Standard Symptom Inventories for Asylum Seekers in a Psychiatric Hospital: Limited Utility Due to Poor Symptom Validity

  • Douwe van der Heide
  • Irena Boskovic
  • Harald Merckelbach
Article
  • 21 Downloads

Abstract

We examined symptom validity in two samples (Ns = 27 and 35) of asylum seekers who had been admitted to a psychiatric facility. Considerable proportions over-endorsed atypical symptoms (63 and 83%, respectively) and underperformed on a simple forced-choice task requiring the identification of basic emotions (41 and 71%, respectively). Over-endorsement and underperformance were unrelated to Dutch language proficiency but were related to raised scores on standard symptom inventories commonly used to assess psychiatric symptoms of asylum seekers. This pattern of findings casts doubts on attempts to monitor symptom severity and treatment progress in psychiatric asylum seekers without taking symptom validity into account.

Keywords

Refugees Asylum seekers Symptom validity tests Symptom over-reporting Underperformance 

Notes

Acknowledgements

The authors would like to thank Hanneke Bot, current head of the clinical facility where this study took place, for her review of the concept version of this article.

Compliance with Ethical Standards

Conflict of Interest

This project received no financial support from outside funding agencies. The authors have no disclosures to make that could be interpreted as conflict of interests.

Human and Animal Rights and Informed Consent

Relevant ethical guidelines regulating research involving human participants were followed throughout the project. All data collection, storage, and processing was done in compliance with the Helsinki Declaration.

