Rapid screening for suicide risk: An algorithmic approach.

INTRODUCTION: In the United States, primary medical care settings are the first accessed resource for both medical and behavioral health care. Thus, there is a clear need for accurate and efficient behavioral health screening in this setting, including routine surveillance screening for suicide risk. The Multidimensional Behavioral Health Screen (MBHS), a broadband but very brief screening tool developed specifically for primary care, has been updated to include an algorithm that classifies suicide risk based on the interpersonal-psychological theory of suicide, and associated interview and decision framework. This study aims to evaluate the predictive accuracy of the new MBHS 2.0 suicide risk algorithm, with actual risk determined by clinical suicide risk interview. METHOD: Data were collected as part of a larger study that, overall, included 551 college student participants. Of these, 309 completed the MBHS 2.0 and the clinical suicide risk interview, the two measures reported here. The final participant count was 299 following the removal of incomplete or invalid cases. Predicted suicide risk as determined by the MBHS 2.0 (Low, Mild, At least Moderate) was compared to actual risk as determined by clinical interview (Low, Moderate, Severe, Extreme). RESULTS: Utilizing chi-square analyses, data show a significant association between the predicted suicide risk category based on the MBHS 2.0 algorithm and the actual risk category based on the semi-structured clinical interview. Furthermore, classification analyses suggest that primary care providers will be able to confidently assess the suicide risk level for the majority of their patients when using the MBHS. CONCLUSION: Findings suggest that the MBHS 2.0 can be an accurate and efficient tool for use by primary care providers in classifying suicide risk. Future research will be useful to evaluate the utility of the suicide risk algorithm among primary care populations.

Additional Validation of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Eating Concerns Scale.

Maladaptive eating behaviors are typically associated with significant impairment in psychological functioning more broadly. The Minnesota Multiphasic Personality Inventory (MMPI) family of instruments has traditionally been the most frequently used psychological assessment of psychopathology by clinical psychologists. The most recent version, the MMPI-3, features a new Eating Concerns (EAT) scale that screens for the presence of problematic eating behaviors. The goals of the current study were (a) to independently replicate validity correlations reported from the college sample during EAT scale development, (b) to evaluate the utility of EAT scale item-level correlations with other substantive MMPI-3 scales, and (c) to evaluate the ability of the EAT items to predict specific frequency counts of dysfunctional eating behaviors. The current study examined the MMPI-3 assessment of dysfunctional eating behaviors among 188 undergraduate participants. Results indicated that the EAT scale is meaningfully associated with core symptom dimensions of maladaptive eating, including binging, vomiting, restricting, and concerns about weight and shape. In addition, this study identified meaningfully distinct patterns of correlations with personality and psychopathology constructs, and specific behavioral frequencies, across the five individual EAT scale items. These results contribute to the enhanced utility of this important screening scale in clinical settings.

New Versions of the MMPI and Rorschach: How Have Training Programs Responded?

In this brief article, we update the training of newer versions of the Minnesota Multiphasic Personality Inventory (MMPI) and Rorschach and compare to a 2015 assessment training survey of American Psychological Association accredited clinical psychology doctoral programs. The survey sample sizes for 2015, 2021, and 2022 were 83, 81, and 88, respectively. By 2015, of the programs teaching any adult MMPI version, almost all (94%) were still teaching the MMPI-2, and 68% had started teaching the MMPI-2-RF. In 2021 and 2022, respectively, almost all programs (96% and 94%) had started teaching the MMPI-2-RF or MMPI-3, although most were still teaching the MMPI-2 (77% and 66%). By 2015, of the programs teaching the Rorschach, 85% were still teaching the Comprehensive System (CS) and 60% had started teaching the Rorschach Performance Assessment System (R-PAS). In 2021 and 2022, respectively, most programs had started teaching R-PAS (77% and 77%) although many (65% and 50%) were still teaching the CS. Therefore, doctoral programs are indeed switching to newer versions of the MMPI and Rorschach, although more slowly than one might expect. We recommend that APA provide more guidance in selecting test versions for training programs, practitioners, and researchers.

Further mapping of the MMPI-3 onto HiTOP in a primary medical care and a college student sample.

The Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017, 2021) is offered as a dimensional alternative to traditional categorical diagnostic nosologies such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). HiTOP researchers have recently published an open-source assessment system for clinical implementation, the HiTOP Digital Assessment and Tracker (Jonas et al., 2021). Here, we argue that the Minnesota Multiphasic Personality Inventory-3 (MMPI-3; Ben-Porath & Tellegen 2020a), given its structural similarities to HiTOP, can augment these efforts to shift the diagnostic paradigm, with the additional strength of being comprehensively validated, standardized, and normed. Sellbom et al. (2021) examined the factor structure of the MMPI-3 Specific Problems Scales (plus RC6 and RC8), finding a pattern of latent factors much like those proposed by HiTOP in both a general mental health sample and a prisoner sample. The present study is a partial replication of Sellbom et al. (2021) with a primary medical care outpatient sample (n = 164) and a college student sample (n = 529). A sequential factoring approach yielded emergent structures that are comparable to the HiTOP model. These findings with different and important samples support the generalizability of the MMPI-3 in assessing HiTOP constructs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Meaning and Clinical Implications of Low MMPI-3 Self-Importance Scores.

The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) includes two self-concept-oriented scales: Self-Doubt (SFD), a measure of low self-esteem, and Self-Importance (SFI), a measure of beliefs that one has special attributes and abilities. Past research has demonstrated that SFD and SFI measure related but distinct constructs. The present study focused on explicating the meaning and clinical implications of low SFI scores. Using three clinical samples (private practice and community mental health and private practice neuropsychology clinics), we investigated whether the presence of interpretable low SFI scores (< 39 T) in the context of interpretable SFD elevations (≥ 65 T) is associated with distinctive MMPI-3 findings, and whether low SFI scores add clinically meaningful information in predicting relevant extra-test criteria. Consistent meaningful findings were obtained with respect to implications of low SFI scores for assessment of depression- and social engagement-related constructs. Additionally, the full range of SFI scores was meaningfully and negatively correlated with depressive disorder diagnoses and suicidal ideation but yielded very small correlations with suicide attempt and nonmeaningful correlations with diagnoses of Social Anxiety or Avoidant Personality Disorder. Hierarchical logistic regression analyses showed that SFI scores could meaningfully increment other related MMPI-3 scales in predicting diagnosed depressive disorders, albeit with small effect sizes.

Construct Validity of the PHQ-9 Depression Screen: Correlations with Substantive Scales of the MMPI-2-RF.

The PHQ-9 is a brief, 9-item, self-administered screening tool widely used in primary care medical settings to assess the potential presence of Major Depressive Disorder (MDD). Most published research on the PHQ-9 has focused on sensitivity and specificity with regard to the DSM-IV (American Psychiatric Association, in Diagnostic and statistical manual of mental disorders, 4th edn, American Psychiatric Publishing, Arlington, VA, 2000) categorical diagnosis of MDD, and, indeed, the PHQ-9 exhibits very good psychometric properties in this regard. The current research is an effort to more precisely assess what is being measured by the PHQ-9, given the notably heterogeneous nature of MDD as broad diagnostic category. Here, we provide correlations between the PHQ-9 and substantive scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, in Minnesota Multiphasic Personality Inventory-Restructured Form: Manual for administration, scoring, and interpretation, University of Minnesota Press, Minneapolis, 2008/2011), a comprehensive measure of personality and psychopathology. Participants were 231 college student volunteers who completed the PHQ-9 and MMPI-2-RF as components of a broader research program. Results show that the PHQ-9 was strongly correlated with the broad Higher-Order EID-Emotional/Internalizing Dysfunction scale of the MMPI-2-RF, as well as with RCd-Demoralization, RC7-Dysfunctional Negative Emotions, NEGE-r-Negative Emotionality, and several specific facet scales. Surprisingly, the correlation with RC2-Low Positive Emotions, was not among the strongest, despite the fact that the PHQ-9 ostensibly targets this specific feature of depression (anhedonia). Substantial correlations with the somatic/cognitive scales of the MMPI-2-RF were also found. Implications for modified interpretation of the PHQ-9, and the need for more precise dimensional (rather than categorical) screening tools, are discussed.

Comparing the PHQ-9 to the Multidimensional Behavioral Health Screen in Predicting Depression-Related Symptomatology in a Primary Medical Care Sample.

Depression is the most common form of psychopathology affecting people in the US. It is commonly diagnosed and treated in primary medical care settings, creating a need for a reliable, quick self-report tool used for the assessment of depression in this context. There is an emerging shift in the way psychopathology is conceptualized, as the field begins to transition from a categorical, syndrome-based model to a dimensional model. This change should be reflected in the assessment tool used within the primary care setting. The PHQ-9 is currently the most frequently used assessment tool for evaluating depression within primary care clinics, despite being based on the heterogenous, categorical method of conceptualizing psychopathology. The Multidimensional Behavioral Health Screen is a brief and efficient screening-level assessment tool for core psychopathology components (rather than syndromes), with a specific focus on depressive symptomatology. This study presents empirical evidence supporting the implementation of the MBHS in primary care clinics as a useful alternative to the PHQ-9.

