Standalone Performance Validity Tests May Be Differentially Related to Measures of Working Memory, Processing Speed, and Verbal Memory in Patients With Multiple Sclerosis.

Cognitive functioning may account for minimal levels (i.e., 5%-14%) of variance of performance validity test (PVT) scores in clinical examinees. The present study extended this research twofold: (a) by determining the variance cognitive functioning explains within three distinct PVTs (b) in a sample of patients with multiple sclerosis (pwMS). Seventy-five pwMS (Mage = 48.50, 70.6% female, 80.9% White) completed the Victoria Symptom Validity Test (VSVT), Word Choice Test (WCT), Dot Counting Test (DCT), and three objective measures of working memory, processing speed, and verbal memory as part of clinical neuropsychological assessment. Regression analyses in credible groups (ns ranged from 54 to 63) indicated that cognitive functioning explained 24% to 38% of the variance in logarithmically transformed PVT variables. Variance from cognitive testing differed across PVTs: verbal memory significantly influenced both VSVT and WCT scores; working memory influenced VSVT and DCT scores; and processing speed influenced DCT scores. The WCT appeared least related to cognitive functioning of the included PVTs. Alternative plausible explanations, including the apparent domain/modality specificity hypothesis of PVTs versus the potential sensitivity of these PVTs to neurocognitive dysfunction in pwMS were discussed. Continued psychometric investigations into factors affecting performance validity, especially in multiple sclerosis, are warranted.

"It's on the tip of my tongue!" exploring confrontation naming difficulties in patients with multiple sclerosis.

BACKGROUND: Naming difficulty is commonly reported by patients with multiple sclerosis (pwMS). Though many cognitive batteries recommended for pwMS include fluency tasks, they do not include naming tasks. The aim of this study was to examine the prevalence of naming impairment in pwMS by using a measure of confrontation naming and to identify correlates with neuroimaging. METHODS: One-hundred-eighty-five pwMS (Mage = 48.75 ± 11.23) completed neuropsychological testing and fifty had brain MRI scans within one year of neuropsychological testing. Controlling for demographic variables, partial correlations and hierarchical regressions with language tests as the outcome variables and neuroimaging variables as predictors were performed. RESULTS: Performance on language tasks ranged within low average to average, with impairment most frequently found on a measure of confrontation naming (Boston Naming Test [BNT];27.6%), followed by a measure of phonemic fluency (Controlled Oral Word Association Test [COWAT]; 24.3%) and semantic fluency (animals [AF]; 18.3%). In the subset of patients with neuroimaging, thalamic volume had the strongest relationship with language variables, followed by white matter volume and T2 lesion volume. Language variables had no association with fractional gray matter volume. Of the language measures, BNT demonstrated the strongest relationship with MRI variables, followed by AF. There were no significant associations between neuroimaging variables and COWAT. Regression results revealed that fractional thalamic volume significantly contributed to BNT scores after adjusting for demographics, while T2 lesion volume predicted AF and no neuroimaging variables emerged as predictors for COWAT after controlling for demographics. CONCLUSIONS: Objective naming impairment is common in pwMS and are more strongly associated with neuroimaging of MS brain pathology than verbal fluency tasks that are commonly used in cognitive batteries for pwMS. Continued research on language (especially naming) deficits and neuroimaging correlates (particularly thalamic involvement) in pwMS is needed.

Clinical utility of the Saint Louis University Mental Status Examination (SLUMS) in a mixed neurological sample: Proposed revised cutoff scores for normal cognition, mild cognitive impairment, and dementia.