References

  1. Ardila, A. (2005). Cultural values underlying psychometric cognitive testing. Neuropsychology Review, 15, 185–195. https://doi.org/10.1007/s11065-005-9180-y.CrossRefPubMedGoogle Scholar
  2. Benuto, L. T., Leany, B. D., & Lee, A. (2014). Assessing effort and malingering with the African American client. In L. T. Benuto & B. D. Leany (Eds.), Guide to psychological assessment with African Americans (pp. 79–85). New York: Springer.Google Scholar
  3. Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735. https://doi.org/10.1097/00005053-198612000-00004.CrossRefPubMedGoogle Scholar
  4. Bianchini, K. J., Curtis, K. L., & Greve, K. W. (2006). Compensation and malingering in traumatic brain injury: A dose-response relationship? The Clinical Neuropsychologist, 20, 831–847. https://doi.org/10.1080/13854040600875203.CrossRefPubMedGoogle Scholar
  5. Boon, S., & Draijer, N. (1993). Multiple personality disorder in The Netherlands: A clinical investigation of 71 patients. American Journal of Psychiatry, 150, 489–494. https://doi.org/10.1176/ajp.150.3.489.CrossRefPubMedGoogle Scholar
  6. Bot, H. (2005). Dialogue interpreting in mental health. New York: Rodopi.Google Scholar
  7. Bush, S. S., Ruff, R. M., Tröster, A. I., Barth, J. T., Koffler, S. P., Pliskin, et al. (2005). Symptom validity assessment: Practice issues and medical necessity. Archives of Clinical Neuropsychology, 20, 419–426. https://doi.org/10.1016/j.acn.2005.02.002.CrossRefPubMedGoogle Scholar
  8. Carlson, E. B., & Rosser-Hogan, R. (1993). Mental health status of Cambodian refugees ten years after leaving their homes. American Journal of Orthopsychiatry, 63, 223–231. https://doi.org/10.1037/h0079422.CrossRefPubMedGoogle Scholar
  9. Dandachi-FitzGerald, B., Merckelbach, H., & Ponds, R. W. (2017). Neuropsychologists’ ability to predict distorted symptom presentation. Journal of Clinical and Experimental Neuropsychology, 39, 257–264. https://doi.org/10.1080/13803395.2016.1223278.CrossRefPubMedGoogle Scholar
  10. Dandachi-FitzGerald, B., Ponds, R. W., Peters, M. J., & Merckelbach, H. (2011). Cognitive underperformance and symptom over-reporting in a mixed psychiatric sample. The Clinical Neuropsychologist, 25, 812–828. https://doi.org/10.1080/13854046.2011.583280.CrossRefPubMedGoogle Scholar
  11. DuAlba, L., & Scott, R. L. (1993). Somatization and malingering for workers' compensation applicants: A cross-cultural MMPI study. Journal of Clinical Psychology, 49, 913–917. https://doi.org/10.1002/1097-4679(199311)49:6<913::AID-JCLP2270490619>3.0.CO;2-1.CrossRefPubMedGoogle Scholar
  12. Egeland, J., Andersson, S., Sundseth, Ø. Ø., & Schanke, A. K. (2015). Types or modes of malingering? A confirmatory factor analysis of performance and symptom validity tests. Applied Neuropsychology: Adult, 22, 215–226. https://doi.org/10.1080/23279095.2014.910212.CrossRefGoogle Scholar
  13. Erdodi, L. A., Nussbaum, S., Sagar, S., Abeare, C. A., & Schwartz, E. S. (2017). Limited English proficiency increases failure rates on performance validity tests with high verbal mediation. Psychological Injury and Law, 10, 96–103. https://doi.org/10.1007/s12207-017-9282-x.CrossRefGoogle Scholar
  14. European Council on Refugees and Exiles. (2012). Asylum Information Database. Retrieved from http://www.asylumineurope.org
  15. Favaro, A., Maiorani, M., Colombo, G., & Santonastaso, P. (1999). Traumatic experiences, posttraumatic stress disorder, and dissociative symptoms in a group of refugees form former Yugoslavia. Journal of Nervous and Mental Disease, 187, 306–308. https://doi.org/10.1097/00005053-199905000-00007.CrossRefPubMedGoogle Scholar
  16. Fox, D. D. (2011). Symptom validity test failure indicates invalidity of neuropsychological tests. The Clinical Neuropsychologist, 25, 488–495. https://doi.org/10.1080/13854046.2011.554443.CrossRefPubMedGoogle Scholar
  17. Friedl, M. C., & Draijer, N. (2000). Dissociative disorders in Dutch psychiatric inpatients. American Journal of Psychiatry, 157, 1012–1013. https://doi.org/10.1176/appi.ajp.157.6.1012.CrossRefPubMedGoogle Scholar
  18. Geraerts, E., Kozaric-Kovacic, D., Merckelbach, H., Peraica, T., Jelicic, M., & Candel, I. (2009). Detecting deception of war-related post traumatic stress disorder. Journal of Forensic Psychiatry and Psychology, 20, 278–285. https://doi.org/10.1080/14789940802340906.CrossRefGoogle Scholar
