4.3 Article

Screening for Postdeployment Conditions: Development and Cross-Validation of an Embedded Validity Scale in the Neurobehavioral Symptom Inventory

Journal

JOURNAL OF HEAD TRAUMA REHABILITATION
Volume 29, Issue 1, Pages 1-10

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HTR.0b013e318281966e

Keywords

veterans; assessment; postconcussion syndrome; neuropsychology; concussions; mild traumatic brain injury

Funding

  1. Department of Veterans Affairs, Veterans Health Administration
  2. Defense and Veterans Brain Injury Center
  3. Department of Veterans Affairs Health Service Research Development [CCN 06-164]
  4. James A. Haley Veterans' Hospital and its HSR&D/RR&D center of excellence

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Objective: To develop and cross-validate internal validity scales for the Neurobehavioral Symptom Inventory (NSI). Participants: Four existing data sets were used: (1) outpatient clinical traumatic brain injury (TBI)/neurorehabilitation database from a military site (n = 403), (2) National Department of Veterans Affairs TBI evaluation database (n = 48 175), (3) Florida National Guard nonclinical TBI survey database (n = 3098), and (4) a cross-validation outpatient clinical TBI/neurorehabilitation database combined across 2 military medical centers (n = 206). Research Design: Secondary analysis of existing cohort data to develop (study 1) and cross-validate (study 2) internal validity scales for the NSI. Main Measures: The NSI, Mild Brain Injury Atypical Symptoms, and Personality Assessment Inventory scores. Results: Study 1: Three NSI validity scales were developed, composed of 5 unusual items (Negative Impression Management [NIM5]), 6 low-frequency items (LOW6), and the combination of 10 nonoverlapping items (Validity-10). Cut scores maximizing sensitivity and specificity on these measures were determined, using a Mild Brain Injury Atypical Symptoms score of 8 or more as the criterion for invalidity. Study 2: The same validity scale cut scores again resulted in the highest classification accuracy and optimal balance between sensitivity and specificity in the cross-validation sample, using a Personality Assessment Inventory Negative Impression Management scale with a T score of 75 or higher as the criterion for invalidity. Conclusions: The NSI is widely used in the Department of Defense and Veterans Affairs as a symptom-severity assessment following TBI, but is subject to symptom overreporting or exaggeration. This study developed embedded NSI validity scales to facilitate the detection of invalid response styles. The NSI Validity-10 scale appears to hold considerable promise for validity assessment when the NSI is used as a population-screening tool.

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