Malingering in persons with a diagnosis of depression

[摘要] ENGLISH ABSTRACT:Malingering is the intentional production or exaggeration of symptoms for personal gainin the context of external incentives. Due to the absence of objective symptoms, depression mayrepresent a relatively attractive option for malingerers. Existing approaches to distinguishbetween depressive symptoms and possible malingering often use time-consuming psychometrictests or unreliable interview techniques. Short screening tests for malingering may be apracticable alternative and recently South African cut-off scores on tests for malingering weredetermined for a student sample. The purpose of this study was to establish South African cut-offscores for persons with a diagnosis of depression on screening instruments for malingering.Fifty-one subjects with a diagnosis of depression (measured by the Zung DepressionScale) were randomly ascribed to one of two groups: an experimental group of 25 subjects(instructed to simulate symptoms based on a malingering case scenario) and a control group of26 subjects (instructed to do their best in the tests). No incentive was provided to the subjects.Each subject completed the 21-item verbal memory forced choice test (FCT), the Rey IS-itemtest (Rey IS-item), the dot-counting test (DCT), the Word Recognition test (WR) that is part ofthe Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) and the StructuredInventory of Malingered Symptomatology (SIMS).The WR test correctly classified 74.5% of subjects with a sensitivity of 93%. The FCT,with a cut-off of> 15.5, correctly classified 72.5% of subjects. A regression equation wascomputed by combining the FCT, DCT and SIMS. This correctly classified 74.5% of patientswith a sensitivity of 69%. The DCT accurately identified 64% of the malingerers using a cut-offscore of> 65.57. The Rey15-item test showed poor results and does not seem to be useful as ascreening instrument.The WR test shows promise as a screening instrument for malingering. Combining testswhen screening for malingering proved to be an effective way to distinguish betweenmalingering of depressive symptoms and real symptoms. The results of this study will helpprovide guidelines to mental health workers on how to diagnose malingering in patients withdepression more objectively.

[发布机构] Stellenbosch University