published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Thesis (MSc)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: Malingering is the intentional production or exaggeration of symptoms for personal gain in the context of external incentives. Due to the absence of objective symptoms, depression may represent a relatively attractive option for malingerers. Existing approaches to distinguish between depressive symptoms and possible malingering often use time-consuming psychometric tests or unreliable interview techniques. Short screening tests for malingering may be a practicable alternative and recently South African cut-off scores on tests for malingering were determined for a student sample. The purpose of this study was to establish South African cut-off scores for persons with a diagnosis of depression on screening instruments for malingering. Fifty-one subjects with a diagnosis of depression (measured by the Zung Depression Scale) were randomly ascribed to one of two groups: an experimental group of 25 subjects (instructed to simulate symptoms based on a malingering case scenario) and a control group of 26 subjects (instructed to do their best in the tests). No incentive was provided to the subjects. Each subject completed the 21-item verbal memory forced choice test (FCT), the Rey IS-item test (Rey IS-item), the dot-counting test (DCT), the Word Recognition test (WR) that is part of the Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) and the Structured Inventory of Malingered Symptomatology (SIMS). The WR test correctly classified 74.5% of subjects with a sensitivity of 93%. The FCT, with a cut-off of> 15.5, correctly classified 72.5% of subjects. A regression equation was computed by combining the FCT, DCT and SIMS. This correctly classified 74.5% of patients with a sensitivity of 69%. The DCT accurately identified 64% of the malingerers using a cut-off score of> 65.57. The Rey15-item test showed poor results and does not seem to be useful as a screening instrument. The WR test shows promise as a screening instrument for malingering. Combining tests when screening for malingering proved to be an effective way to distinguish between malingering of depressive symptoms and real symptoms. The results of this study will help provide guidelines to mental health workers on how to diagnose malingering in patients with depression more objectively. / AFRIKAANSE OPSOMMING: Malingering is die opsetlike nabootsing of oordrywing van simptome vir persoonlike gewin in die konteks van eksterne vergoeding. As gevolg van die subjektiewe aard van simptome, kan depressie 'n relatief aantreklike opsie wees wanneer psigiatriese kondisies gesimuleer word. Bestaande maniere om te onderskei tussen werklike depressiewe simptome en moontlike malingering, gebruik tydrowende psigometriese toetse of onbetroubare onderhoudstegnieke. Kort siftingstoetse vir malingering kan 'n praktiese altenatief wees en onlangse Suid-Afrikaanse afsnypunte op toetse vir malingering is bepaal vir 'n studentesteekproef. Die doel van hierdie studie was om Suid-Afrikaanse afsnypunte te verkry vir malingeringstoetse vir mense met 'n diagnose van depressie. Een en vyftig subjekte met 'n diagnose van depressie (gemeet deur die Zung Depressieskaal) is ewekansig toegewys aan een van twee groepe: 'n eksperimentele groep van 25 subjekte (met die opdrag om simptome te simuleer op grond van 'n malingering-scenario) en 'n kontrolegroep van 26 subjekte (met die opdrag om hulle bes te doen in die toetse). Geen vergoeding is aan proefpersone gebied nie. Elke subjek het die 21-item verbal memory forced choice test (FfC), die Rey 15-item test (Rey IS-item), die dot-counting test (DCT), die Word Recognition test (WR) wat deel vorm van die Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) en die Structured Inventory of Malingered Symptomatology (SIMS) voltooi. Die WR het 74.5% van die subjekte korrek geklasifiseer met 'n sensitiwiteit van 93%. Die FCT, met 'n afsnypunt van <15.5, het 72.5% van die subjekte korrek geklassifiseer. 'n Regressie-vergelyking is bereken deur 'n kombinering van die FCT, DCT en SIMS. Dit het 74.5% van die subjekte korrek geklassifiseer met 'n sensitiwiteit van 69%. Die DeT kon 64% van die malingeerders akkuraat identifiseer deur gebruik te maak van 'n afsnypunt van> 65.57. Die Rey IS-item toets het swak resultate getoon en blyk nie bruikbaar te wees as 'n siftingstoets nie. Die WR toon potensiaal as In siftingstoets vir malingering. Die kombinering van toetse wanneer pasiënte gesif word vir malingering blyk 'n effektiewe manier te wees om te onderskei tussen die malingering van depressiewe simptome en werklike simptome. Die resultate van hierdie studie kan help om riglyne te skep vir geestesgesondheidswerkers oor hoe om malingering van depressie meer objektief te diagnoseer.

