An Examination of Factors Related to Suboptimal Cognitive Validity Test Performance in a Mildly Concussed Military Sample

While cognitive and emotional symptoms which persist beyond what is typical following a mild traumatic brain injury (mTBI) are often attributed to the physical or neurological impact of the concussion, numerous studies have suggested that these symptoms are maintained by other factors, such as psychiatric symptoms and compensation seeking (Binder & Rohling, 1996; Feinstein, Ouchterlony, Iverson & Lange, 2003; Somerville & Jardine, 2011). The current study utilized archival data to examine these factors in an active military sample (N=76). Effort and ethnicity’s impact on participants’ cognitive validity test (CVT) performance was also examined. It was hypothesized that a subset of clinical and subscale scores from the Personality Assessment Inventory (PAI) would mediate the relationship between ethnicity and performance on CVTs (Test of Memory Malingering and Reliable Digit Span). It was also predicted that involvement with a Medical Evaluation/Physical Evaluation Board would moderate the relationship between PAI results and performance on CVTs. Statistical analyses were run using PROCESS, a logistic regression based program that estimates direct and indirect effects (Hayes, 2012). While some direct effects were found (e.g., higher scores on scales measuring depressive, somatic, and traumatic stress symptoms were associated with failure on a greater number of CVTs), the predicted mediational and moderational relationships were not supported. Results from the study provide support for the notion that cognitive validity tests are associated with psychological and emotional symptoms and not always secondary gain. Additionally, findings show that differences in the way people from different ethnic backgrounds express psychopathology may impact cognitive validity test performance. As not all predictions were supported, future studies should examine other factors (e.g., substance abuse) that may influence CVT performance in an active military population with history of mTBI