1
|
Ingram PB, Armistead-Jehle P, Childers LG, Herring TT. Cross validation of the response bias scale and the response bias scale-19 in active-duty personnel: use on the MMPI-2-RF and MMPI-3. J Clin Exp Neuropsychol 2024; 46:141-151. [PMID: 38493366 DOI: 10.1080/13803395.2024.2330727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
The Response Bias Scale (RBS) is the central measure of cognitive over-reporting in the MMPI-family of instruments. Relative to other clinical populations, the research evaluating the detection of over-reporting is more limited in Veteran and Active-Duty personnel, which has produced some psychometric variability across studies. Some have suggested that the original scale construction methods resulted in items which negatively impact classification accuracy and in response crafted an abbreviated version of the RBS (RBS-19; Ratcliffe et al., 2022; Spencer et al., 2022). In addition, the most recent edition of the MMPI is based on new normative data, which impacts the ability to use existing literature to determine effective cut-scores for the RBS (despite all items having been retained across MMPI versions). To date, no published research exists for the MMPI-3 RBS. The current study examined the utility of the RBS and the RBS-19 in a sample of Active-Duty personnel (n = 186) referred for neuropsychological evaluation. Using performance validity tests as the study criterion, we found that the RBS-19 was generally equitably to RBS in classification. Correlations with other MMPI-2-RF over- and under-reporting symptom validity tests were slightly stronger for RBS-19. Implications and directions for research and practice with RBS/RBS-19 are discussed, along with implications for neuropsychological assessment and response validity theory.
Collapse
Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, USA, TX
- Dwight D. Eisenhower Veteran Affairs Medical Center, Eastern Kansas Veteran Healthcare System, Leavenworth, USA, KS
| | | | - Lucas G Childers
- Department of Psychological Sciences, Texas Tech University, Lubbock, USA, TX
| | - Tristan T Herring
- Department of Psychological Sciences, Texas Tech University, Lubbock, USA, TX
| |
Collapse
|
2
|
Keller AV, Muller-Cohn CM, Austin TA, Jak AJ, Twamley EW. Neuropsychological functioning, neurobehavioral symptoms, and community reintegration in unstably housed veterans with mental health conditions. Clin Neuropsychol 2023; 37:1728-1744. [PMID: 36772819 PMCID: PMC10415532 DOI: 10.1080/13854046.2023.2176364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
Objective: Returning Veterans often have conditions (e.g. posttraumatic stress disorder [PTSD], depression, and history of traumatic brain injury [TBI]) associated with cognitive dysfunction and problems with work, school, housing, and relationships. Rehabilitative efforts in Veterans aim to promote community reintegration, or successful adjustment in one's home, community, and desired social roles. We examined associations between neuropsychological performance, neurobehavioral symptoms, and community reintegration in Veterans. Method: 89 Iraq/Afghanistan Veterans at risk for homelessness and receiving residential mental healthcare completed a neuropsychological assessment and the Community Reintegration for Service Members-Computer Adaptive Test (CRIS-CAT). Neuropsychological components were derived using Principal Component Analysis. Bivariate Pearson correlations between neuropsychological variables, neurobehavioral symptoms, and CRIS-CAT scales (Extent of Participation, Perceived Limitations, and Satisfaction) were used to determine significant correlates of community reintegration. Regression models were used to examine associations between bivariate-significant neuropsychological components, neurobehavioral symptoms, and CRIS-CAT scales. Results: Bivariate analyses revealed that better community reintegration was associated with better performance in attention/executive functioning and fewer neurobehavioral symptoms. Three regression models examining predictors of variance in Extent of Participation, Perceived Limitations, and Satisfaction in community reintegration were statistically significant overall, with only fewer affective symptoms emerging as significantly and uniquely associated with greater participation and greater satisfaction in community functioning. Conclusions: Veterans with fewer affective symptoms reported greater participation and satisfaction with community functioning. Future longitudinal research examining associations between neurobehavioral symptoms, cognition, and risk factors of poorer community reintegration in unstably housed Veterans is warranted.
