Symptom burden, validity, and cognitive performance in Iraq and Afghanistan veterans

Abstract

Introduction

The present study evaluates the complex relationships between symptom burden, validity, and cognition in a sample of Iraq and Afghanistan veterans to identify key characteristic symptoms and validity measures driving cognitive performance. We hypothesized that symptom and performance validity would account for poorer outcomes on cognitive performance beyond psychological symptoms.

Methods

Veterans (n = 226) completed a cognitive test battery, Personality Assessment Inventory (PAI), Word Memory Test (WMT), and Miller Forensic Assessment Symptom Test (M-FAST). Partial least squares structural equation modeling (PLS-SEM) modeled the fully-adjusted relationships among PAI subscales, validity, and cognitive performance.

Results

23.45% of participants failed validity indices (19.9% WMT; 7.1% M-FAST). PLS-SEM indicated PAI subscales were not directly associated with performance or symptom validity measures, and there were no direct effects between validity performance and cognitive performance. Several PAI subscales were directly associated with measures of verbal abstraction, visual processing, and verbal learning and memory.

Conclusion

Contrary to hypotheses, symptom and performance validity did not account for poorer outcomes on cognitive performance beyond symptom burden in the PLS-SEM model. Results highlight the association between psychiatric symptoms and cognitive performance beyond validity status.

Keywords:

• Cognition
• neuropsychology
• PTSD
• symptoms
• validity
• veteran

Acknowledgments

This research was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness, Research, and Treatment, the W. G. (Bill) Hefner VA Healthcare System, Durham Veterans Affairs Medical Center, Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC), and the Department of Veterans Affairs Office of Research and Development.

Disclosure statement

The authors have no conflicts of interest to report. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States government, or any of the institutions with which the authors are affiliated.