Early detection of cognitive impairment is of paramount importance in clinical settings, with several brief screening tools having been developed for that purpose. The present study sought to evaluate the clinical utility of the Saint Louis University Mental Status examination (SLUMS) at identifying examinees with normal cognition, mild cognitive impairment, or dementia syndrome using the criterion of a comprehensive neuropsychological assessment. Two hundred sixty-three examinees (M age = 67.84 ± 12.72; 59.3% female; 81.4% white) were referred for comprehensive neuropsychological evaluation at a private, Mid-Atlantic medical center. Using original cutoff scores, the SLUMS correctly classified just over half (55.1%) of examinees. Classification statistics suggested modified cutoff scores for mild cognitive impairment (≤24) and dementia (≤17) with strong discriminability between cognitive status groups (AUCs ranged from .834 to .986). These proposed revised cutoff scores improved overall concordance between SLUMS and diagnostic conclusions from comprehensive clinical neuropsychological testing, correctly classifying nearly two-thirds of examinees (65.4%). The SLUMS and its revised cutoff scores appear to have clinical utility for cognitive screening in primary care and neurological settings to inform treatment plans and appropriate referrals for comprehensive neuropsychological assessment.

The Relationship Between Religiousness/Spirituality and Psychometric Intelligence in the United States.

An inverse relationship between religiousness/spirituality (R/S) and psychometric intelligence (IQ) is well-documented in previous literature. However, the studies that have examined group differences on IQ regarding R/S have limited generalizability. The present study contributed to the literature by evaluating IQ among participants identifying as differentially religious/spiritual (i.e., religious only, spiritual only, both religious and spiritual, or neither religious nor spiritual) and among those classified as either Christian/Catholic, Atheist, or Agnostic. Four hundred and thirty-two participants (M age = 37.9; 36% men) participated online via Amazon's Mechanical Turk as part of a larger study and completed a brief measure of IQ, a scale of religiousness and spirituality, and a demographics questionnaire. Correlations between IQ and self-reported religiousness/spirituality were small and negative (Mean r = -0.17), consistent with previous literature. Multivariate analyses of covariance (MANCOVAs) controlling for age, gender, education, and socioeconomic status (operationalized by estimated annual household income) indicated that IQ scores tended to be lowest (p < 0.001) for "religious only" participants (estimated marginal mean [EMM] = 93.0) and highest for "neither religious nor spiritual" participants (EMM = 103.7). Furthermore, IQ scores were significantly lower (ps < 0.001) for Christian/Catholic participants (EMM = 96.7) compared to both Atheist (EMM = 104.9) and Agnostic participants (EMM = 107.5). Discussion of these findings, relationships to previous theoretical and empirical work, limitations of the present study, and directions for future inquiry are provided.

The dimensionality of the Behavior Rating Inventory of Executive Function, Second Edition in a clinical sample.

The parent-report Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) is a widely used pediatric neuropsychological measure. Unfortunately, despite meaningful changes from its predecessor, few studies have examined its internal factor structure (now with Behavioral Regulation [BRI], Emotion Regulation [ERI], and Cognitive Regulation [CRI]), and no available literature has investigated higher order models for the BRIEF-2. This study sought to address this shortcoming in the literature by investigating and reporting on the dimensionality of the parent-report BRIEF-2 in a clinical sample. Two hundred and two (202) pediatric neuropsychology examinees (M age = 9.90; 68% males) with complete data for the parent-report BRIEF-2 were included. Descriptive results revealed generally elevated scores across BRIEF-2 scales (Global Executive Composite M T = 70.16). Exploratory factor analyses suggested two factors (CRI and BRI/ERI) should be extracted, and that higher order models should be considered. Confirmatory factor analyses suggested that a direct hierarchical/bifactor two-factor structure (which was more parsimonious than the theoretical three-factor model) provided the best fit, with a bulk of the variance explained by the general GEC factor. The BRIEF-2 may be best interpreted at the overall level, with relatively less weight given to the index variables, particularly within clinical samples with high levels of reported executive functioning difficulties. Implications of these findings, limitations of the present study, and appropriate directions for future inquiry were discussed.

The utility of the Wisconsin card sorting test, 64-card version to detect noncredible attention-deficit/hyperactivity disorder.