Collapse
Affiliation(s)
- Amber V. Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
- Research Service, VA San Diego Healthcare System
| | - Chantal M. Muller-Cohn
- Research Service, VA San Diego Healthcare System
- California School of Professional Psychology, Alliant International University
| | - Tara A. Austin
- The VISN 17 Center of Excellence for Research on Returning War Veterans
| | - Amy J. Jak
- Mental Health Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
| | - Elizabeth W. Twamley
- Research Service, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
| |
Collapse
|
3
|
Binder LM, Tadrous-Furnanz SK, Storzbach D, Larrabee GJ, Salinsky MC. The rate of psychiatric disorders in veterans undergoing intensive EEG monitoring is associated with symptom and performance invalidity. Clin Neuropsychol 2022; 36:2120-2134. [PMID: 34632958 DOI: 10.1080/13854046.2021.1974564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To determine if the number of participants with psychiatric disorders increased in association with failures on symptom validity tests (SVTs) and a performance validity test (PVT) in Veterans admitted for evaluation of possible seizures. The 254 participants were Veterans undergoing inpatient video-EEG monitoring for the diagnosis of possible seizures. DSM-IV psychiatric disorders were diagnosed with the SCID IV. Symptom exaggeration was assessed with the MMPI-2-RF and performance validity with the TOMM. On the MMPI-2-RF, 27.6%-32.7% showed symptom exaggeration. Participants who exaggerated on the MMPI-2-RF were more often diagnosed with psychiatric disorders. The TOMM was failed by 15.4% of the sample. Participants who failed the TOMM were more often diagnosed with an Axis I disorder but not with a personality disorder. The MMPI-2-RF was invalid in more cases than the TOMM, but 7.9% of the sample generated a valid MMPI-2-RF and an invalid TOMM. The correlational design does not allow conclusions about cause and effect. The invalid groups may have had a higher rate of psychopathology. The number of participants with psychiatric disorders increased in association with symptom exaggeration and performance invalidity. Symptom exaggeration was more frequent than performance invalidity, but the TOMM made a unique contribution to identification of invalidity. The routine clinical use of SVTs and PVTs is supported. The results also suggest the need for caution in diagnosing psychiatric disorders when there is symptom exaggeration or performance invalidity, because diagnostic validity is dependent on the accuracy of symptom reporting.
Collapse
Affiliation(s)
| | | | | | | | - Martin C Salinsky
- VA Healthcare System, Portland, Oregon, USA.,Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
4
|
Morris NM, Mattera J, Golden B, Moses S, Ingram PB. Evaluating the performance of the MMPI-3 over-reporting scales: Sophisticated simulators and the effects of comorbid conditions. Clin Neuropsychol 2022; 36:2361-2369. [PMID: 34470583 DOI: 10.1080/13854046.2021.1968037] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We examined the utility of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) to detect feigned over-reporting using a symptom-based coaching simulation design across a control group and three diagnostic conditions: posttraumatic stress disorder (PTSD), minor traumatic brain injury (mTBI), and comorbid PTSD and mTBI. METHOD Participants were310 college students who wererandomly assigned to one of the four conditions. For participants in the feigning conditions, they were provided with a descriptionof their respective disorder condition throughout the duration of the session and asked to feign according to their condition while completing the MMPI-3. RESULTS MMPI-3 over-reporting scales perform well at classifying feigning. There is low sensitivity, high specificity, and effect magnitudes are medium to large range (1.12 - 2.47). There are no differences in scales assessing over-reporting between diagnostic conditions with dissimilar symptoms. CONCLUSIONS Findings provide initial support for the use of the MMPI-3 overreporting scales for detecting feigned PTSD, mTBI, and comorbid PTSD and mTBI. Further, individuals feigning different disorders, namely PTSD, mTBI, and comorbid PTSD and mTBI, feign predominantly general psychopathological symptoms, making Fp the strongest scale in terms of detecting these feigned disorders. Future research will benefit from establishing relevant diagnostic comparison groups to contrast with this study and utilizing known-group designs withboth PVT and SVT administration.
