Detection of symptom over-reporting on the Neurobehavioral Symptom Inventory in OEF/OIF/OND veterans with history of mild TBI

Bodapati, Anjuli S.; Combs, Hannah L; Pastorek, Nicholas J.; Miller, Brian; Troyanskaya, Maya; Romesser, Jennifer; Sim, Anita H.; Linck, John

doi:10.1080/13854046.2018.1482003

Cited by 24 publications

(19 citation statements)

References 31 publications

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“…For example, Lange, Brickell, Lippa, and French (2015) examined military personnel and how well the NSI validity scales differentiated between groups based on valid or invalid performance on the PAI; the Validity-10 outperformed the other two scales, with optimal cutoffs ranging from 19 to 28 depending on degree of confidence. Similarly, Bodapati et al (2019) examined the NSI validity scales in a veteran sample and reported that Validity-10 cutoffs ranging between 22 and 27 optimally discriminated between valid and invalid groups based on the MMPI-2-RF.…”

Section: Resultsmentioning

confidence: 99%

Review of the Neurobehavioral Symptom Inventory.

Silva¹

2021

Rehabilitation Psychology

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Purpose/Objective: To describe the psychometrics and utility of the Neurobehavioral Symptom Inventory (NSI) and provide suggestions for clinical usage and future research. Research Method/Design: Thirty studies examining aspects of the NSI, published between 1995 and 2020, were reviewed. Results: The NSI is a 22-item self-report questionnaire of neurobehavioral symptoms. The NSI was first published in 1995 and has since been adopted by the Department of Defense and Department of Veterans affairs for traumatic brain injury (TBI) research and clinical evaluation. Most research on the NSI has been conducted in veteran and military samples with predominantly mild TBI. Cronbach’s alpha ranged from .81 to .96 for the total score and exceeded .80 for most scales. Test–retest values ranged from .78 to .94 for the total score and ranged from .52 to .91 for subscales. Item content overlaps with psychiatric disorders and is expectedly correlated with psychiatric measures and emotional distress. Although consensus about its factor structure is lacking, the 3- and 4-factor solutions have been replicated and have the strongest support. Subsequent researchers have published reliable change indices, embedded validity indices, and normative data using civilian and military samples. Conclusions/Implications: The NSI has acceptable reliability and some evidence supporting its validity in measuring neurobehavioral symptoms. Although not intended to diagnose TBI, the NSI has value for clinicians and researchers in characterizing the presence and severity of symptom complaints and tracking symptomatic change in persons with TBI.

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Section: Resultsmentioning

confidence: 99%

Review of the Neurobehavioral Symptom Inventory.

Silva¹

2021

Rehabilitation Psychology

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“…The total score with a cutoff of >58 was initially presented with a sensitivity of .79 and .59 in development and clinical samples (Vanderploeg et al, 2014), respectively. The total score was evaluated in only two additional studies in the VA (Table 7), with recommended cutoffs ranging from ≥51 to ≥67 (Ashendorf, 2019;Bodapati et al, 2019). Both of these prior studies used similar samples to ours (VA Iraq/ Afghanistan veteran sample, mild TBI), though both prior studies used the MMPI-2-RF as the criterion.…”

Section: Discussionmentioning

confidence: 99%

“…The first aim of this article was to validate the NSI SVTs and mBIAS using the SIMS as a validity criterion. Prior studies have predominantly used the MMPI-2/RF (Armistead-Jehle et al, 2018; Ashendorf, 2019; Bodapati et al, 2019; Lange et al, 2015; Lippa et al, 2016) or the PAI (Vanderploeg et al, 2014) validity scales as an external criterion. The SIMS is a stand-alone SVT with five subscales created to sample overreporting of neurological, affective, psychotic, intellectual, and amnestic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Three subscales have been identified in the NSI: somatosensory, affective, and cognitive (Vanderploeg et al, 2014). Two of the embedded validity measures that have been previously identified are the Validity-10, which includes 10 low-frequency items (Vanderploeg et al, 2014), and the total score of all 22 items (Ashendorf, 2019; Bodapati et al, 2019).…”

Section: Methodsmentioning

confidence: 99%

“…In addition to the Validity-10, the NSI total score has been investigated as a symptom validity index. For example, Bodapati et al (2019) derived optimal cut scores for the NSI total score and Validity-10 in a sample of 183 veterans with a history of mild TBI (mTBI). The authors noted adequate specificity for both measures (>94%), but less-than-optimal sensitivity (27%-43%), when employing overreported and invalid scores on Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales as the criterion measure.…”

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confidence: 99%

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Self-reported neurobehavioral symptoms in combat veterans: An examination of NSI with mBIAS symptom validity scales and potential effects of psychological distress.

