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Martinez BS, Rowland JA, Shura RD, Magnante AT, Morey RA, Martindale SL. Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans. J Psychiatr Res 2024; 172:411-419. [PMID: 38458113 DOI: 10.1016/j.jpsychires.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. METHOD Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. RESULTS There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). CONCLUSIONS Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
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Affiliation(s)
- Brandy S Martinez
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA.
| | - Jared A Rowland
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert D Shura
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna T Magnante
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rajendra A Morey
- Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA; VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Sarah L Martindale
- VA (VISN 6) Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Etzel L, Miskey HM, Webb JB, Demakis GJ, Harris HL, Shura RD. An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters. Arch Clin Neuropsychol 2024; 39:11-23. [PMID: 37565825 DOI: 10.1093/arclin/acad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/30/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. METHOD Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. RESULTS After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. CONCLUSIONS Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.
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Affiliation(s)
- Lena Etzel
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- W. G. (Bill) Hefner VA Medical Center, Research & Academic Affairs, Salisbury, NC, USA
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Medical Center, Mental Health and Behavioral Sciences, Salisbury, NC, USA
- VA VISN 6 Mid Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - Jennifer B Webb
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - George J Demakis
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA
| | - Henry L Harris
- University of North Carolina at Charlotte, Department of Counseling, Charlotte, NC, USA
| | - Robert D Shura
- W. G. (Bill) Hefner VA Medical Center, Research & Academic Affairs, Salisbury, NC, USA
- VA VISN 6 Mid Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, NC, USA
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Shura RD, Ingram PB, Miskey HM, Martindale SL, Rowland JA, Armistead-Jehle P. Validation of the personality assessment inventory (PAI) cognitive bias (CBS) and cognitive bias scale of scales (CB-SOS) in a post-deployment veteran sample. Clin Neuropsychol 2023; 37:1548-1565. [PMID: 36271822 DOI: 10.1080/13854046.2022.2131630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
Abstract
Objective: The present study evaluated the function of four cognitive, symptom validity scales on the Personality Assessment Inventory (PAI), the Cognitive Bias Scale (CBS) and the Cognitive Bias Scale of Scales (CB-SOS) 1, 2, and 3 in a sample of Veterans who volunteered for a study of neurocognitive functioning. Method: 371 Veterans (88.1% male, 66.1% White) completed a battery including the Miller Forensic Assessment of Symptoms Test (M-FAST), the Word Memory Test (WMT), and the PAI. Independent samples t-tests compared mean differences on cognitive bias scales between valid and invalid groups on the M-FAST and WMT. Area under the curve (AUC), sensitivity, specificity, and hit rate across various scale point-estimates were used to evaluate classification accuracy of the CBS and CB-SOS scales. Results: Group differences were significant with moderate effect sizes for all cognitive bias scales between the WMT-classified groups (d = .52-.55), and large effect sizes between the M-FAST-classified groups (d = 1.27-1.45). AUC effect sizes were moderate across the WMT-classified groups (.650-.676) and large across M-FAST-classified groups (.816-.854). When specificity was set to .90, sensitivity was higher for M-FAST and the CBS performed the best (sensitivity = .42). Conclusion: The CBS and CB-SOS scales seem to better detect symptom invalidity than performance invalidity in Veterans using cutoff scores similar to those found in prior studies with non-Veterans.