Collapse
Affiliation(s)
- Nicole M Morris
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Jessica Mattera
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Brittney Golden
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Serena Moses
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| |
Collapse
|
5
|
Sullivan KA, Bennett D. An Experimental Study of the Effects of Biased Responding on the Modified Rivermead Post-concussion Symptoms Questionnaire and Validity Indicators. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
6
|
Relations Among Performance and Symptom Validity, Mild Traumatic Brain Injury, and Posttraumatic Stress Disorder Symptom Burden in Postdeployment Veterans. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09415-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
7
|
Lippa SM, Kenney K, Riedy G, Ollinger J. White Matter Hyperintensities Are Not Related to Symptomatology or Cognitive Functioning in Service Members with a Remote History of Traumatic Brain Injury. Neurotrauma Rep 2021; 2:245-254. [PMID: 34223555 PMCID: PMC8244514 DOI: 10.1089/neur.2021.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study aimed to determine whether magnetic resonance imaging (MRI) white matter hyperintensities (WMHs) are associated with symptom reporting and/or cognitive performance in 1202 active-duty service members with prior single or multiple mild traumatic brain injury (mTBI). Patients with mTBI evaluated at the National Intrepid Center of Excellence (NICoE) at Walter Reed National Military Medical Center (WRNMMC) were divided into those with (n = 632) and without (n = 570) WMHs. The groups were compared on several self-report scales including the Neurobehavioral Symptom Inventory (NSI), Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C), Satisfaction with Life Scale (SWLS), and Short Form-36 Health Survey (SF-36). They were also compared on several neuropsychological measures, including tests of attention, working memory, learning and memory, executive functioning, and psychomotor functioning. After correction for multiple comparisons, there were no significant differences between the two groups on any self-reported symptom scale or cognitive test. When comparing a subgroup with the highest (20+) WMH burden (n = 60) with those with no WMHs (n = 60; matched on age, education, sex, race, rank, and TBI number), only SF-36 Health Change significantly differed between the subgroups; the multiple WMH subgroup reported worsening health over the past year (t[53] = 3.52, p = 0.001, d = 0.67) compared with the no WMH subgroup. These findings build on prior research suggesting total WMHs are not associated with significant changes in self-reported symptoms or cognitive performance in patients with a remote history of mTBI. As such, clinicians are encouraged to use caution when reporting such imaging findings.
Collapse
Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gerard Riedy
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| |
Collapse
|
8
|
Williams MW, Graham D, Sciarrino NA, Estey M, McCurry KL, Chiu P, King-Casas B. Does Validity Measure Response Affect CPT Group Outcomes in Veterans with PTSD? Mil Med 2021; 185:e370-e376. [PMID: 31735961 DOI: 10.1093/milmed/usz385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION There is a dearth of research on the impact of pre-treatment assessment effort and symptom exaggeration on the treatment outcomes of Veterans engaging in trauma-focused therapy, handicapping therapists providing these treatments. Research suggests a multi-method approach for assessing symptom exaggeration in Veterans with posttraumatic stress disorder (PTSD), which includes effort and symptom validity tests, is preferable. Symptom exaggeration has also been considered a "cry for help," associated with increased PTSD and depressive symptoms. Recently, research has identified resilience as a moderator of PTSD and depressive symptom severity and an important predictor of treatment response among individuals with PTSD. Thus, it is important to examine the intersection of symptom exaggeration, resilience, and treatment outcome to determine whether assessment effort and symptom exaggeration compromise treatment response. MATERIALS AND METHODS We recruited Veterans, aged 18-50 who served during the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era, from mental health clinics and fliers posted in a large Veterans Affairs Medical Center. Veterans met inclusion criteria if they were diagnosed with PTSD via a clinician-administered assessment. Sixty-one Veterans consented to participate and self-selected into a cognitive processing