Shura

Armistead-Jehle²,

Rowland

et al. 2021

Psychological Assessment

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This study evaluated symptom validity scales from the Neurobehavioral Symptom Inventory (NSI) and mild Brain Injury Atypical Symptom Scale (mBIAS) in a sample of 338 combat veterans. Classification statistics were computed using the Structured Inventory of Malingered Symptomatology (SIMS) as the validity criterion. Symptom distress was assessed with the Patient Health Questionnaire-9 and Posttraumatic Stress Disorder (PTSD) Checklist-5. At SIMS > 14, the NSI total score resulted in the highest area under the curve (AUC; .91), followed by Validity-10 (AUC = .88) and mBIAS (AUC = .67). At SIMS > 23, both NSI total and Validity-10 AUCs decreased to .88; in contrast, mBIAS AUC increased to .75. The NSI total score and Validity-10 were interpreted to reflect symptom magnification, whereas the mBIAS may reflect symptom fabrication. There was a subsample with elevated Patient Health Questionnaire-9 (PHQ-9) and PTSD Checklist-5 scores who were significantly distressed but not deemed invalid on the NSI; however, there appears to be an upper threshold on the NSI total score (>69) beyond which nobody produced an invalid score on the SIMS. A recommended approach is provided for using NSI-related validity measures. Public Significance StatementThis study extends prior research on symptom validity indices associated with the Neurobehavioral Symptom Inventory. A recommended interpretive approach is presented involving multiple indices.

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Differences in Brain Volume in Military Service Members and Veterans After Blast-Related Mild TBI

Dennis,

Rowland,

Esopenko

et al. 2024

JAMA Netw Open

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ImportanceBlast-related mild traumatic brain injuries (TBIs), the “signature injury” of post-9/11 conflicts, are associated with clinically relevant, long-term cognitive, psychological, and behavioral dysfunction and disability; however, the underlying neural mechanisms remain unclear.ObjectiveTo investigate associations between a history of remote blast-related mild TBI and regional brain volume in a sample of US veterans and active duty service members.Design, Setting, and ParticipantsProspective cohort study of US veterans and active duty service members from the Long-Term Impact of Military-Relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC), which enrolled more than 1500 participants at 5 sites used in this analysis between 2014 and 2023. Participants were recruited from Veterans Affairs medical centers across the US; 774 veterans and active duty service members of the US military met eligibility criteria for this secondary analysis. Assessment dates were from January 6, 2015, to March 31, 2023; processing and analysis dates were from August 1, 2023, to January 15, 2024.ExposureAll participants had combat exposure, and 82% had 1 or more lifetime mild TBIs with variable injury mechanisms.Main Outcomes and MeasuresRegional brain volume was calculated using tensor-based morphometry on 3-dimensional, T1-weighted magnetic resonance imaging scans; history of TBI, including history of blast-related mild TBI, was assessed by structured clinical interview. Cognitive performance and psychiatric symptoms were assessed with a battery of validated instruments. We hypothesized that regional volume would be smaller in the blast-related mild TBI group and that this would be associated with cognitive performance.ResultsA total of 774 veterans (670 [87%] male; mean [SD] age, 40.1 [9.8] years; 260 [34%] with blast-related TBI) were included in the sample. Individuals with a history of blast-related mild TBI had smaller brain volumes than individuals without a history of blast-related mild TBI (which includes uninjured individuals and those with non–blast-related mild TBI) in several clusters, with the largest centered bilaterally in the superior corona radiata and subcortical gray and white matter (cluster peak Cohen d range, −0.23 to −0.38; mean [SD] Cohen d, 0.28 [0.03]). Additionally, causal mediation analysis revealed that these volume differences significantly mediated the association between blast-related mild TBI and performance on measures of working memory and processing speed.Conclusions and RelevanceIn this cohort study of 774 veterans and active duty service members, robust volume differences associated with blast-related TBI were identified. Furthermore, these volume differences significantly mediated the association between blast-related mild TBI and cognitive function, indicating that this pattern of brain differences may have implications for daily functioning.

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Detection of symptom over-reporting on the Neurobehavioral Symptom Inventory in OEF/OIF/OND veterans with history of mild TBI

Abstract: Both the NSI Total and Validity-10 cut scores consistently identified potential symptom exaggeration across three mild TBI samples. Clinicians and researchers who use the NSI are encouraged to utilize either embedded validity measure in their practice.

Cited by 24 publications

References 31 publications

Review of the Neurobehavioral Symptom Inventory.

Review of the Neurobehavioral Symptom Inventory.

Self-reported neurobehavioral symptoms in combat veterans: An examination of NSI with mBIAS symptom validity scales and potential effects of psychological distress.

Differences in Brain Volume in Military Service Members and Veterans After Blast-Related Mild TBI

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