  19. Geraerts, E., Merckelbach, H. L. C. J., & Jelicic, M. (2007). Het simuleren van posttraumatische stresssymptomen: De Nederlandse versie van de Morel Emotional Numbing Test (MENT) [Feigning symptoms of posttraumatic stress: The Dutch version of the Morel Emotional Numbing Test (MENT)]. Neuropraxis, 11, 8–12. https://doi.org/10.1007/BF03079115.CrossRefGoogle Scholar
  20. Griffin, G. A., Normington, J., May, R., & Glassmire, D. (1996). Assessing dissimulation among Social Security disability income claimants. Journal of Consulting and Clinical Psychology, 64, 1425–1430. https://doi.org/10.1037/0022-006X.64.6.1425.CrossRefPubMedGoogle Scholar
  21. Immigration & Naturalization Services. (2016). Protocol Bureau Medische Advisering [Protocol of the Bureau for Medical Advice]. Retrieved from https://ind.nl/documents/protocol%20bma%202016%20webversie.pdf
  22. Institute of Medicine. (2015). Psychological testing in the service of disability determination. Washington DC: The National Academic Press.Google Scholar
  23. Kleijn, W. C., Hovens, J. E. J. M., Rodenburg, J. J., & Rijnders, R. J. P. (1998). Psychiatrische symptomen bij vluchtelingen aangemeld bij het psychiatrisch centrum de Vonk [Psychiatric symptoms of refugees referred to psychiatric center De Vonk]. Nederlands Tijdschrift voor Geneeskunde, 142, 1724–1728.PubMedGoogle Scholar
  24. Kleijn, W. C., & Mook, J. (1999). Nederlands-Engelstalige adaptatie van de Harvard Trauma Questionnaire [Dutch-English adaptation of the Harvard Trauma Questionnaire]. Oegstgeest: Centrum’45.Google Scholar
  25. Meffert, S. M., Musalo, K., McNiel, D. E., & Binder, R. L. (2010). The role of mental health professionals in political asylum processing. Journal of the American Academy of Psychiatry and the Law, 38, 479–489.PubMedGoogle Scholar
  26. Meijer, D., & Noijons, J. (2008). Gemeenschappelijk Europees referentiekader voor moderne vreemde talen: Leren, onderwijzen, beoordelen [Common European framework of reference for modern languages: Learning, teaching, assessment]. The Hague: Nederlandse Taalunie.Google Scholar
  27. Merckelbach, H., Langeland, W., De Vries, G., & Draijer, N. (2014). Symptom overreporting obscures the dose-response relationship between trauma severity and symptoms. Psychiatry Research, 217, 215–219. https://doi.org/10.1016/j.psychres.2014.03.018.CrossRefPubMedGoogle Scholar
  28. Merckelbach, H., & Smith, G. P. (2003). Diagnostic accuracy of the Structured Inventory of Malingered Symptomatology (SIMS) in detecting instructed malingering. Archives of Clinical Neuropsychology, 18, 145–152. https://doi.org/10.1093/arclin/18.2.145.CrossRefPubMedGoogle Scholar
  29. Merckelbach, H. L. G. J., Koeyvoets, N., Cima, M., & Nijman, H. (2001). De Nederlandse versie van de SIMS [The Dutch version of the SIMS]. De Psycholoog, 11, 586–591.Google Scholar
  30. Mollica, R., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180, 111–116. https://doi.org/10.1097/00005053-199202000-00008.CrossRefPubMedGoogle Scholar
  31. Montes, O., & Guyton, M. R. (2014). Performance of Hispanic inmates on the Spanish Miller Forensic Assessment of Symptoms Test (M-FAST). Law and Human Behavior, 38, 428–438. https://doi.org/10.1037/lhb0000074.CrossRefPubMedGoogle Scholar
  32. Morel, K. R. (1998). Development and preliminary validation of a forced-choice test of response bias for posttraumatic stress disorder. Journal of Personality Assessment, 70, 299–314. https://doi.org/10.1207/s15327752jpa7002_8.CrossRefPubMedGoogle Scholar
  33. Nijdam-Jones, A., & Rosenfeld, B. (2017). Cross-cultural feigning assessment: A systematic review of feigning instruments used with linguistically, ethnically, and culturally diverse samples. Psychological Assessment. Advance online publication. https://doi.org/10.1037/pas0000438.
  34. Putnam, F. W., Carlson, E. B., Ross, C. A., & Anderson, G. (1996). Patterns of dissociation in clinical and nonclinical samples. Journal of Nervous and Mental Disease, 184, 673–679. https://doi.org/10.1097/00005053-199611000-00004.CrossRefPubMedGoogle Scholar
  35. Reko, A., Bech, P., Wohlert, C., Noerregaard, C., & Csillag, C. (2015). Usage of psychiatric emergency services by asylum seekers: Clinical implications based on a descriptive study in Denmark. Nordic Journal of Psychiatry, 69, 587–593. https://doi.org/10.3109/08039488.2015.1019923.CrossRefPubMedGoogle Scholar
  36. Rogers, R. (2008). An introduction to response styles. In R. Rogers (Ed.), Clinical assessment of malingering and deception (3rd ed., pp. 3–13). New York: Guilford.Google Scholar