Empirically based methods of detecting retrospective malingering (i.e., the false assertion or exaggeration of physical or psychological symptoms reportedly experienced during a prior time period) are needed given that retrospective evaluations are commonplace in forensic assessments. This study's main objective was to develop and validate a focused, standardized measure of retrospective malingering. This objective was addressed by revising the Structured Interview of Reported Symptoms (SIRS), an established measure of current feigning. The SIRS' strategies were retained and its items modified to produce two new SIRS versions: The Retrospective Structured Interview of Reported Symptoms (R-SIRS) and The Concurrent-Time Structured Interview of Reported Symptoms (CT-SIRS). Forensic inpatients were used to test the R-SIRS (n = 25) and CT-SIRS (n = 26) which both showed good internal consistency and interrater reliability. The overall effectiveness of the R-SIRS and the CT-SIRS in the classification of malingerers and genuine patients was established in this initial validation study. Moreover, their classification rates were similar to those obtained by the SIRS. Pending additional validation, these measures are expected to increase the quality of forensic evaluations by providing the first standardized methods of assessing retrospective malingering.

The accurate determination of malingering relies on the use of validated and clinically relevant assessment measures. Simulation design is the most often-used research design to accomplish this. However, its external validity is sometimes questioned. The goal of the thesis was to systematically evaluate these major elements: situation, incentives, and coaching. The situation in simulation studies can vary from relevant (academic failure in a college population) to irrelevant (capital murder) for the samples being studied. Incentives refer to the external motivation given to improve simulators' performance and can be positive (extra credit and monetary reward) or negative (extra time and effort). Finally, coaching refers to whether the participant receives any information on detection strategies that are designed to identify feigners. Using a large undergraduate sample in a factorial design, results indicate that a scenario familiar to the participants generally improved the believability of their responses. Coaching also improved the ability to feign convincingly, while incentive type was not associated with any change in scores. The implications of these findings for future research designs and the connection to practice are discussed.

This study examined the effectiveness of cautioning and education on simulating a mild traumatic brain injury on several neuropsychological measures. The measures used included the Word Memory Test (WMT), Wechsler Adult Intelligence Scales® - Third Edition (WAIS®-III), Wechsler Memory Scales®-3rd Edition instrument (WMS®-III), 16-item version of the Rey Memory Test, and a self-report symptom checklist. Five experimental groups were used including clinical and non-clinical controls, as well as three simulation groups. The design and implementation of this study also attempted to correct several methodological short comings of prior research by increasing the incentives for participants, expanding the generalizability of findings and examining research compliance and participant self-perception through debriefing. Discriminant analysis was utilized to determine if specific functions existed that would correctly classify and distinguish each experimental group. Several discriminant functions had at least moderate canonical correlations and good classification accuracy. Results also include utility estimates given projected varying base rates of malingering.

Psychological assessment of mentally disordered offenders requires a systematic consideration of response styles, including malingering and defensiveness. Important components of these evaluations are standardized diagnostic interviews. However, the ability of offenders to feign mental disorders on such measures to achieve such external incentives as treatment, placement on safer units, or possible release from jail remains uninvestigated. With a known-groups comparison with the data from the Structured Interview of Reported Symptoms as a criterion, 24 suspected malingerers were compared to 64 genuine patients on the Schedule of Affective Disorders and Schizophrenia (SADS), the abbreviated SADS-C, the Suicide Probability Scale, and the Referral Decision Scale.

The capacity of Raven's Standard Progressive Matrices (SPM) and the Booklet Category Test (BCT) to discriminate between groups of brain-injured, simulated malingering, and normal participants was investigated in this study. Exploratory analyses were also conducted to examine the differences between groups categorized as sophisticated and naive fakers. Clinical decision rules and discriminant function analyses were utilized to identify malingerers. Clinical decision rules ranged in hit rates from 41% to 78%, in sensitivity from 2% to 100%, and in specificity from 86% to 100%. Discriminant functions ranged in hit rates from 81% to 86%, in sensitivity from 68% to 73% and in specificity from 82% to 87%. Overall, the least helpful detection method examined was below chance responding on either measure, while the most efficient was gross errors for SPM.