Clinicians who evaluate patients with concerns related to attention-deficit/hyperactivity disorder (ADHD) are encouraged to include validity indicators throughout clinical assessment procedures. To date, no known previous literature has examined the Wisconsin Card Sorting Test (WCST) specifically to address noncredible ADHD, and none has attempted to identify an embedded PVT within the 64-card version. The present study sought to address these gaps in the literature with a simulation study. Sixty-seven undergraduate participants (M age = 19.30) were grouped as credible (combining healthy controls and individuals with ADHD) or noncredible (combining coached and uncoached participants simulating ADHD-related impairment) and administered a battery of neuropsychological tests. Results revealed the noncredible group performed significantly worse on several WCST-64 variables, including failure to maintain set, number of trials to first category, and total categories. Raw scores from these variables were entered as predictors as one set in a logistic regression (LR) with group membership as the outcome variable. An exponentiated equation (EE) derived from LR results yielded acceptable discriminability (area under receiver operating characteristic curve = .73) with modest sensitivity (.38) while maintaining ideal specificity (.91), generally commensurate with a standalone forced-choice memory PVT and better than an embedded attention-based PVT. These findings suggested the WCST-64 may be sensitive to noncredible performance in the context of ADHD and reiterates the importance of considering tests of various cognitive abilities in the evaluation of performance validity. Implications of these findings, limitations of the present study, and directions for future inquiry, including cross-validation in clinical samples, were discussed.

Examination of five- and four-subtest short form IQ estimations for the Wechsler Intelligence Scale for Children-Fifth edition (WISC-V) in a mixed clinical sample.

Evaluating general cognitive ability (i.e., intelligence) is common in neuropsychological practice, and identifying abbreviated assessments of intelligence is often advantageous. Despite the Wechsler Intelligence Scale for Children, Fifth Edition's (WISC-V) widespread contemporary use, limited research has identified clinically useful short form (SF) full scale IQ (FSIQ) estimations in clinical samples. This study sought to address this gap in the literature. Two hundred sixty-eight pediatric participants (M age = 9.79; 69% male; 88% Caucasian/White) who underwent psychological/neuropsychological evaluation were included. Mean scores for WISC-V scores fell in the low average-to-average ranges, consistent with the clinical nature of this sample (e.g., M FSIQ = 85.3). Ten unique SF combinations with five (pentad) and four (tetrad) subtests, each intentionally selected to represent a breadth of domains subsumed by WISC-V FSIQ, were described by summing subtest age-corrected scaled scores. Regression-based and prorated FSIQ estimates were calculated, and mean differences suggested some prorated estimates should be arithmetically adjusted. Both regression-based and prorated/adjusted methods provided FSIQ estimates that were accurate within five Standard Score points of true FSIQ for approximately 81-92% (pentad) and 65-76% (tetrads) of participants. Prorated/adjusted estimates appeared to provide somewhat better accuracy than regression-based estimates. Relationships between SFs and true FSIQ did not appear to be moderated by participant age, gender, nor how many WISC-V subtests were administered to participants within this archival sample (i.e., 7 vs. 10). Implications of these findings, including benefits, detriments, and other considerations of each SF combination, in addition to limitations of this study, are discussed in detail.

Detecting feigned symptoms of depression, anxiety, and ADHD, in college students with the structured inventory of malingered symptomatology.

OBJECTIVE: Research consistently shows how easily students can feign symptoms of ADHD on self-report checklists to determine eligibility for curricular and standardized testing accommodations. However, it is unclear how easily students can feign psychological symptoms to accesses academic accommodations, making the assessment of symptom validity important in both populations. METHOD: Using a between-subjects design, 75 college students were randomly assigned to one of three groups: (1) coached feigning of ADHD, (2) coached feigning of depression and anxiety (DA), and (3) honest responding (HR). Participants completed the Depression, Anxiety, and Stress Scale (DASS-21) and the Structured Inventory of Malingered Symptomatology (SIMS). RESULTS: The SIMS showed 100% specificity, but low sensitivity (36-52%) for detecting feigned symptoms with different cutoffs. Differences on SIMS subtests were apparent by group with elevated scores for the DA group on the Affective Disorders subscale and elevation for the ADHD group on the Low Intelligence and Amnestic subscales. Participants identified as feigning by the SIMS typically reported more severe symptoms than participants not identified on the DASS-21. CONCLUSIONS: The SIMS equally classified the feigned ADHD and DA participants for both cutoff scores utilized. Potential reasons for low sensitivity rates are discussed and future research recommendations are made.