therapy (CPT) group or treatment-as-usual. We offered self-selection because low recruitment rates delayed treatment start dates and were consistent with a Veteran-centered care philosophy. Veterans were assessed before and after treatment to determine the impact of assessment effort and symptom exaggeration scores on measures of PTSD and depressive symptoms and resilience. This study examined whether assessment effort failure and symptom exaggeration were associated with compromised psychotherapy outcomes in Veterans with PTSD undergoing CPT group. We hypothesized that a pattern of responding consistent with both effort and symptom exaggeration would result in higher (ie, more severe) pre- and post-treatment scores on PTSD and depressive symptom outcome measures and lower resiliency when compared to Veterans providing good effort and genuine responding. Hypotheses were evaluated using bivariate correlation analyses, analysis of variance, and chi-square analyses. RESULTS Pre-treatment scores on measures of PTSD and depressive symptoms were higher among Veterans whose pattern of responding was consistent with poor assessment effort and symptom exaggeration; these Veterans also scored lower on a measure of resiliency. At post-treatment, there were no differences between Veterans displaying good and failed effort testing on measures of PTSD and depressive symptoms or in whether they completed treatment. Post-treatment resiliency scores remained significantly lower in those with failed effort testing. CONCLUSION These results suggest that Veterans with PTSD whose validity testing scores are indicative of poor effort and symptom exaggeration may be less resilient but may still complete a CPT group treatment and benefit from treatment at a rate comparable to Veterans who evidence good assessment effort and genuine symptom reporting pre-treatment. These findings also challenge the assumption that pre-treatment assessment effort failure and symptom exaggeration accurately predict poor effort in trauma-focused psychotherapy.
Collapse
Affiliation(s)
- M Wright Williams
- Michael E. DeBakey Veterans Affairs Medical Center, Mental Health Care Line, 2002 Holcombe Blvd. Houston, TX 77030.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030.,VISN 16 South Central MIRECC Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
| | - David Graham
- Michael E. DeBakey Veterans Affairs Medical Center, Mental Health Care Line, 2002 Holcombe Blvd. Houston, TX 77030.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030.,VISN 16 South Central MIRECC Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
| | - Nicole A Sciarrino
- Ralph H. Johnson Veterans Affairs Medical Center, PTSD Clinical Team, 109 Bee St., Charleston, SC 29401
| | - Matt Estey
- Program Director Menninger 360, Menninger Clinic, 12301 S Main St., Houston, TX 77035
| | - Katherine L McCurry
- Salem VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153 University of Virginia School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016.,Fralin Biomedical Research Institute at VTC, Virginia Tech, 2 Riverside Circle, Roanoke, VA 24016
| | - Pearl Chiu
- Salem VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153 University of Virginia School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016.,Fralin Biomedical Research Institute at VTC, Virginia Tech, 2 Riverside Circle, Roanoke, VA 24016.,Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg VA, 24061.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, 2017 South Jefferson, Roanoke, VA 24014
| | - Brooks King-Casas
- Salem VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153 University of Virginia School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016.,Fralin Biomedical Research Institute at VTC, Virginia Tech, 2 Riverside Circle, Roanoke, VA 24016.,Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg VA, 24061.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, 2017 South Jefferson, Roanoke, VA 24014
| |
Collapse
|
9
|
