Content uploaded by Holly Miskey
Author content
All content in this area was uploaded by Holly Miskey on Mar 02, 2017
Content may be subject to copyright.
PCL-5
CAPS-5 DTS SIMS
Fail
B = -13.60 B = -0.63 B = 0.08
p< .001 p< .001 p = .009
PCL-5
CAPS-5 DTS Amnestic
Disorders
B = -13.60 B = -0.63 B = 0.08
p< .001 p< .001 p< .001
Post hoc 2: SIMS Amnestic Disorders (AM); CAPS-5 not a significant predictor of AM (p= .192).
PCL-5
CAPS-5 DTS Neuro
Impairment
B = -13.60 B = -0.63 B = 0.07
p< .001 p< .001 p = .002
Post hoc 1: SIMS Neurologic Impairment (NI); CAPS-5 not a significant predictor of NI (p= .210).
PCL-5
CAPS-5 DTS Affective
Disorders
B = -13.60 B = -0.63 B = 0.08
p< .001p< .001 p< .001
Post hoc 3: SIMS Affective Disorders (AF); CAPS-5 not a significant predictor of AF (p= .143).
Analysis 1: serial mediation analysis predicting MSVT pass/fail was not completed because CAPS,
DTS, and PCL-M were not significant predictors of MSVT outcome.
Analysis 2: serial mediation analysis predicting bTest pass/fail was not completed because CAPS, DTS,
and PCL-M were not significant predictors of bTest outcome.
Analysis 3: serial mediation analysis predicting SIMS pass/fail was significant, B = 0.70, CI [0.16, 2.26].
After mediators were entered into the model, CAPS-5 continued to significantly predict SIMS (p= .032).
Post hoc serial mediation analyses were run on the SIMS subscales (continuous scores). Models were
NOT significant for Psychosis, B = 0.24, CI [-0.11, 0.75] or Low Intelligence, B = 0.15, CI [-0.07, 0.59].
The model significantly predicted Neurologic Impairment, B = 0.54, CI [0.19, 1.41], Amnestic Disorders,
B = 0.64, CI [0.26, 1.49], and Affective Disorders subscales, B = 0.64, CI [0.25, 1.54].
BACKGROUND
PTSD
Symptoms
Distress
Tolerance
Validity
Results
PTSD
Diagnosis
METHOD
RESULTS
CONCLUSIONS
ACKNOWLEDGEMENTS
This material is based upon work supported in part by the U.S. Army Medical Research and Material Command
and from the U.S. Department of Veterans Affairs [Chronic Effects of Neurotrauma Consortium] under Award No.
W81XWH-13-2-0095, the Department of Veterans Affairs Rehabilitation Research and Development Service
under Award No. I01RX002172-01, the Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical
Center, and the W.G. (Bill) Hefner VAMC, Salisbury NC. Any opinions, findings, conclusions or recommendations
expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S.
Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.
Symptom Validity Test (SVT): test that measures extent to which self-report
accurately reflects the presence of symptoms AND the degree of impairment.
Performance Validity Test (PVT): test that measures extent to which scores on
measures of cognition reflect actual ability (including presence/absence of
impairment, and degree of impairment).
Assessment of validity “is an essential part of a neuropsychological evaluation”
(Bush et al., 2005, p. 421) in forensic, clinical, and research settings.
Research indicates that psychiatrists CANNOT detect lying at GREATER THAN
CHANCE LEVELS (Morel, 2010).
After eliminating participants failing PVTs, some research has found NO effect of
PTSD on cognition (Demakis et al., 2008, Wisdom et al., 2013).
Hypothesis: the relationship between PTSD diagnosis and performance on SVT
and PVTs would be mediated by distress tolerance and PTSD symptom severity
Participants
OEF/OIF/OND Veterans (N= 65; 89.2% male; 74% White, 26% African American)
Measures
Clinician Administered PTSD Scale for DSM-5 (CAPS-5), Distress Tolerance Scale
(DTS), PTSD Checklist-5 (PCL-5), Medical Symptom Validity Test (MSVT), bTest,
Structured Inventory of Malingered Symptomatology (SIMS).
Inclusion Criteria
One or more OEF/OIF/OND deployment/s with combat exposure; > 18 years old
Exclusion Criteria
Greater than mild TBI; non-deployment TBI with LOC; penetrating TBI; neurological
history; psychotic or bipolar disorder; current substance use disorder
Analyses
Manualized cutoffs were used for SVTs and PVTs.Three separate serial mediation
analyses were completed using the PROCESS macro for SPSS (Hayes, 2013).
Confidence intervals reported are 95%, bootstrapped and accelerated, with 10,000
subsamples. Results were significant if p< .05 and 0 was not included in the CI.
Independent Variable: CAPS-5 PTSD diagnosis (dichotomous, 1 = present)
Mediators: DTS total score, PCL-5 total score
Dependent Variables: 1) MSVT pass/fail, 2) bTest pass/fail, 3) SIMS pass/fail
Dependent Variables for post hoc analyses: continuous SIMS subscale scores;
Psychosis, Low Intelligence, Neurologic Impairment, Amnestic Disorders, Affective
Disorders)
Demographic/Measure
M
SD
Min.
Max.
Age
41.23
9.81 26 68
Education (years)
14.89
2.02 12 19
Tours Served 2.45 1.79 1 10
DTS Total Score
52.43
15.44
16 75
PCL-5 Total Score
32.55
20.69
0 77
• A PTSD diagnosis was associated with decreased ability to tolerate negative emotions, which was
predictive of increased self-report of PTSD symptoms. This, in turn, predicted failure on a measure of
symptom validity (SIMS). Higher self-report of neurological impairment, anmestic symptoms, and
affective symptoms was associated with poorer distress tolerance in Veterans with PTSD.
• In Veterans with PTSD, difficulty managing negative emotional states in general may contribute to
symptom overreporting.
• Neither a PTSD diagnosis nor symptom distress, or distress tolerance was related to failing either
performance validity test. Results suggest that, in Veterans with PTSD, psychiatric distress should not
be considered as an explanation for failed validity on cognitive performance tasks.
Demographics:
On average, participants
were 41 years old, had
some college education,
and served more than one
military tour.
Holly M. Miskey, Ph.D.1-4 Sarah L. Martindale, Ph.D.1-3, Robert D. Shura, Psy.D.,1-4 & Katherine H. Taber, Ph.D., FANPA2-5
Distress Tolerance and Symptom Severity Mediate Failure on a
Symptom Validity Test in Iraq and Afghanistan Veterans with PTSD
1. W.G. (Bill) Hefner VAMC; 2. Veterans Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center, VISN 6; 3. Wake Forest School of Medicine; 4. Edward Via College of Osteopathic Medicine; 5. Baylor College of Medicine
Disclaimer: The views expressed in this poster are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the Department of Defense, or the US government. The Hefner VAMC Privacy Officer has reviewed this material to ensure it is fully de-identified.