Contribution of Perceived Cognitive Functioning to Quality of Life in Service Members and Veterans With Posttraumatic Stress Disorder.

Perceived cognitive impairment is a core clinical feature of posttraumatic stress disorder (PTSD) and may be an important determinant of quality of life (QOL) in those who suffer from this disorder. Using a clinical data repository, we evaluated this hypothesis in a cross-sectional sample of U.S. military service members and veterans who served after September 11, 2001, and were seeking mental health treatment at a tertiary outpatient clinic. A consecutive series of 117 patients with a clinical diagnosis of PTSD completed a battery of questionnaires at intake, including the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993), a 4-item Cognitive Symptom subscale of the Neurobehavioral Symptom Inventory (Cicerone & Kalmar, 1995), the Depression Anxiety Stress Scale-21 (Lovibond & Lovibond, 1995), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Endicott, Nee, Harrison, & Blumenthal, 1993). Cognitive symptom reporting was very high, even in the subgroup without a history of traumatic brain injury. In a regression analysis, cognitive symptom severity was independently associated with QOL (ß = -.204). This relationship was not explained by comorbid traumatic brain injury, but was restricted to patients with comorbid depression (ß = -.278 in the subgroup with an elevated Depression Anxiety Stress Scale-21 Depression subscale; n = 91). In conclusion, perceived cognitive impairment was common in this PTSD sample and helped to explain impairments in QOL, especially in patients with comorbid depression.

Analysis of Minnesota Multiphasic Personality Inventory-2-Restructured Form response bias indicators as suppressors or moderators in a medical setting.

The use of response bias indicators in psychological measurement has been contentious, with debate as to whether they actually suppress or moderate the ability of substantive psychological indicators to identify the construct of interest. Suppression would indicate that predictor variables contain invalid variance that the bias indicators can suppress, while moderation would indicate differential levels of predictive validity at different levels of bias. Response bias indicators on the Minnesota Multiphasic Personality Inventory (MMPI)-2-Restructured Form (MMPI-2-RF) [infrequent responses (F-r), infrequent somatic responses (Fs), infrequent psychopathology responses (Fp-r), adjustment validity (K-r), uncommon virtues (L-r), symptom validity (FBS-r), and Response Bias Scale (RBS)] were tested to determine whether they suppressed or moderated the ability of the Restructured Clinical Scale 1 (RC1) and Neurologic Complaints (NUC) scale to discriminate between epileptic seizures (ES) and nonepileptic seizures (NES, a conversion disorder that is often misdiagnosed as ES). The MMPI-2-RF was completed by 399 patients with a confirmed diagnosis of ES or NES via Epilepsy Monitoring Unit evaluation. Moderated logistic regression was used to test for moderation, and logistic regression was used to test for suppression. Most of the response bias variables showed a suppressor effect, but moderator effects were not found. These findings extend the use of bias indicators to a psychomedical context.

The relationship of pre-operative health status to sustained outcome in gastric bypass surgery.

The task of sustaining initial weight loss after gastric bypass surgery has been identified as the area of greatest concern in this intervention. The present study investigated the role of good vs. poor pre-operative health as a moderator variable in identifying useful pre-operative predictors of continued weight loss. Follow-up data at a mean of 12.8 months and again at 3.2 years post-operatively were available for 79 patients on 227 interview variables and four psychological assessment instruments. These measures were studied for their success in predicting continued weight loss over the 1­3-year period separately for patients who were in good and in poor general pre-operative health. Previous findings showed that the overall mean simple weight loss to 12.8 months was 45.61 kg, but additional weight loss to 3.2 years was only 0.28 kg. The good and poor pre-operative health groups differed little on these figures. However, the significant predictors of continued weight loss for good-health patients (high anxiety and distress, low self-esteem, poor eating habits, strong expectations of life improvement, and good achievement and coping skills) were quite different from those for poor-health patients (good psychological health and happiness, strong personal support and life satisfaction, good eating habits, and little knowledge about their health). Thus, pre-operative health status served as a powerful moderator in predicting continued weight loss from pre-operative characteristics. These findings offer a means of making more accurate predictions as to which patients are the best candidates for surgery, and also suggest that different psychological and other interventions should be selected according to pre-operative health status.

The effect of underreporting response bias on the assessment of psychopathology.

A recent review offered the conclusion that the utility of considering response bias--in particular, underreporting, or defensiveness--in assessing psychopathology with structured inventories has not been demonstrated in practical criterion-related situations. The present research tested for the presence of suppressor and moderator effects in 3 such mental health classification tasks (disordered participants vs. control participants) using relevant predictors. Regression analyses showed the presence of one or both effects for all 3 tasks. The practical effects of these response biases were then illustrated by examining 4 measures of predictive accuracy at different levels of the response-bias measure: predictor/criterion correlations, hit rates, sensitivity/specificity, and positive/negative predictive power. It was concluded that there is clear utility in taking account of underreporting response bias in practical situations, particularly where extreme response bias is likely to be present. Confirmation of these findings with additional response-bias measures is needed.

Randomized comparison of the Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory-2 in the epilepsy monitoring unit.

The two most common personality measures used in evaluation of patients on epilepsy monitoring units (EMUs) are the Personality Assessment Inventory (PAI) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Both have been evaluated separately for their ability to distinguish patients with epilepsy from patients with psychogenic events, but they have never been compared directly. The primary aim of this study was to provide comparison data in an EMU population between the PAI, MMPI-2, and the MMPI-2-RF (MMPI-2 Restructured Form). Results show that the PAI Somatic Complaints (SOM) scale and the Conversion subscale (SOM-C), with classification rates of 79%, outperform other indicators from the PAI and indicators from the MMPI-2 and the MMPI-2-RF. Given its other strengths combined with better diagnostic validity performance, the PAI may be the better personality assessment measure for use in distinguishing patients with epilepsy from those with psychogenic seizures in the EMU.

Independent validation of the MMPI-2-RF Somatic/Cognitive and Validity scales in TBI Litigants tested for effort.

The MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) is replacing the MMPI-2 as the most widely used personality test in neuropsychological assessment, but additional validation studies are needed. Our study examines MMPI-2-RF Validity scales and the newly created Somatic/Cognitive scales in a recently reported sample of 82 traumatic brain injury (TBI) litigants who either passed or failed effort tests (Thomas & Youngjohn, 2009). The restructured Validity scales FBS-r (restructured symptom validity), F-r (restructured infrequent responses), and the newly created Fs (infrequent somatic responses) were not significant predictors of TBI severity. FBS-r was significantly related to passing or failing effort tests, and Fs and F-r showed non-significant trends in the same direction. Elevations on the Somatic/Cognitive scales profile (MLS-malaise, GIC-gastrointestinal complaints, HPC-head pain complaints, NUC-neurological complaints, and COG-cognitive complaints) were significant predictors of effort test failure. Additionally, HPC had the anticipated paradoxical inverse relationship with head injury severity. The Somatic/Cognitive scales as a group were better predictors of effort test failure than the RF Validity scales, which was an unexpected finding. MLS arose as the single best predictor of effort test failure of all RF Validity and Somatic/Cognitive scales. Item overlap analysis revealed that all MLS items are included in the original MMPI-2 Hy scale, making MLS essentially a subscale of Hy. This study validates the MMPI-2-RF as an effective tool for use in neuropsychological assessment of TBI litigants.