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Article ; Online: Evaluation of telehealth administration of MMPI symptom validity scales.

Shura, Robert D / Sapp, Alison / Ingram, Paul B / Brearly, Timothy W

Journal of clinical and experimental neuropsychology

2024 , Page(s) 1–9

Abstract: Introduction: Telehealth assessment (TA) is a quickly emerging practice, offered with increasing frequency across many different clinical contexts. TA is also well-received by most patients, and there are numerous guidelines and training opportunities ... ...

Abstract	Introduction: Telehealth assessment (TA) is a quickly emerging practice, offered with increasing frequency across many different clinical contexts. TA is also well-received by most patients, and there are numerous guidelines and training opportunities which can support effective telehealth practice. Although there are extensive recommended practices, these guidelines have rarely been evaluated empirically, particularly on personality measures. While existing research is limited, it does generally support the idea that TA and in-person assessment (IA) produce fairly equitable test scores. The MMPI-3, a recently released and highly popular personality and psychopathology measure has been the subject of several of those experimental or student (non-client) based studies; however, no study to date has evaluated these trends within a clinical sample. This study empirically tests for differences in TA and IA test scores on the MMPI-3 validity scores when following recommended administration procedures. Method: Data were from a retrospective chart review. Veterans ( Results: Results suggest that there were minimal differences in elevation rates or mean scores across modality, supporting the use of TA. Conclusions: This study's findings support the use of the MMPI via TA with ADHD evaluations, Veterans, and in neuro/psychological evaluation settings more generally. Observed elevation rates and mean scores of this study were notably different from those seen in other VA service clinics sampled nationally, which is an area of future investigation.
Language	English
Publishing date	2024-02-20
Publishing country	England
Document type	Journal Article
ZDB-ID	605982-x
ISSN	1744-411X ; 0168-8634 ; 1380-3395
ISSN (online)	1744-411X
ISSN	0168-8634 ; 1380-3395
DOI	10.1080/13803395.2024.2314734
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Article ; Online: Base Rates of Performance and Symptom Validity Test Failures in Active Duty and Veteran Samples Referred for Attention-Deficit/Hyperactivity Disorder Evaluation.

Shura, Robert D / Armistead-Jehle, Patrick

Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists

2023

Abstract: Objective: The objective of this study was to determine base rates of response bias in veterans and service members (SM) referred specifically for attention-deficit/hyperactivity disorder (ADHD) evaluation.: Method: Observational study of various ... ...

Abstract	Objective: The objective of this study was to determine base rates of response bias in veterans and service members (SM) referred specifically for attention-deficit/hyperactivity disorder (ADHD) evaluation. Method: Observational study of various performance validity tests (PVTs) and symptom validity tests (SVTs) in a sample of SMs (n = 94) and veterans (n = 504) referred for clinical evaluation of ADHD. Results: SVT and PVT failure rates were similar between the samples, but they were lower than previous Veterans Affairs (VA) and SM studies that were not exclusive to ADHD evaluations. Invalid reporting across all SVT scales on the Minnesota Multiphasic Personality Inventory and Personality Assessment Inventory was relatively uncommon, with rates of invalid scores falling at less than 7%. In both samples, free-standing PVTs were failed at about 22%. Conclusions: Although the base rates of PVT and SVT failures in ADHD-specific evaluations were lower than previously published data on non-ADHD-specific evaluations in veterans and SMs, the current study continues to support the inclusion of these measures.
Language	English
Publishing date	2023-12-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	632972-x
ISSN	1873-5843 ; 0887-6177
ISSN (online)	1873-5843
ISSN	0887-6177
DOI	10.1093/arclin/acad092
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Article ; Online: A systematic review of the utility of continuous performance tests among adults with ADHD.

Varela, Jacob L / Magnante, Anna T / Miskey, Holly M / Ord, Anna S / Eldridge, Adrienne / Shura, Robert D

The Clinical neuropsychologist

2024 , Page(s) 1–62

Abstract: Objective: The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review ... ...

