Establishing the concordance between performance validity tests and novel embedded symptom validity tests in the Beck Depression Inventory and Beck Anxiety Inventory among neuropsychiatric and medical outpatients.

Abstract

Objective: Research examining performance (PVTs) and symptom (SVTs) validity tests has largely included freestanding SVTs or SVTs included in lengthy personality inventories, whereas few studies have assessed this relationship using embedded SVTs. This study investigated the concordance between newly developed embedded SVTs derived from the Beck Depression Inventory-Second Edition (BDI-II) and Beck Anxiety Inventory and performance validity status.

Methods: A mixed clinical sample of 420 adult medical and neuropsychiatric patients referred for outpatient neuropsychological evaluation at an urban academic medical center. Performance validity status was determined by the Dot Counting Test, Medical Symptom Validity Test, WAIS-IV Reliable Digit Span, and Test of Memory Malingering-Trial 1. Symptom validity status was determined by SVTs validated from the BDI-II and BAI total scores.

Results: BDI-II and BAI SVTs were moderately correlated (r=.69), whereas weak correlations emerged between these embedded SVT and PVTs (r=.09-.22). Patients with invalid performance on PVTs had significantly higher elevations rates on the BDI-II (2.5x) and BAI (2x) SVTs. However, neither the BDI-II nor BAI SVTs, as well as a combined BDI-II/BAI composite score accurately differentiated invalid from valid performance validity status (AUCs=.573-.583). Results essentially replicated after supplementary analyses excluding those with 1 PVT failure.

Conclusions: Results align with previous research showing that that PVTs and newly-developed embedded SVTs in the BDI-II and BAI assess non-redundant constructs and should both be routinely included in neuropsychological evaluations. In short, performance invalidity does not necessarily convey noncredible symptom reporting and vice versa.