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Journal of Head Trauma Rehabilitation:
doi: 10.1097/HTR.0b013e318281966e
Original Articles

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

Vanderploeg, Rodney D. PhD; Cooper, Douglas B. PhD; Belanger, Heather G. PhD; Donnell, Alison J. PhD; Kennedy, Jan E. PhD; Hopewell, Clifford A. PhD; Scott, Steven G. DO

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

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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.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins


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