The present study attempted to incorporate several tests that had specific indices for identifying memory malingering into a battery for the assessment of memory malingering. Two measures, a famous faces test and a subjective memory questionnaire were constructed originally by the author. These measures were pilot-tested on a group of demented community geriatric participants (n=10) and control geriatric participants (n = 12). Three indices indicative of memory malingering in Hong Kong List Learning Test (HKLLT) were explored. The indices of the HKLLT, the two new measures and the Test of Memory Malingering were incorporated into a battery for detection of memory malingering. Using an analogue design, the battery was tested on a group of community participants (N = 58) who were randomized into two conditions, simulated malingering (SM) condition (n = 25, one was excluded because of non-compliance to experimental instructions) and true effort (TE) condition (n = 32). Participants in the SM group were given instruction to exaggerate memory complaints after a hypothetical head injury while the TE condition instructed participants to do his/her best. The subjects were tested on 6 measures of the battery and 2 other tests. A manipulation check was also completed. The results indicated significant difference between the two conditions on all the measures. The cut-off scores of the measures attained sensitivity from .4 to .84 and specificity of .9 to 1. Using discriminant analysis, the overall hit rate was 93% and using logistic regression, the overall hit rate was 98%. The measures were then tested on a group of depressed patients (N = 39) who were randomized into SM (n = 19) and TE condition (n = 20). Manipulation check indicated that about 80% of depressed participants of SM group were unable to comply with malingering instruction. Analysis was then done to compare the performance of community SM sample (n = 25) with community TE sample (n = 32) and depressed TE sample (n = 20). Results found significant difference between simulated malingering and control and depressed sample respectively. No significant difference was found between community control and depressed sample. Using the cut-off scores obtained from the normal sample, specificity of depressed sample on 3 measures was lowered. Using discriminant analysis and logistic regression, two-group classification (simulated malingering and non-simulated malingering) reached an overall hit rate of 92% and 94% respectively. Using 4 indictors of the battery achieved sensitivity of 68%, specificity of 100 % in normal control and 100% in depressed sample. The effect of depression, base rate of malingering in affecting the classification, the issue of use of simulation in research design and future research direction was discussed. / Chang Suk Yi Sonia. / "July 2006." / Adviser: Agnes Chan. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1919. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 156-179). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Malingering is the deliberate production of feigned symptoms by a person seeking external gain such as: financial compensation, exemption from duty, or leniency from the criminal justice system. The Test Translation and Adaptation Guidelines developed by the International Test Commission (ITC) specify that only tests which have been formally translated into another language and validated should be available for use in clinical practice. Thus, the current study evaluated the psychometric properties of a Spanish translation of the Structured Interview of Reported Symptoms (SIRS). Using a simulation design with 80 Spanish-speaking Hispanic American outpatients, the Spanish SIRS was produced reliable results with small standard errors of measurement (SEM). Regarding discriminant validity, very large effect sizes (mean Cohen's d = 2.00) were observed between feigners and honest responders for the SIRS primary scales. Research limitations and directions for future research are also discussed.

