiguous measurement invariance across groups divided by sex.

Measurement invariance for age
Two age groups were used for the calculations, namely 15-17 (n = 205, M = 16,50, SD =.56) and 18-20 (n = 111, M = 18.27,SD =.54).The groups were divided according to Sweden's border between child and adult (>18 years).The configural invariance model demonstrated an excellent fit to the data, indicating that the factor structure of SCS-Y-SE was equivalent for the two age groups, the metric invariance model showed an excellent fit, indicating that the factor loadings of the items were the same between the age groups; the scalar invariance model showed an excellent fit, indicating that there are no observable age differences in the intercepts (Table 6).

Discussion
The Swedish version SCS-Y-SE was shown to be a reliable self-report questionnaire (with some limitations) in line with the validation results of the United States' version of the scale (Neff et al., 2021).SCS-Y-SE had good internal consistency overall, the exception being the subscale mindfulness for boys (as was also seen in Neff et al. (2021)).SCS-Y-SE showed moderate to good test-retest reliability and ICC (Koo & Li, 2016), over a period of three weeks (.66-.74 for the subscales and .86 for the total scale), similar to SCS-Y's score (.83) for the same test-retest period.

Differences related to sex and age groups
We found that girls had more self-judgement, more sense of isolation and more over-identification than boys, which is in line with previous adolescent (Bluth & Blanton, 2015;Bluth et al., 2017;Henje et al., 2020) and adult (Yarnell et al., 2015) compassion research.There can be several complex interacting explanations for this pattern, including biological (Susman & Dorn, 2009), social (Connell, 2009) and psychological factors (Susman & Dorn, 2009).For example, girls are generally more sensitive to relational problems because they are raised to be more relational than boys (Connell, 2009).Another explanation could be the self-objectification and body shame that many girls suffer from (Liss & Erchull, 2015).Similar to Neff et al. (2021), we found no age differences in selfcompassion.

Confirmatory factor analyses
Both the single-bifactor model and the two-bifactor model using CFA had a good fit in SCS-Y-SE.
How to best measure the construct of selfcompassion has been heavily debated (Cleare et al., 2018;Ferrari et al., 2022;Muris & Petrocchi, 2017).Neff et al. ( 2019) compared various models in 20 international samples of adults and found that fit was excellent using ESEM for the 6-factor correlated, singlebifactor and correlated two-bifactor models and that for SCS-Y in particular, a single-bifactor ESEM had the best fit.Our best models were the single-bifactor model and the two-bifactor model (both using CFA) without any significant differences.According to the principle of parsimony, and in line with Neff et al. (2019), we propose that the single-bifactor model should be used.The question of whether CSR and UCS are one single dimension or two semi-independent, unipolar dimensions lies outside the scope of this research.

Measurement invariance
We found measurement invariance for age and ambiguous invariance for sex.For age, the factor structure, loading and intercept were the same.For sex, the factor structure was the same between groups according to the configural invariance model, but metric inequality indicated that one or more items of the questionnaire resulted in response bias (i.e., were answered differently by girls and boys).In addition, scalar invariance for sex was not found, and the intercepts were interpreted as inequal.We conclude that the test can be used across the tested ages (15-20), but it is unclear whether it can be used equally well by both sexes.

Convergent and divergent validity
Evidence was found for convergent and divergent validity using correlations with other self-report questionnaires of similar and different constructs.These findings are in line with previous findings that selfreported self-compassion negatively correlates with anxiety (Karen Bluth, Gaylord, et al., 2016) (Neff & McGehee, 2010), depression (Henje et al., 2020;Neff & McGehee, 2010) and anger (Henje et al., 2020), and positively correlates with well-being (Bluth & Blanton, 2015;Bluth et al., 2017;Henje et al., 2020).Selfcompassion had a much lower correlation with other constructs like the SDQ impact scale and pain interference as measured by the PROMIS-instrument.

Limitations
Participants were not geographically stratified, and a convenience sample was used, which limits generalisability.SCS-Y-SE was validated for the age span 15 to 20 years, and these results are therefore not directly comparable to the original sample (ages 10-14) (Neff et al., 2021).
Another limitation was that several of these questionnaires were not validated for ages 19-20.More girls than boys participated in the study (67%).Measurement invariance calculations were done even though the sample sizes were quite small (100 to 150 in each group), since good results have been reported with both small and skewed samples (Cheung & Rensvold, 2002;Finch et al., 2018).

Conclusions
The single bi-factor model with six subscales using CFA had a good fit.We recommend further research to ensure measurement invariance for sex.The instrument could be interpreted over the included ages (15-20), but not the sexes.SCS-Y is therefore validated (with some limitations) in our Swedish school sample.
In addition, we found that CSR and UCS could be both one single dimension or two semi-independent unipolar dimensions.However, we recommend following the principle of parsimony and Neff et al. (2021) original theory that one single dimension of selfcompassion is the best model for the scale.The Swedish version of SCS-Y (SCS-Y-SE) will be useful in future Swedish self-compassion research and for measuring self-compassion in therapy.SCS-Y-SE can be used for measuring self-compassion as a protective factor.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
The work was supported by the Region Västerbotten (ALF) Clinical Science, Umeå University.

Figure 1 .
Figure 1.Graphical comparison of the two CFA.CFA: Confirmatory Factor Analysis; Circles represent latent factors; squares represent scale items.

Table 1 .
Descriptive statistics of the total scale and subscales for total sample, boys and girls in the self-compassion scale for youth in Swedish.

Table 2 .
Descriptive statistics of the items for total sample, boys and girls in the self-compassion scale for youth in Swedish.

Table 4 .
Internal consistency of the SCS-Y translated to Swedish.SD = standard deviation, α = Cronbach alpha.ω = McDonald's omega.# = Omega cannot be estimated because the number of items is less than 3.

Table 5 .
Descriptive statistics of validity measures and Pearson's correlations between scales.

Table 6 .
Measurement invariance goodness-of-fit for the 6-factor model of SCS-Y-SE presented by sex and age-group.