Abstract	Objective: The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review the literature to investigate the clinical utility of various commercially available CPTs, including the Conner's Continuous Performance Test (CCPT), Test of Variables of Attention (TOVA), Gordon Diagnostic System (GDS), and Integrated Visual and Auditory Continuous Performance Test (IVA) in the adult ADHD population. Methods: This systematic review followed the a priori PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were gathered from PsycINFO, PsycARTICLES, Academic Search Complete, and Google Scholar on 11 April 2022. Sixty-nine articles were included in the final review. Risk of bias was assessed using the National Institute of Health Quality Assessment Took for Observational Cohort and Cross-Sectional Studies. Results: Most articles demonstrated high risk of bias, and there was substantial heterogeneity across studies. Overall, the reviewed CPTs appeared to have limited diagnostic utility and classification accuracy. Although many studies showed differing scores between adults with ADHD and comparison groups, findings were not consistent. Characteristics of CPT performances among adults with ADHD were mixed, with little consistency and no evidence of a clear profile of performances; however, CCPT commission errors appeared to have the most utility when used a treatment or experimental outcome measure, compared to other CCPT scores. Conclusion: Overall, CPTs should not be used in isolation as a diagnostic test but may be beneficial when used as a component of a comprehensive assessment.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	639080-8
ISSN	1744-4144 ; 0920-1637 ; 1385-4046
ISSN (online)	1744-4144
ISSN	0920-1637 ; 1385-4046
DOI	10.1080/13854046.2024.2315740
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Article ; Online: Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans.

Martinez, Brandy S / Rowland, Jared A / Shura, Robert D / Magnante, Anna T / Morey, Rajendra A / Martindale, Sarah L

Journal of psychiatric research

2024 Volume 172, Page(s) 411–419

Abstract: Objective: Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, ... ...

Abstract	Objective: Mild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. Method: Participants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. Results: There were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). Conclusions: Severe Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.
MeSH term(s)	Humans ; Male ; Female ; Veterans/psychology ; Suicidal Ideation ; Stress Disorders, Post-Traumatic/psychology ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Violence ; Brain Concussion
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Journal Article
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2024.02.058
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Article ; Online: Suicidal ideation and clinician-rated suicide risk in veterans referred for ADHD evaluation at a VA Medical Center.

Bjork, James M / Shull, Elizabeth R / Perrin, Paul B / Shura, Robert D

Psychological services

2022 Volume 21, Issue 1, Page(s) 13–23

Abstract: The U.S. military veteran population experiences elevated rates of suicide relative to demographically matched community samples. Understanding suicide risk factors in veterans is therefore of critical importance. Accordingly, the Veterans Health ... ...

Abstract	The U.S. military veteran population experiences elevated rates of suicide relative to demographically matched community samples. Understanding suicide risk factors in veterans is therefore of critical importance. Accordingly, the Veterans Health Administration (VHA) has implemented elevated vigilance for suicidal ideation in its health care. One potential risk factor for suicidal ideation or behavior may be attention-deficit/hyperactivity disorder (ADHD), which is frequently characterized by impaired impulse control and experience of intense emotions. To determine whether ADHD, as diagnosed by VHA assessment, may represent an independent or interactive risk factor for suicidal ideation or suicide attempt, we examined potential linkages between VHA-assessed symptomatology of ADHD and suicide attempts or ideation, either with or without the presence of comorbid VHA-assessed psychiatric symptomatology. In a retrospective chart review, we compared severity of clinician-rated suicide risk in 342 veterans (82.5% male) referred to a VHA medical center for ADHD assessment, of whom 198 were diagnosed with ADHD. Contrary to our preregistered hypotheses, there were no main or additive effects of ADHD in terms of increased suicidal ideation, clinician-rated suicide risk or in incidence of lifetime suicide attempt. Motoric impulsivity in neurocognitive testing also showed no relationship with suicide risk or attempts. Rather, consistent with previous literature, presence of a mood disorder or other non-ADHD psychopathology was linked to suicide risk ratings and attempts, irrespective of presence of ADHD symptoms. These data suggest that once comorbid symptomatology such as depression is controlled for, ADHD alone is not associated with elevated suicidal ideation or attempts in veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
MeSH term(s)	Humans ; Male ; Female ; Suicidal Ideation ; Veterans/psychology ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Attention Deficit Disorder with Hyperactivity/diagnosis ; Retrospective Studies ; Suicide, Attempted/psychology ; Risk Factors
Language	English
Publishing date	2022-04-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2156662-8
ISSN	1939-148X ; 1541-1559
ISSN (online)	1939-148X
ISSN	1541-1559
DOI	10.1037/ser0000659
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Article ; Online: Telehealth in Response to the COVID-19 Pandemic in Rural Veteran and Military Beneficiaries.

