Clinical utility of the mBIAS and NSI validity-10 to detect symptom over-reporting following mild TBI: A multicenter investigation with military service members

Abstract

Self-report measures are commonly relied upon in military healthcare environments to assess service members following a mild traumatic brain injury (mTBI). However, such instruments are susceptible to over-reporting and rarely include validity scales. This study evaluated the utility of the mild Brain Injury Atypical Symptoms scale (mBIAS) and the Neurobehavioral Symptom Inventory Validity-10 scale to detect symptom over-reporting. A total of 359 service members with a reported history of mTBI were separated into two symptom reporting groups based on MMPI-2-RF validity scales (i.e., non-over-reporting versus symptom over-reporting). The clinical utility of the mBIAS and Validity-10 as diagnostic indicators and screens of symptom over-reporting were evaluated by calculating sensitivity, specificity, positive test rate, positive predictive power (PPP), and negative predictive power (NPP) values. An mBIAS cut score of ≥10 was optimal as a diagnostic indicator, which resulted in high specificity and PPP; however, sensitivity was low. The utility of the mBIAS as a screening instrument was limited. A Validity-10 cut score of ≥33 was optimal as a diagnostic indicator. This resulted in very high specificity and PPP, but low sensitivity. A Validity-10 cut score of ≥7 was considered optimal as a screener, which resulted in moderate sensitivity, specificity, NPP, but relatively low PPP. Owing to low sensitivity, the current data suggests that both the mBIAS and Validity-10 are insufficient as stand-alone measures of symptom over-reporting. However, Validity-10 scores above the identified cut-off of ≥7should be taken as an indication that further evaluation to rule out symptom over-reporting is necessary.

Posttraumatic Stress Disorder is a Stronger Predictor of Long‐Term Neurobehavioral Outcomes Than Traumatic Brain Injury Severity

“…The Validity‐10 scale (Vanderploeg et al., ) is a symptom validity test (SVT) designed to detect symptom exaggeration. Clinical validation studies have supported its use for this purpose (Armistead‐Jehle et al., ; Dretsch et al., ; Lange, Brickell, & French, ; Lange, Brickell, Lippa, & French, ; Lippa et al., ; Sullivan, Lange, & Edmed, ). As recommended by Vanderploeg and colleagues (), a score of 22 or higher was used to classify symptom exaggeration.…”

Patterns of MMPI-2-Restructured Form (MMPI-2-RF) validity scale scores observed across Veteran Affairs settings.

“…For instance, Nelson and colleagues (2011) evaluated overreporting scale patterns across three groups of veterans (veteran simulation, disability neuropsychological evaluation, and nondisability neuropsychological evaluation) for cognitive complaints, such as concussion or mild traumatic brain injury, and those participants undergoing an evaluation tied to the compensation process (e.g., those with a motive for secondary gains) had greater evidence of exaggeration on the MMPI-2-RF overreporting scales ( d = .34 –.79). Likewise, when service members are grouped based on their overreporting scores, scores on an extratest measures of symptom overreporting are likewise elevated (Armistead-Jehle et al, 2018). Consistent with the research trend toward the MMPI-2-RF validity scales functioning effectively within veteran and active-duty populations, veterans asked to simulate PTSD had substantially higher scores compared to genuine patients with PTSD, with effect sizes for the overreporting scales ranging from 0.74 to 1.62 (Goodwin, Sellbom, & Arbisi, 2013).…”

Intimate Partner Violence and Brain Injury Screening

“…Future studies would do well to set up a trauma-informed protocol for data collection within organizations serving IPV survivors, after all staff in the organization have been properly trained. Our data were based on self-report and subject to possible symptom reporting bias (Armistead-Jehle et al, 2018; Zasler & Bender, 2019), and there was no corroborating medical record review to confirm their responses.…”