Methodological considerations of assessing meaningful/reliable change in computerized neurocognitive testing following sport-related concussion.

OBJECTIVE: Traditional reliable change index (RCI) methods may be psychometrically limited due to their inability to account for particularly high or low baseline performance and regression to the mean following serial testing. The current study sought to examine differences between RCI and standardized regression-based (RBz) methods in a cohort of adolescent athletes engaged in sport-related concussion recovery. METHODS: Consultation records and results of computerized testing data via the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery were retrospectively reviewed among 240 adolescent athletes involved in return-to-play protocols following a sport-related concussion. RESULTS: High concordance rates were found between RCI and RBz metrics across ImPACT composites, consistent with previous literature. However, especially for those with lower baseline performance, RBz scores tended to suggest cognitive performance not meeting or exceeding baseline scores despite RCI metrics being appropriate across speed-based ImPACT composites. In contrast, results revealed high rates of RCI scores suggesting continued cognitive difficulties despite RBz metrics being within normal limits, especially for adolescents with higher baseline performance. CONCLUSIONS: Results suggest value in interpreting RBz values in addition to RCI values as these allow for clinical interpretation more sensitive to statistical confounds, including baseline performance and regression to the mean.

Nonmemory Composite Embedded Performance Validity Formulas in Patients with Multiple Sclerosis.

OBJECTIVE: Research regarding performance validity tests (PVTs) in patients with multiple sclerosis (MS) is scant, with recommended batteries for neuropsychological evaluations in this population lacking suggestions to include PVTs. Moreover, limited work has examined embedded PVTs in this population. As previous investigations indicated that nonmemory-based embedded PVTs provide clinical utility in other populations, this study sought to determine if a logistic regression-derived PVT formula can be identified from selected nonmemory variables in a sample of patients with MS. METHOD: A total of 184 patients (M age = 48.45; 76.6% female) with MS were referred for neuropsychological assessment at a large, Midwestern academic medical center. Patients were placed into "credible" (n = 146) or "noncredible" (n = 38) groups according to performance on standalone PVT. Missing data were imputed with HOTDECK. RESULTS: Classification statistics for a variety of embedded PVTs were examined, with none appearing psychometrically appropriate in isolation (areas under the curve [AUCs] = .48-.64). Four exponentiated equations were created via logistic regression. Six, five, and three predictor equations yielded acceptable discriminability (AUC = .71-.74) with modest sensitivity (.34-.39) while maintaining good specificity (≥.90). The two predictor equation appeared unacceptable (AUC = .67). CONCLUSIONS: Results suggest that multivariate combinations of embedded PVTs may provide some clinical utility while minimizing test burden in determining performance validity in patients with MS. Nonetheless, the authors recommend routine inclusion of several PVTs and utilization of comprehensive clinical judgment to maximize signal detection of noncredible performance and avoid incorrect conclusions. Clinical implications, limitations, and avenues for future research are discussed.

Examining the Clinical Utility of Selected Memory-Based Embedded Performance Validity Tests in Neuropsychological Assessment of Patients with Multiple Sclerosis.