Shura, Robert D / Brearly, Timothy W / Tupler, Larry A

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

2020 Volume 37, Issue 1, Page(s) 200–204

MeSH term(s)	COVID-19/epidemiology ; Health Status ; Humans ; Mental Health ; Military Personnel ; Pandemics ; Rural Health Services/organization & administration ; SARS-CoV-2 ; Stress, Psychological/epidemiology ; Telemedicine/organization & administration ; United States/epidemiology ; Veterans
Keywords	covid19
Language	English
Publishing date	2020-05-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639160-6
ISSN	1748-0361 ; 0890-765X
ISSN (online)	1748-0361
ISSN	0890-765X
DOI	10.1111/jrh.12454
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Article ; Online: Preliminary evidence for digit span performance validity indicators within the neuropsychological assessment battery.

Varela, Jacob L / Ord, Anna S / Phillips, Jacob I / Shura, Robert D / Sautter, Scott W

Applied neuropsychology. Adult

2022 , Page(s) 1–7

Abstract: The purpose of this study was to evaluate multiple embedded performance validity indicators within the Digits Forward and Digits Backward subtests of the Neuropsychological Assessment Battery (NAB), including Reliable Digit Span (RDS), as no published ... ...

Abstract	The purpose of this study was to evaluate multiple embedded performance validity indicators within the Digits Forward and Digits Backward subtests of the Neuropsychological Assessment Battery (NAB), including Reliable Digit Span (RDS), as no published papers have examined embedded digit span validity indicators within these subtests of the NAB. Retrospective archival chart review was conducted at an outpatient neuropsychology clinic. Participants were 92 adults (ages 19-68) who completed NAB Digits Forward and Digits Backward, and the Word Choice Test (WCT). Receiver operating characteristic (ROC) curves,
Language	English
Publishing date	2022-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2673736-X
ISSN	2327-9109 ; 2327-9095
ISSN (online)	2327-9109
ISSN	2327-9095
DOI	10.1080/23279095.2022.2076602
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Article ; Online: Symptom validity indices in the Posttraumatic Stress Disorder Checklist for DSM-5.

Shura, Robert D / Rowland, Jared A / Miskey, Holly M / Ord, Anna S / Magnante, Anna T / Martindale, Sarah L

Journal of traumatic stress

2023 Volume 36, Issue 5, Page(s) 919–931

Abstract: The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for ... ...

Abstract	The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self-report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). This research aimed to develop and validate PCL-5 SVTs in two samples of veterans. Participants completed one of two prospective research studies that included cognitive and psychological tests. Participants in Study 1 were veterans (N = 464) who served following the September 11, 2001, terrorist attacks; participants in Study 2 were veterans or service members (N = 338) who had been deployed to Iraq and/or Afghanistan. Both studies included the PCL-5 and the Structured Inventory of Malingered Symptomatology (SIMS), the latter of which served as the criterion for identifying PCL-5 SVTs. For Study 1, two separate SVTs were developed: the PCL-5 Symptom Severity scale (PSS), based on the PCL-5 total score, and the PCL-5 Rare Items scale (PRI), based on PCL-5 items infrequently endorsed at the highest item ratings. At the most conservative SIMS cutoff score, the PSS achieved excellent discrimination for both the Study 1, AUC = .840, and Study 2 samples, AUC = .858, with specific cutoff scores of ≥ 51 and ≥ 56 maximizing sensitivity while maintaining a specificity of .90. The PRI achieved good discrimination, AUCs = .760 and.726, respectively, with a cutoff score of 2 or higher indicated by both studies. The results of these two studies provide provisional support for these two embedded SVTs in the PCL-5.
Language	English
Publishing date	2023-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	639478-4
ISSN	1573-6598 ; 0894-9867
ISSN (online)	1573-6598
ISSN	0894-9867
DOI	10.1002/jts.22957
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Article ; Online: An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters.