Ord AS, Shura RD, Sansone AR, Martindale SL, Taber KH, Rowland JA. Performance validity and symptom validity tests: Are they measuring different constructs? Neuropsychology 2021; 35:241-251. [PMID: 33829824 DOI: 10.1037/neu0000722] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the relationships among performance validity, symptom validity, symptom self-report, and objective cognitive testing. METHOD Combat Veterans (N = 338) completed a neurocognitive assessment battery and several self-report symptom measures assessing depression, posttraumatic stress disorder (PTSD) symptoms, sleep quality, pain interference, and neurobehavioral complaints. All participants also completed two performance validity tests (PVTs) and one stand-alone symptom validity test (SVT) along with two embedded SVTs. RESULTS Results of an exploratory factor analysis revealed a three-factor solution: performance validity, cognitive performance, and symptom report (SVTs loaded on the third factor). Results of t tests demonstrated that participants who failed PVTs displayed significantly more severe symptoms and significantly worse performance on most measures of neurocognitive functioning compared to those who passed. Participants who failed a stand-alone SVT also reported significantly more severe symptomatology on all symptom report measures, but the pattern of cognitive performance differed based on the selected SVT cutoff. Multiple linear regressions revealed that both SVT and PVT failure explained unique variance in symptom report, but only PVT failure significantly predicted cognitive performance. CONCLUSIONS Performance and symptom validity tests measure distinct but related constructs. SVTs and PVTs are significantly related to both cognitive performance and symptom report; however, the relationship between symptom validity and symptom report is strongest. SVTs are also differentially related to cognitive performance and symptom report based on the utilized cutoff score. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Anna S Ord
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC)
| | | | | | | | | | | |
Collapse
|
10
|
Sabelli AG, Messa I, Giromini L, Lichtenstein JD, May N, Erdodi LA. Symptom Versus Performance Validity in Patients with Mild TBI: Independent Sources of Non-credible Responding. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09400-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
11
|
Young G. Thirty Complexities and Controversies in Mild Traumatic Brain Injury and Persistent Post-concussion Syndrome: a Roadmap for Research and Practice. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09395-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
12
|
Khazem LR, Anestis JC, Erbes CR, Ferrier-Auerbach AG, Schumacher MM, Arbisi PA. Assessing the Clinical Utility of the MMPI-2-RF in Detecting Suicidal Ideation in a High Acuity, Partially-Hospitalized Veteran Sample. J Pers Assess 2020; 103:10-18. [PMID: 32208938 DOI: 10.1080/00223891.2020.1739057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) has demonstrated utility in suicide risk assessment. Limited research with the MMPI-2-RF in higher acuity populations exists, particularly regarding the impact of possible underreporting on prediction of suicide risk. The current study serves to extend previous findings of the utility of clinically indicated MMPI-2-RF scales and proxy indices in 293 veterans (83.62% White, 85.32% male, and 74.40% with past-week suicide ideation) enrolled in a Veterans Affairs Medical Center partial psychiatric hospitalization program. Differences in self-report indicators and MMPI-2-RF scales and proxy indices relevant in assessing suicide ideation between veterans indicated as possibly underreporting and those who were not and the ability of the scales and proxy indices to predict current suicide ideation were examined. These indicators, scales, and proxy indices, with the exception of SUI, were significantly impacted by underreporting, and none of the examined scales or proxy indices (or their interaction) were consistently associated with self-reported suicide ideation after accounting for SUI. However, SUI was consistently associated with suicide ideation and was less influenced by under-reporting. In acutely ill psychiatric patients, SUI may be the most robust indicator of current suicide ideation.
Collapse
Affiliation(s)
- Lauren R Khazem
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah
| | - Joye C Anestis
- Department of Psychology, Univeristy of Southern Mississippi, Hattiesburg, Mississippi
| | - Christopher R Erbes
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychology, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota
| | - Amanda G Ferrier-Auerbach
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | | | - Paul A Arbisi
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
13
|
Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI. J Int Neuropsychol Soc 2020; 26:108-118. [PMID: 31658923 DOI: 10.1017/s1355617719000997] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance. METHOD Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass). RESULTS Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition. CONCLUSION Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
Collapse
|