Performance validity tests with low verbal mediation can be robust in culturally diverse mixed psychiatric populations.

Abstract

Objective: Performance validity tests (PVTs) are designed to differentiate between genuine and exaggerated cognitive impairment but may be confounded by both psychiatric morbidity and differences in language and culture. We examined the cultural validity of the Emotion Recognition Test (ERT), a local Dutch PVT, and investigated whether in a refugee mental health center, patients with a prediagnosed severe mental disorder can pass such a test. Method: Fifty-six patients completed the Test of Memory Malingering (TOMM), which is a PVT with established cultural validity; the ERT; and a standard cognitive test, the Study Path Selection Test (SPST). The accuracy of the ERT was determined in criterion groups created by the TOMM at various cutoffs; the correlations between the ERT, the TOMM, and the SPST were calculated; and their scores were compared in two incentive groups. Patients' performance had direct implications for their treatment plan. Results: We found acceptable accuracy for the ERT in comparison to the TOMM. The ERT and the TOMM correlated with each other, but not with the SPST. Patients without incentives scored poorly on the SPST, but in the valid range of the PVTs, whereas those with incentives mostly provided invalid scores. Linked to PVT performance, the psychiatric medication was reduced by 79%. Conclusions: These findings offer proof of concept for the cross-cultural validity of the employed PVTs in a refugee mental health center. The introduction of validity tests had a major effect on clinical practice. Public Significance StatementPerformance validity tests (PVTs) are designed to distinguish between exaggerated and genuine cognitive impairment, but in mixed psychiatric populations, PVT failure is common, even in the absence of obvious incentives to underperform. In referral centers for refugee mental health, cultural and linguistic diversity cause additional confounding. However, this study indicates that even in these settings, PVTs with low verbal mediation can be robust. In the referral center for refugee mental health where this study was conducted, the introduction of validity tests had a major effect on clinical practice.