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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

Sahra Kim Open the ORCID record for Sahra Kim [Opens in a new window] ,
Alyssa Currao ,
Emma Brown ,
William P. Milberg  and
Catherine B. Fortier Open the ORCID record for Catherine B. Fortier [Opens in a new window]
Sahra Kim*
Affiliation:
Translational Research Center for TBI and Stress Disorders and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
Alyssa Currao
Affiliation:
Translational Research Center for TBI and Stress Disorders and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
Emma Brown
Affiliation:
Translational Research Center for TBI and Stress Disorders and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
William P. Milberg
Affiliation:
Translational Research Center for TBI and Stress Disorders and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
Catherine B. Fortier
Affiliation:
Translational Research Center for TBI and Stress Disorders and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
*
Corresponding author: Sahra Kim; Email: Sahra.Kim@va.gov
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Abstract

Objective:

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.

Method:

Five hundred and sixteen post-9/11 veterans participated in clinical interviews, neuropsychological testing, and several validity measures.

Results:

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).

Conclusion:

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

Veteran healthneuropsychological testsperformance validity testssymptom validity testspost-traumatic stress disorderpsychiatric disorders
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

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