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Vol.5 , No. 2, Publication Date: Apr. 25, 2019, Page: 58-63
 allegedly measures malingering. The test is based on the construct of “effort.” Scores in the category of poor effort are interpreted as malingering. The test is very well designed and supported by numerous statistical studies on various clinical groups, except for patients with symptom pattern that combines an intense chronic pain, pain related insomnia, post-concussive symptoms, fatigue, and related depression, such as patients who survived potentially lethal car accidents, or injured war veterans-. The Green’s test is often used by psychologists in evaluations of insurance claims related to motor vehicle accidents (MVAs). This article analyses symptom patterns potentially contributing to false positives (i.e., patients falsely classified as malingerers) on Green’s test, is i.e., factors which would interfere with their ability to make a consistent effort, show a sustained attentional focus, or even to have the willingness to make such effort. <i>Method</i>. Symptom patterns of 103 patients (mean age 42.4 years, SD=14.1, 40 males, 63 females) assessed after their MVA in the context of insurance claims were examined statistically. They were administered the Brief Pain Inventory, Insomnia Severity Index, and the Rivermead Post-Concussion Symptoms Questionnaire. <i>Results</i>. The mean ratings of pain were in the moderate to severe range (4 to 8 points on Items 3 to 5 of the Brief Pain Inventory). On the Insomnia Severity Index, 33.6% of patients scored within category of moderate and 64.4% within the category of severe insomnia. The average total score on the Rivermead scale was very elevated: 42.0, SD=5.3, with 85.7% scoring > 30. Moderate fatigue was reported by 25.5% and severe by 65.3% of the patients and 46.9% admitted to severe irritability. <i>Discussion</i>. Pain, insomnia, post-concussion syndrome, and fatigue are likely to jointly interfere with these patients’ ability to exert sustained effort and consistent attentional focus on the “effort tests” such as Green’s. High levels of these symptoms in post-MVA patients are likely to cause Green’s test to misclassify many as malingerers, thus leading to denials of their insurance claims for treatment and for other legally owed compensation. The onus is on the publisher of Green’s test to demonstrate its validity for post-MVA patients or to develop the norms of this test for that specific group.&picture=http://www.aascit.org/aascit/decorators/img/journal/929.jpg)
| [1] | John Jack Remo Ferrari, Psychological Clinic, London, Canada. |
| [2] | Zack Zdenek Cernovsky, Department of Psychiatry, University of Western Ontario, London, Canada. |
| [3] | James Dominic Mendonça, Department of Psychiatry, University of Western Ontario, London, Canada. |
Introduction. Green’s Medical Symptom Validity Test (MSVT) allegedly measures malingering. The test is based on the construct of “effort.” Scores in the category of poor effort are interpreted as malingering. The test is very well designed and supported by numerous statistical studies on various clinical groups, except for patients with symptom pattern that combines an intense chronic pain, pain related insomnia, post-concussive symptoms, fatigue, and related depression, such as patients who survived potentially lethal car accidents, or injured war veterans-. The Green’s test is often used by psychologists in evaluations of insurance claims related to motor vehicle accidents (MVAs). This article analyses symptom patterns potentially contributing to false positives (i.e., patients falsely classified as malingerers) on Green’s test, is i.e., factors which would interfere with their ability to make a consistent effort, show a sustained attentional focus, or even to have the willingness to make such effort. Method. Symptom patterns of 103 patients (mean age 42.4 years, SD=14.1, 40 males, 63 females) assessed after their MVA in the context of insurance claims were examined statistically. They were administered the Brief Pain Inventory, Insomnia Severity Index, and the Rivermead Post-Concussion Symptoms Questionnaire. Results. The mean ratings of pain were in the moderate to severe range (4 to 8 points on Items 3 to 5 of the Brief Pain Inventory). On the Insomnia Severity Index, 33.6% of patients scored within category of moderate and 64.4% within the category of severe insomnia. The average total score on the Rivermead scale was very elevated: 42.0, SD=5.3, with 85.7% scoring > 30. Moderate fatigue was reported by 25.5% and severe by 65.3% of the patients and 46.9% admitted to severe irritability. Discussion. Pain, insomnia, post-concussion syndrome, and fatigue are likely to jointly interfere with these patients’ ability to exert sustained effort and consistent attentional focus on the “effort tests” such as Green’s. High levels of these symptoms in post-MVA patients are likely to cause Green’s test to misclassify many as malingerers, thus leading to denials of their insurance claims for treatment and for other legally owed compensation. The onus is on the publisher of Green’s test to demonstrate its validity for post-MVA patients or to develop the norms of this test for that specific group.
Keywords
Malingering, False Positives, Green’s Test, Iatrogenic Impact
Reference
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