Within the neuropsychological assessment, clinicians are responsible for ensuring the validity of obtained cognitive data. As such, increased attention is being paid to performance validity in patients with multiple sclerosis (pwMS). Experts have proposed batteries of neuropsychological tests for use in this population, though none contain recommendations for standalone performance validity tests (PVTs). The California Verbal Learning Test, Second Edition (CVLT-II) and Brief Visuospatial Memory Test, Revised (BVMT-R)-both of which are included in the aforementioned recommended neuropsychological batteries-include previously validated embedded PVTs (which offer some advantages, including expedience and reduced costs), with no prior work exploring their utility in pwMS. The purpose of the present study was to determine the potential clinical utility of embedded PVTs to detect the signal of non-credibility as operationally defined by below criterion standalone PVT performance. One hundred thirty-three (133) patients (M age = 48.28; 76.7% women; 85.0% White) with MS were referred for neuropsychological assessment at a large, Midwestern academic medical center. Patients were placed into "credible" (n = 100) or "noncredible" (n = 33) groups based on a standalone PVT criterion. Classification statistics for four CVLT-II and BVMT-R PVTs of interest in isolation were poor (AUCs = 0.58-0.62). Several arithmetic and logistic regression-derived multivariate formulas were calculated, all of which similarly demonstrated poor discriminability (AUCs = 0.61-0.64). Although embedded PVTs may arguably maximize efficiency and minimize test burden in pwMS, common ones in the CVLT-II and BVMT-R may not be psychometrically appropriate, sufficiently sensitive, nor substitutable for standalone PVTs in this population. Clinical neuropsychologists who evaluate such patients are encouraged to include standalone PVTs in their assessment batteries to ensure that clinical care conclusions drawn from neuropsychological data are valid.

Is computerized screening for processing speed impairment sufficient for identifying MS-related cognitive impairment in a clinical setting?

BACKGROUND: Annual screening for processing speed impairment (PSI) is recommended for patients with multiple sclerosis (pwMS). However, cognitive deficits in pwMS are heterogeneous, and whether PSI screening identifies patients with impairment in other cognitive domains is unclear. The objective of this study was to examine sensitivity and specificity of the self-administered, computerized Processing Speed Test (PST) in identifying cognitive impairment defined by a comprehensive neuropsychological battery (NPT). METHODS: Ninety-one pwMS completed PST and NPT, with raw scores demographically adjusted. Cognitive impairment on NPT was defined as performance <5th percentile in at least one domain. Receiver operating characteristic (ROC) analyses were performed to determine the ability of the PST to discriminate between cognitively normal (CN) and cognitively impaired with PSI (CI-PSI) and cognitively impaired with normal processing speed (CI-PSN) groups. RESULTS: Cognitive impairment was observed in 23.1% of pwMS on PST and in 42.9% on NPT. PST demonstrated excellent ability to discriminate between CN (57.1%) and CI-PSI (20.9%) groups (Area Under the Curve [AUC] = 0.86, p < 0.001). In contrast, PST was unable to discriminate CN and CI-PSN (22.0%) groups (AUC = 0.42, p = 0.32). CONCLUSION: The PST demonstrates excellent ability to detect PSI in pwMS but is unable to identify cognitively impaired pwMS without PSI, highlighting the importance of developing additional screening measures.

Detecting noncredible performance with the neuropsychological assessment battery, screening module: A simulation study.

OBJECTIVE: While the Neuropsychological Assessment Battery, Screening Module (S-NAB) is a commonly used cognitive screening measure, no composite embedded performance validity test (PVT) formula has yet been described within it. This study sought to empirically derive PVT formulas within the S-NAB using an analog simulation paradigm. METHOD: Seventy-two university students (M age = 18.92) were randomly assigned to either an Asymptomatic (AS) or simulated mild traumatic brain injury (S-mTBI) group and were administered a neuropsychological test battery that included the S-NAB and standalone and embedded PVTs. The AS group was instructed to perform optimally, and the S-mTBI group received symptom and test coaching to help simulate mTBI-related impairment. Both groups received warnings regarding the presence of PVTs throughout the test battery. RESULTS: Groups showed significant differences (all ps < .001) on all S-NAB domain scores and PVTs. In the S-NAB, the Attention (S-ATT) and Executive Function (S-EXE) domains showed the largest effect sizes (Cohen's ds = 2.02 and 1.79, respectively). Seven raw scores from S-ATT and S-EXE subtests were entered as predictor variables in a direct logistic regression (LR). The model accurately classified 90.3% of cases. Two PVT formulas were described: (1) an exponentiated equation from LR results and (2) an arithmetic formula using four individually meaningful variables. Both formulas demonstrated outstanding discriminability between groups (AUCs = .96-.97) and yielded good classification statistics compared to other PVTs. CONCLUSIONS: This study is the first to describe composite, embedded PVT formulas within the S-NAB. Implications, limitations, and appropriate future directions of inquiry are discussed.

