Screening for postdeployment conditions: development and cross-validation of an embedded validity scale in the neurobehavioral symptom inventory

Research Type: 
DVBIC Publications

Abstract:

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 over-reporting 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.

Citation:  Vanderploeg RD, Cooper DB, Belanger HG, Donnell AJ, Kennedy JE, Hopewell CA, Scott SG. Screening for postdeployment conditions: development and cross-validation of an embedded validity scale in the neurobehavioral symptom inventory. J Head Trauma Rehabil. 2014 Jan-Feb; 29(1): 1-10.
Publication Date: 
2014