Psychometric Performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in Veteran PTSD Assessment
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Psychometric Performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in Veteran PTSD Assessment Erika J. Wolf 1,2 & Stephanie Ellickson-Larew 1 & Rachel E. Guetta 1,3 & Shaline Escarfulleri 1 & Karen Ryabchenko 1,2 & Mark W. Miller 1,2 Received: 30 October 2019 / Accepted: 1 March 2020 # This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract This study examined the psychometric properties of a widely used measure of symptom exaggeration, the Miller Forensic Assessment of Symptoms Test (M-FAST, Miller, 2001), in a sample of 209 (83.7% male) trauma-exposed veterans (57.9% probable current posttraumatic stress disorder; PTSD). M-FAST total scores evidenced acceptable internal consistency, but several subscales showed poor internal consistency. Factor analytic and item-response theory analyses identified seven poorly performing items. Comparisons with other measures of psychopathology and response validity (including subscales from the Minnesota Multiphasic Personality Inventory-2 Restructured Form) revealed that M-FAST scores were highly correlated with indices of psychopathology while less strongly associated with measures of symptom over-reporting. Empirically and clinically-derived (using a follow-up testing-the-limits procedure) revised M-FAST scores failed to improve the measure’s psychometric performance. Results raise concerns about the validity of the M-FAST for identifying malingering in veterans with PTSD and carry implications for access to care and forensic evaluations in this population. Keywords Malingering . Symptom exaggeration . M-FAST . PTSD . Over-reporting . Psychometric
One of the most commonly used stand-alone measures of symptom exaggeration in psychiatric and disability-claimrelated populations is the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001). The measure was developed initially in forensic inpatient psychiatry units to quickly screen for exaggerated symptom reporting consistent with malingering using an interview format in which a clinician reads a series of statements concerning unusual psychological symptoms and suggestibility and provides categorical Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12207-020-09373-y) contains supplementary material, which is available to authorized users. * Erika J. Wolf [email protected] 1
National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave. (116B-2), Boston, MA, USA
2
Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
3
Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
response options for the respondent (e.g., true/false, always/ sometimes/never), with each item scored dichotomously (present/absent). It was designed to align with the Structured Interview for Reported Symptoms (SIRS, Rogers, Bagby, & Dickens, 1992), a lengthier, structured clinician-administered interview that was considered to be the “gold
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