Examination of Wechsler adult Intelligence Scale-Fourth Edition short-form IQ estimations in an outpatient psychoeducational sample.

OBJECTIVE: The Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV) is a commonly utilized cognitive battery across many clinical settings. However, due to various patient variables, an abbreviated assessment of intellectual abilities, may be clinically advantageous to allow for a more thorough assessment of other cognitive domains. The current study represents an attempt to propose additional short-form IQ estimations in an outpatient clinical sample. METHODS: We examined archival data from 318 concurrent psychological/psychoeducational evaluations performed within a university clinic (Mage = 28.67; 53.8% women). Thirty-six unique 4-subtest short-form IQ combinations were created to ensure that each WAIS-IV index score was represented by a single subtest. RESULTS: Complete data for the ten core subtests and FSIQ were available for 192 cases. Stepwise regression analyses revealed three short-form combinations that significantly accounted for unique variance in true FSIQ scores in the final model (R2 = .981, F[3, 188] = 3257.597, p < .001). Regression-based and prorated FSIQ estimates were calculated, and both methods revealed that approximately 70-75% of participants' FSIQ estimates fell within five Standard Score points of true FSIQ. CONCLUSION: Results suggest the utility of three derived 4-subtest short-form IQ estimations for use within a clinical sample.

Verbal Short-Form FSIQ Estimations for Possible Use With Individuals With Motor and Visual Impairment or in Virtual Environments.

OBJECTIVE: Abbreviated and virtual neuropsychological assessment practices are growing in popularity and viable alternatives to traditional testing methods are needed, especially in the face of global health concerns. This study generated and examined short form (SF) full-scale IQ (FSIQ) estimations, which lend themselves to virtual test administration. METHODS: Archival data were procured from 318 concurrent cognitive evaluations at a university clinic. Twenty-six unique SF combinations, including dyads, triads, tetrads, and pentads, were created from Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV) subtests within verbal comprehension and working memory indices due to these tests' ability to be administered without visual stimuli or psychomotor involvement. RESULTS: Stepwise regression analyses revealed 9 SF combinations (i.e., 1 pentad, 3 tetrads, 2 triads, and 3 dyads) that significantly accounted for unique variance in FSIQ scores and provided good accuracy estimating FSIQ. CONCLUSION: Results suggest the potential viability of verbal WAIS-IV SF FSIQ estimations for clinical use when assessing patients with motor or visual impairments, as well as performing tele-neuropsychological services.

DSM-5 Level 1 cross-cutting measure in an online sample: evaluating its latent dimensionality and utility detecting nonspecific psychological distress.

Included in the most recent Diagnostic and Statistical Manual of Mental Disorders is the Level 1 Cross-Cutting Symptom Measure (CCSM), a self-report checklist with 23 items assessing 13 major psychiatric symptom clusters. To date, minimal literature has examined the factor structure of the CCSM and its utility identifying significant psychological distress, and existing studies pose notable limitations. Four hundred (400) American adults (M age = 34.13; 50.2% female) participated online via Amazon Mechanical Turk as part of a larger study, which included the CCSM. The sample was randomly split to conduct exploratory and confirmatory factor analyses (EFAs and CFAs). EFAs revealed structures with one (general psychopathology) and two (externalizing/serious mental illness and internalizing/affective) factors accounting for 67.3% and 73.7% of the variance, respectively. CFAs indicated good fit for both models, though statistical comparison of the models via χ2 difference test revealed the two-factor model provided significantly better fit. Areas under the receiver operating curve (AUCs) suggested that all CCSM variables of interest poorly differentiated those currently receiving mental health treatment from those who have never received mental health treatment (AUCs ranged from .57 to .68). Implications of these findings, various limitations, and recommendations for future lines of inquiry were discussed.

Five-Factor Model Personality Traits and Self-Classified Religiousness and Spirituality.

