Prevalence of overreporting on symptom validity tests in a large sample of psychosomatic rehabilitation inpatients.

Objective

Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectations may play a significant role in clinical patients. We studied the prevalence of noncredible symptom report in patients treated for minor mental disorders in an inpatient setting.Method: Five hundred and thirty seven clinical inpatients of a psychosomatic rehabilitation center were studied (mean age: 50.2 years; native speakers of German). They were referred for treatment of depression, anxiety, somatoform disorder, adjustment disorder, and neurasthenia. Results of two symptom validity tests (Structured Inventory of Malingered Symptomatology, SIMS; Self-Report Symptom Inventory, SRSI) and the Beck Depression Inventory-II (BDI-II) were analyzed.

Results

At screening level, 34.5% and 29.8% of the patients were found to presumably overreport symptoms on the SIMS and SRSI, respectively. At the standard cut score of the SRSI (maximum false positive rate: 5%), the proportion of diagnosed overreporting was 18.8%. SIMS and SRSI pseudosymptom endorsement correlated at .73. Highly elevated depressive symptom claims with BDI-II scores above 40, found in 9.3% of the patients, were associated with elevated pseudosymptom endorsement. Moreover, extended times of sick leave and higher expectations of disability pension were associated with elevated pseudosymptom endorsement.

Conclusions

The prevalence of symptom overreporting in some clinical patient groups is a serious, yet underinvestigated problem. The current estimates yielded a high prevalence of distorted, noncredible symptom claims in psychosomatic rehabilitation patients. The challenges arising to health professionals working in such settings are immense and need more consideration.