  37. Rogers, R., Sewell, K. W., & Goldstein, A. (1994). Explanatory models of malingering: A prototypical analysis. Law and Human Behavior, 18, 543–552. https://doi.org/10.1007/BF01499173.CrossRefGoogle Scholar
  38. Shoeb, M., Weinstein, H., & Mollica, R. (2007). The Harvard trauma questionnaire: Adapting a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. International Journal of Social Psychiatry, 53, 447–463. https://doi.org/10.1177/0020764007078362.CrossRefPubMedGoogle Scholar
  39. Smith, G. P. (2008). Brief screening measures for the detection of feigned psychopathology. In R. Rogers (Ed.), Clinical assessment of malingering and deception (3rd ed., pp. 323–339). New York: Guilford.Google Scholar
  40. Smith, G. P., & Burger, G. K. (1997). Detection of malingering: Validation of the Structured Inventory of Malingered Symptomatology (SIMS). Journal of the American Academy of Psychiatry and the Law, 25, 183–189.PubMedGoogle Scholar
  41. Sollman, M. J., & Berry, D. T. (2011). Detection of inadequate effort on neuropsychological testing: A meta-analytic update and extension. Archives of Clinical Neuropsychology, 26, 774–789. https://doi.org/10.1093/arclin/acr066.CrossRefPubMedGoogle Scholar
  42. Söndergaard, H. P., & Theorell, T. (2004). Alexithymia, emotions and PTSD; findings from a longitudinal study of refugees. Nordic Journal of Psychiatry, 58, 185–191. https://doi.org/10.1080/08039480410006214.CrossRefPubMedGoogle Scholar
  43. Storm, I. (2003). Ervaringen van Marokkaanse en Turkse migranten met een functiebeperking of chronische ziekte in de zorg [Experiences of Moroccan and Turkish migrants with impairments of chronic illness in healthcare]. Retrieved from http://www.bbvz.nl/files/definitieve_rapportage_sppmf.pdf
  44. Van der Heide, D. H., & Merckelbach, H. (2016). Validity of symptom reports of asylum seekers in a psychiatric hospital: A descriptive study. International Journal of Law and Psychiatry, 49, 40–46. https://doi.org/10.1016/j.ijlp.2016.05.007.CrossRefPubMedGoogle Scholar
  45. Van Dijk, D. G. L., Kortmann, F., Kooijman, M., & Bot, J. (1999). De Harvard Trauma Questionnaire (HTQ) als transcultureel screeningsinstrument voor de posttraumatische stress-stoornis bij opgenomen vluchtelingen [The Harvard Trauma Questionnaire (HTQ) as transcultural screening instrument for posttraumatic stress disorder among refugee inpatients]. Tijdschrift voor Psychiatrie, 41, 45–49.Google Scholar
  46. Van Impelen, A., Merckelbach, H., Jelicic, M., & Merten, T. (2014). The Structured Inventory of Malingered Symptomatology (SIMS): A systematic review and meta-analysis. The Clinical Neuropsychologist, 28, 1336–1365. https://doi.org/10.1080/13854046.2014.984763.CrossRefPubMedGoogle Scholar
  47. Vilar-López, R., Santiago-Ramajo, S., Gómez-Río, M., Verdejo-García, A., Llamas, J. M., & Pérez-García, M. (2007). Detection of malingering in a Spanish population using three specific malingering tests. Archives of Clinical Neuropsychology, 22, 379–388. https://doi.org/10.1016/j.acn.2007.01.012.CrossRefPubMedGoogle Scholar
  48. Weiss, R. A., & Rosenfeld, B. (2017). Identifying feigning in trauma-exposed African immigrants. Psychological Assessment, 29, 881–889. https://doi.org/10.1037/pas0000381.CrossRefPubMedGoogle Scholar
  49. Wisdom, N. M., Pastorek, N. J., Miller, B. I., Booth, J. E., Romesser, J. M., Linck, J. F., & Sim, A. H. (2014). PTSD and cognitive functioning: Importance of including performance validity testing. The Clinical Neuropsychologist, 28, 128–145. https://doi.org/10.1080/13854046.2013.863977.CrossRefPubMedGoogle Scholar
  50. Wright, D. B., & Loftus, E. F. (1999). Measuring dissociation: Comparison of alternative forms of the Dissociative Experiences Scale. American Journal of Psychology, 112, 497–519. https://doi.org/10.2307/1423648.CrossRefPubMedGoogle Scholar
  51. Young, G. (2014). Malingering, feigning, and response bias in psychiatric/psychological injury: implications for practice and court. doi:https://doi.org/10.1007/978-94-007-7899-3.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Phoenix, ProPersonaWolfhezeThe Netherlands
  2. 2.GGZ CentraalErmeloThe Netherlands
  3. 3.Forensic Psychology SectionMaastricht UniversityMaastrichtThe Netherlands
  4. 4.University of PortsmouthPortsmouthUK

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