A review of the literature investigating the relationship between religion and spirituality and broad personality traits reveals methodological limitations. The present study sought to contribute to the present literature by investigating differences on personality traits among men and women who identified as either religious only (R), spiritual only (S), both spiritual and religious (B), or neither spiritual nor religious (N). One thousand thirty-seven (1037) adults (M age = 36.34, SD = 12.62) participated online via Amazon's Mechanical Turk as part of a larger study and completed the IPIP-NEO-120, Spiritual Transcendence Scale, Duke University Religion Index, and demographic information. Results revealed that men were more likely to identify as R and N than women, and women were more likely to identify as B than men. Women showed more significant differences among Big Five traits than men. Compared to other women, R-women reported the lowest levels of Openness, Agreeableness, and Neuroticism, and highest levels of Extraversion. N-women reported the highest levels of Neuroticism, while S-women reported highest Openness. Among men, R-men reported the lowest Openness, and S-men reported the highest Openness. B-men reported higher Extraversion than N-men. Additionally, Big Five traits appeared to account for significantly more variance in self-reported religiousness for women than men. Implications of these findings and recommendations for future research are provided and discussed.

Multidimensionality of the Langner Symptom Survey and Replication of a Cutoff Score in Emerging Adults.

This study investigated the dimensionality of the Langner Symptom Survey and replicated a recent finding regarding a clinically validated cutoff score in emerging adults. Nine hundred thirteen (631 females and 282 males) students at a private university in the Midwestern United States participated online as part of a larger study and completed the Langner Symptom Survey and a demographic questionnaire. Results from exploratory principal components and confirmatory factor analyses provided support for both a six- and three-factor model of the Langner Symptom Survey, with the three-factor model offering marginally better confirmatory fit indices and greater parsimony of interpretation. A cutoff score of 5 denoting clinically significant psychological distress and need for treatment was supported through analysis of receiver-operating characteristic, sensitivity, specificity, and total classification accuracy based on psychological service utilization, and this result successfully replicated a recently published finding. The Langner Symptom Survey may function as a multidimensional measure of psychological distress and need for treatment in emerging adults that may need a lexical update.

Religious Integration and Psychological Distress: Different Patterns in Emerging Adult Males and Females.

This study examined differences between male and female emerging adults on low, moderate, and high levels of religious integration in relation to psychological distress. Participants were recruited from undergraduate courses at a religiously affiliated, Midwestern university and completed the integration scale of the Personal Religious Inventory and the Langner Symptom Survey. Due to significantly higher reports of religious integration in female participants, the sample was separated by sex. A significant, negative correlation between religious integration and psychological distress was found only for females. Similarly, females in the low religious integration group reported significantly higher levels of psychological distress than females high in religious integration, while no differences were found among males. This study corroborates previous research suggesting a general link between religion and mental health, but further suggests religious integration and psychological distress are uniquely related for males and females. Possible reasons and future areas of study are noted.

Confirming the Tripartite Structure of the Duke University Religion Index: A Methodological Approach.

The present study provided a methodological critique regarding psychometric investigations of the Duke University Religion Index (DUREL) and its variants. Nine hundred seventeen (630 females and 287 males) university students (M age = 19.24) completed the DUREL, the Personal Religious Inventory, and the Daily Spiritual Experiences Scale online. Confirmatory factor analyses were performed to assess a three-factor (organizational religious activity; non-organizational religious activity; and intrinsic religiosity) and a unidimensional model of the DUREL. Chi-square difference tests were performed, and Akaike information criterion values and Bayesian information criterion values were compared between the models, each of which supported the three-factor model for the DUREL over the unidimensional model. Convergent validity for the three factors of the DUREL emerged through Spearman's rho correlations with measures of personal prayer, ritual religious attendance, religious integration, Closeness to the Divine. This study concluded that the DUREL is a multidimensional measurement of religion for use in English-speaking university students, and it provided a broad methodological note regarding future investigations of measures of religion or spirituality that possess an existing theoretical model.