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Affiliation(s)
- Robert D Shura
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Paul B Ingram
- Texas Tech University, Lubbock, TX, USA
- Dwight D. Eisenhower Veteran Affairs Medical Center, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sarah L Martindale
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared A Rowland
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Ingram PB, Herring TT, Armistead-Jehle P. Evaluating Personality Assessment Inventory Response Patterns in Active-Duty Personnel With Head Injury Using a Latent Class Approach. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2023:6988103. [PMID: 36647732 DOI: 10.1093/arclin/acac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Previous research has found that among those with brain injury, individuals have a variety of different potential symptom sets, which will be seen on the Personality Assessment Inventory (PAI). The number of different groups and what they measure have varied depending on the study. METHOD In active-duty personnel with a remote history of mild traumatic brain injury (n = 384) who were evaluated at a neuropsychology clinic, we used a retrospective database to examine if there are different groups of individuals who have distinct sets of symptoms as measured on the PAI. We examined the potential of distinct groups of respondents by conducting a latent class analysis of the clinical scales. Post hoc testing of group structures was conducted on concurrently administered cognitive testing, performance validity tests, and the PAI subscales. RESULTS Findings indicate a pattern of broad symptom severity as the most probable reason for multiple groups of respondents, suggesting that there are no distinct symptom sets observed within this population. Pathology levels were the most elevated on internalizing and thought disorder scales across the various class solutions. CONCLUSION Findings indicate that among active-duty service members with remote brain injury, there are no distinct groups of respondents with different sets of symptom types as has been found in prior work with other neuropsychology samples. We conclude that the groups found are likely a function of general psychopathology present in the population/sample rather than bona fide differences.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.,Dwight D Eisenhower Veteran Affairs Medical Center, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA
| | - Tristan T Herring
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Johnstone B, Butt C, Baydoun H, Schneider J, Camp B. Factor analysis of the Personality Assessment Inventory in service members with traumatic brain injury. Brain Inj 2022; 36:94-99. [PMID: 35175865 DOI: 10.1080/02699052.2022.2034950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To identify the factor structure of the Personality Assessment Inventory (PAI) clinical scales for military service members with traumatic brain injury (TBI). RESEARCH DESIGN Retrospective analysis of existing data base. METHODS AND PROCEDURES The sample included 210 service members with TBI who completed the PAI as part of a neuropsychological evaluation at a military TBI clinic. Statistical analysis included exploratory factor analysis of 214 items of the 11 PAI clinical scales. MAIN OUTCOMES AND RESULTS Exploratory factor analysis indicated a four-factor solution accounting for 30.4% of the variance in scores. A review of the face validity of the items from each factor generated the following factor labels: Somatic/Psychiatric/Cognitive Distress, Social Distress, Substance Misuse, and Depression. CONCLUSIONS The PAI appears to assess general distress (i.e., somatic/psychiatric/cognitive) and substance misuse constructs for both psychiatric and TBI populations, but it also appears to assess a "social distress" construct (i.e., difficulties socializing in both military and civilian populations) that is unique to military populations. Suggestions are offered to re-conceptualize PAI clinical scales specific to psychopathology (i.e., schizophrenia, paranoia, mania, borderline, antisocial) and personality disorders (i.e., borderline, antisocial) in terms of neurologic and military specific issues for service members with TBI.
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Affiliation(s)
- Brick Johnstone
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
| | - Catherine Butt
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
| | - Hind Baydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | | | - Brittany Camp
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
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Martindale SL, Shura RD, Ord AS, Williams AM, Brearly TW, Miskey HM, Rowland JA. Symptom burden, validity, and cognitive performance in Iraq and Afghanistan veterans. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1068-1077. [PMID: 33202168 DOI: 10.1080/23279095.2020.1847111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The present study evaluates the complex relationships between symptom burden, validity, and cognition in a sample of Iraq and Afghanistan veterans to identify key characteristic symptoms and validity measures driving cognitive performance. We hypothesized that symptom and performance validity would account for poorer outcomes on cognitive performance beyond psychological symptoms. METHODS Veterans (n = 226) completed a cognitive test battery, Personality Assessment Inventory (PAI), Word Memory Test (WMT), and Miller Forensic Assessment Symptom Test (M-FAST). Partial least squares structural equation modeling (PLS-SEM) modeled the fully-adjusted relationships among PAI subscales, validity, and cognitive performance. RESULTS 23.45% of participants failed validity indices (19.9% WMT; 7.1% M-FAST). PLS-SEM indicated PAI subscales were not directly associated with performance or symptom validity measures, and there were no direct effects between validity performance and cognitive performance. Several PAI subscales were directly associated with measures of verbal abstraction, visual processing, and verbal learning and memory. CONCLUSION Contrary to hypotheses, symptom and performance validity did not account for poorer outcomes on cognitive performance beyond symptom burden in the PLS-SEM model. Results highlight the association between psychiatric symptoms and cognitive performance beyond validity status.