Etzel, Lena / Miskey, Holly M / Webb, Jennifer B / Demakis, George J / Harris, Henry L / Shura, Robert D

Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists

2023 Volume 39, Issue 1, Page(s) 11–23

Abstract: Objective: Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten ... ...

Abstract	Objective: Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. Method: Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. Results: After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. Conclusions: Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.
MeSH term(s)	Humans ; Stress Disorders, Post-Traumatic/epidemiology ; Stress Disorders, Post-Traumatic/diagnosis ; Combat Disorders/complications ; Combat Disorders/diagnosis ; Combat Disorders/epidemiology ; Cross-Sectional Studies ; Syndrome ; Neuropsychological Tests ; Veterans/psychology
Language	English
Publishing date	2023-08-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	632972-x
ISSN	1873-5843 ; 0887-6177
ISSN (online)	1873-5843
ISSN	0887-6177
DOI	10.1093/arclin/acad055
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Article ; Online: Cost of malingering mild traumatic brain injury-related cognitive deficits during compensation and pension evaluations in the veterans benefits administration.

Denning, John H / Shura, Robert D

Applied neuropsychology. Adult

2017 Volume 26, Issue 1, Page(s) 1–16

Abstract: Given the high rates of exaggeration in those claiming long-term cognitive deficits as a result of mild traumatic brain injury (mTBI), the aim of this study was to evaluate the rates of malingering in those seeking disability through the Veterans ... ...

Abstract	Given the high rates of exaggeration in those claiming long-term cognitive deficits as a result of mild traumatic brain injury (mTBI), the aim of this study was to evaluate the rates of malingering in those seeking disability through the Veterans Benefits Administration and estimate the financial burden of disability payments for those receiving compensation despite exaggerated mTBI-related cognitive deficits. Retrospective review included 74 veterans seen for Compensation and Pension evaluations for mTBI. Rates of malingering were based on failure of the Medical Symptom Validity Test (MSVT) and/or the Test of Memory Malingering (TOMM) trial 1 ≤ 40. Total estimated compensation was based on the level of disability awarded and the number of individuals found to be malingering cognitive deficits. Overall, 33-52% of the sample was found to be malingering mTBI-related cognitive deficits. The malingering groups were receiving approximately $71,000-$121,000/year ($6,390-$7,063 per year, per veteran on average). Estimated nationwide disability payments for those possibly malingering mTBI-related cognitive deficits would be $136-$235 million/year (projected costs from 2015-2020 = $700 million-$1.2 billion). It is critical that providers and administrative officials identify those exaggerating disability claims attributed to mTBI. The cost of malingering impacts society in general as well as veterans themselves, as it diverts needed funds/resources away from those legitimately impaired by their military service.
MeSH term(s)	Adult ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Brain Concussion/economics ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/economics ; Cognitive Dysfunction/etiology ; Disability Evaluation ; Humans ; Male ; Malingering/diagnosis ; Malingering/economics ; Middle Aged ; United States ; Veterans/statistics & numerical data ; Veterans Disability Claims/economics
Language	English
Publishing date	2017-08-17
Publishing country	United States
Document type	Journal Article
ISSN	2327-9109
ISSN (online)	2327-9109
DOI	10.1080/23279095.2017.1350684
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