Multiple Elevations on Symptom Validity Indicators Embedded in Psychopathology Screening Measures Improves Specificity When Classifying Invalid Symptom Overreporting.

Abstract

Traditional symptom validity tests (SVT) are crucial yet costly components of routine evaluations. Embedded overreporting SVT cutoffs in commonly used psychopathology screeners exist, but it is unclear how multiple elevations across these measures impact detection accuracy. This study explored if the convergence of elevations across three embedded SVTs, Beck Depression Inventory-Second Edition, Beck Anxiety Inventory, and Posttraumatic Stress Disorder Checklist for DSM-5, improves invalidity detection accuracy using preselected and sample-derived cutoffs. Individual screeners demonstrated high specificity but low sensitivity, and each screener uniquely predicted validity status. Using conservative/preselected cutoffs, elevating ≥2 embedded SVTs significantly improved specificity to >99% with modest sensitivity (32%), while ≥3 elevations using liberal/sample-derived cutoffs resulted in 98% specificity but an improved sensitivity of 41%. Multiple elevations across embedded SVTs can identify noncredible responding/symptom endorsement on psychopathology screeners, thus signaling that more robust validity testing can be discontinued. However, given the lower sensitivity of this approach, these embedded SVTs may better rule in rather than rule out noncredible responding when elevated.