Thesis (MOccTher)-- University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Malingering, the intentional simulation or exaggeration of symptoms for secondary gain, has a significant financial impact on disability insurance given its prevalence. Multidisciplinary professionals involved in disability determination therefore require a tool which would assist in the screening of suspected malingerers. AIM: The Credibility Assessment Tool (CAT), a tool which was developed as part of the Performance APGAR, was reviewed in terms of its validity and application to the screening of malingering. Research objectives included the review of face and content validity through a literature review and concept analysis, as well as the review of construct and concurrent validity by comparing the results with the operationalised malingering construct and available malingering protocols. The adapted Slick criteria as proposed by Aronoff, applicable to chronic pain, neurocognitive, neurological and psychiatric symptoms, was identified as the most suitable criterion standard for use of comparison. DESIGN: The research design was a descriptive analytical design, which was performed retrospectively with a report review from insurance referrals to the researcher. Informed consent was obtained from insurers who legally own the reports. A saturated sample of convenience of 184 cases with depression and pain as predominant symptoms were analysed. Recall bias were minimised through omission of personal identifiers and the use of a peer check of 20 random cases. Results in the peer check were suggestive of poor inter-rater reliability, rather than recall bias. METHOD: Cases were analysed according to the guidelines from the respective authors of the CAT and adapted Slick criteria, however this was further defined to ensure that the study could be replicated. RESULTS: Face validity was adequate in terms of purpose, item selection and association between consistency criteria, however require improvement in terms of standardised instruction and weighting of the scale. Content validity was rated as adequate to excellent, given that it supports criteria linked to the malingering construct. Construct validity was adequate as demonstrated by association between concepts obtained through concept analysis. Correlation between the CAT and adapted Slick was strong (r>0.5) however caution is expressed that this requires further research. CONCLUSION: Recommendations for further research included the review of content validity with subject experts, criterion and predictive valid through a case-control study of known-groups, as well as the reliability of the CAT, and the use of specialised ADL indices for malingering detection. Adaptation to the CAT was depicted in the proposed Consistency Assessment Tool. / AFRIKAANSE OPSOMMING: Malingering, die opsetlike nabootsing of oordrywing van simptome vir sekondêre gewin, het ‘n beduidende finansiële impak op ongeskiktheidsversekering as gevolg van die prevalensie daarvan. Multidissiplinêre professionele persone betrokke by ongeskiktheidsevaluasies het daarom ‘n meetinstrument nodig om moontlike malingeerders te identifiseer. DOEL: Die Credibility Assessment Tool (CAT), wat ontwikkel was as deel van die Performance APGAR, was ondersoek in terme van geldigheid en toepassing op malingering. Navorsingsdoelwitte het die ondersoek van voorkoms- en inhoudsgeldigheid deur ‘n literatuurstudie en konsep analise behels, sowel as konstruk- en korrelasie geldigheid deur die vergelyking van die resultate met beskikbare malingering protokolle en operasionele konstrukte. Die aangepaste Slick kriteria soos voorgestel deur Aronoff, wat toepaslik is op kroniese pyn, neurokognitiewe, neurologiese en psigiatriese simptome, was ge-identifiseer as die meeste gepaste kriterium standaard vir vergelyking. ONTWERP: Die studieontwerp was ‘n beskrywende analitiese studie wat retrospektief uitgevoer was deur ‘n ondersoek van verslae van versekeraars. Ingeligte toestemming was verkry van versekeraars wat die wetlike eienaars van die verslae is. ‘n Gerieflikheidsteekproef van 184 gevalle met depressie en pyn as hoof simptome was geanaliseer. Sydighede was verminder deur persoonlike inligting te verwyder en die gebruik van ‘n eweknie evaluasie van 20 ewekansige getrekte gevalle. Voorlopige resultate dui onbevredigende betroubaarheid aan, eerder as sydighede. METODE: Gevalle was ge-evalueer volgends die riglyne van die verskeie outeure van die CAT en aangepaste Slick kriteria, en was sodanig verder gedefinieer om te verseker dat die studie herhaal kan word. RESULTATE: Voorkomsgeldigheid was voldoende, maar verbetering is aanbeveel in terme van gestandardiseerde instruksie en skaal verdeling. Inhoudsgeldigheid was beduidend in vergelyking met die wetenskaplike literatuur en die geoperasionaliseerde konstrukte. Konstrukgeldigheid was bevestig deur die positiewe verhoudings tussen die aangepaste Slick en CAT kriteria. ‘n Sterk korrelasie was gevind tussen die aangepaste Slick en CAT, maar hierdie moet versigtig geinterpreteer word aangesien verdere navorsing verlang word. GEVOLGTREKKING: Aanbevelings vir verdere navorsing sluit in die ondersoek van die inhoudsgeldigheid met eksperte, kriterium- en voorspellingsgeldigheid, sowel as die betroubaarheid van die CAT en die gebruik van gespesialiseerde ADL indekse vir uitkenning van malingering. Aanpassing vir die CAT word ook voorgestel.