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Affiliation(s)
- Sarah L Martindale
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA.,Physiology & Pharmacology Division, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert D Shura
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA.,Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna S Ord
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
| | - Ann M Williams
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
| | - Timothy W Brearly
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA.,Neuropsychology Assessment - Directorate of Behavioral Health (Consultation & Education), Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Holly M Miskey
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA.,Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared A Rowland
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA.,Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Merritt VC, Jurick SM, Crocker LD, Hoffman SN, Keller AV, DeFord N, Jak AJ. Evaluation of objective and subjective clinical outcomes in combat veterans with and without mild TBI and PTSD: A four-group design. J Clin Exp Neuropsychol 2019; 41:665-679. [DOI: 10.1080/13803395.2019.1610161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Victoria C. Merritt
- Psychology Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Sarah M. Jurick
- Psychology Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Laura D. Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Amber V. Keller
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Nicole DeFord
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Amy J. Jak
- Psychology Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
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Elliott TR, Hsiao YY, Kimbrel NA, Meyer E, DeBeer BB, Gulliver SB, Kwok OM, Morissette SB. Resilience and Traumatic Brain Injury Among Iraq/Afghanistan War Veterans: Differential Patterns of Adjustment and Quality of Life. J Clin Psychol 2016; 73:1160-1178. [PMID: 27922725 DOI: 10.1002/jclp.22414] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/28/2016] [Accepted: 10/05/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure. METHOD A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4- and 8-month follow-ups. RESULTS Veterans with resilient personalities reported less sleep disturbance, more health-promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD. CONCLUSION Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed.
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Affiliation(s)
| | | | - Nathan A Kimbrel
- Durham Veterans Affairs Medical Center.,VA Mid-Atlantic Mental Illness Research, Education Clinical Center.,Duke University Medical Center
| | - Eric Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System.,Texas A&M University Health Science Center
| | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System.,Texas A&M University Health Science Center
| | - Suzy Bird Gulliver
- Texas A&M University Health Science Center.,Warrior Research Institute at Baylor Scott & White Health
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Jurick SM, Twamley EW, Crocker LD, Hays CC, Orff HJ, Golshan S, Jak AJ. Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2016; 53:571-584. [PMID: 27898153 DOI: 10.1682/jrrd.2015.05.0094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/01/2015] [Indexed: 11/05/2022]
Abstract
A comprehensive evaluation, including the assessment of neurobehavioral symptoms, has been instituted at the Department of Veterans Affairs (VA) healthcare system to address the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans returning with mild traumatic brain injuries (mTBIs). The Validity-10 is measure of symptom overreporting embedded within the Neurobehavioral Symptom Inventory, a component of the comprehensive evaluation that assesses postconcussive symptom severity. The Validity-10 is composed of 10 unlikely/low-frequency items and a validated cutoff score to identify postconcussive symptom overreporting. We examined the items and cutoff used in the initial development and validation study of the Validity-10 through retrospective chart reviews of 331 treatment-seeking Veterans who sustained an mTBI. The Validity-10 exhibited significant relationships with psychiatric variables, VA service connection, and neuropsychological performance validity (all p < 0.01), but nonsignificant relationships with demographic and injury variables (all p > 0.05). Furthermore, the Validity-10 modestly predicted neuropsychological performance validity test failure over and above psychiatric comorbidities and VA service connection. The present study supports the use of the Validity-10 to assess symptom validity in treatment-seeking OIF/OEF Veterans with a history of mTBI.
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Affiliation(s)
- Sarah M Jurick
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA.,Veterans Medical Research Foundation, San Diego, CA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Laura D Crocker
- Psychology Service, VA San Diego Healthcare System, San Diego, CA
| | - Chelsea C Hays
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA.,Veterans Medical Research Foundation, San Diego, CA
| | - Henry J Orff
- Center of Excellence for Stress and Mental Health, Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Shahrokh Golshan
- Veterans Medical Research Foundation, San Diego, CA.,Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA
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