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Importance of validity testing in psychiatric assessment: evidence from a sample of multimorbid post-9/11 veterans
Published online by Cambridge University Press: 28 November 2023
Abstract
Performance validity (PVTs) and symptom validity tests (SVTs) are necessary components of neuropsychological testing to identify suboptimal performances and response bias that may impact diagnosis and treatment. The current study examined the clinical and functional characteristics of veterans who failed PVTs and the relationship between PVT and SVT failures.
Five hundred and sixteen post-9/11 veterans participated in clinical interviews, neuropsychological testing, and several validity measures.
Veterans who failed 2+ PVTs performed significantly worse than veterans who failed one PVT in verbal memory (Cohen’s d = .60–.69), processing speed (Cohen’s d = .68), working memory (Cohen’s d = .98), and visual memory (Cohen’s d = .88–1.10). Individuals with 2+ PVT failures had greater posttraumatic stress (PTS; β = 0.16; p = .0002), and worse self-reported depression (β = 0.17; p = .0001), anxiety (β = 0.15; p = .0007), sleep (β = 0.10; p = .0233), and functional outcomes (β = 0.15; p = .0009) compared to veterans who passed PVTs. 7.8% veterans failed the SVT (Validity-10; ≥19 cutoff); Multiple PVT failures were significantly associated with Validity-10 failure at the ≥19 and ≥23 cutoffs (p’s < .0012). The Validity-10 had moderate correspondence in predicting 2+ PVTs failures (AUC = 0.83; 95% CI = 0.76, 0.91).
PVT failures are associated with psychiatric factors, but not traumatic brain injury (TBI). PVT failures predict SVT failure and vice versa. Standard care should include SVTs and PVTs in all clinical assessments, not just neuropsychological assessments, particularly in clinically complex populations.
Keywords
- Type
- Research Article
- Information
- Journal of the International Neuropsychological Society , Volume 30 , Issue 4 , May 2024 , pp. 410 - 419
- Copyright
- © Veterans Affairs Boston Healthcare System, 2023. This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of International Neuropsychological Society