The Multidimensional Behavioral Health Screen 1.0: A Translational Tool for Primary Medical Care.

The Multidimensional Behavioral Health Screen (MBHS) is a brief, 27-item questionnaire designed for screening every patient in primary medical care settings. It measures nine psychopathology constructs that represent the major distinctive core dimensions of the types of behavioral health symptoms most commonly encountered in primary care (anxiety-related, depressive, and attention/cognitive symptoms). The underlying design of the MBHS is based on the major paradigm shift that has occurred in the field of theoretical psychopathology, replacing categorical syndromes, or "disorders," with hierarchical-dimensional constructs. Existing screening tests such as the PHQ-9 and GAD-7 are based explicitly on the categorical paradigm and thus suffer from the same (numerous) shortcomings as the categorical model itself. The dimensional paradigm supports enhanced measurement precision with very short scales. The goals of the MBHS are threefold: (1) to provide accurate, treatment-relevant behavioral health information to the medical provider; (2) to provide clear referral cut-points; (3) to contribute nine psychometrically sound behavioral health variables to the "healthcare big data cloud" to support future scholarship of discovery. Presented here are the basic psychometric properties of the MBHS, including reliability, convergent and discriminant validity, and classification accuracy, as well as implementation considerations.

Examining the Construct Validity of the MMPI-2-RF Interpersonal Functioning Scales Using the Computerized Adaptive Test of Personality Disorder as a Comparative Framework.

This study aimed to examine the construct validity of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) interpersonal functioning scales (Ben-Porath & Tellegen, 2008/2011 ) using as a criterion measure the Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF; Simms et al., 2011 ). Participants were college students (n = 98) recruited through the university subject pool. A series of a priori hypotheses were developed for each of the 6 interpersonal functioning scales of the MMPI-2-RF, expressed as predicted correlations with construct-relevant CAT-PD-SF scales. Of the 27 specific predictions, 21 were supported by substantial (≥ |.30|) correlations. The MMPI-2-RF Family Problems scale (FML) demonstrated the strongest correlations with CAT-PD-SF scales Anhedonia and Mistrust; Cynicism (RC3) was most highly correlated with Mistrust and Norm Violation; Interpersonal Passivity (IPP) was most highly correlated with Domineering and Rudeness; Social Avoidance (SAV) was most highly correlated with Social Withdrawal and Anhedonia; Shyness (SHY) was most highly correlated with Social Withdrawal and Anxioiusness; and Disaffiliativeness (DSF) was most highly correlated with Emotional Detachment and Mistrust. Results are largely consistent with hypotheses suggesting support for both models of constructs relevant to interpersonal functioning. Future research designed to more precisely differentiate Social Avoidance (SAV) and Shyness (SHY) is suggested.

Using the Research Domain Criteria Framework to Explore Associations Between MMPI-2-RF Constructs and Physiological Variables Assessed by Eye-Tracker Technology.

The National Institute of Mental Health has proposed a paradigm shift in the conceptualization of psychopathology, abandoning the traditional categorical model in favor of one based on hierarchically organized dimensional constructs (Insel et al., 2010 ). One explicit goal of this initiative, the Research Domain Criteria (RDoC) project, is to facilitate the incorporation of newly available neurobiologic variables into research on psychopathology. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011 ) represents a similar paradigm shift, also adopting a hierarchical arrangement of dimensional constructs. This study examined associations between MMPI-2-RF measures of psychopathology and eye-movement metrics. Participants were college students (n = 270) who completed the MMPI-2-RF and then viewed a sequence of 30-s video clips. Results show a pattern of positive correlations between pupil size and emotional/internalizing dysfunction scales when viewing video eliciting negative emotional reactions, reflecting greater arousability in individuals with higher scores on these measures. In contrast, when viewing stimuli depicting angry, threatening material, a clear pattern of negative correlations was found between pupil size and behavioral/externalizing trait measures. These data add to the construct validity of the MMPI-2-RF and support the use of the RDoC matrix as a framework for research on psychopathology.

Personality differences in treatment-seeking and non-treatment-seeking individuals with self-reported anorexia.

Research on anorexia has tended to focus on individuals who are seeking treatment, leading to treatment models that are based on individuals already receiving help. Therefore, the purpose of this study was to explore personality differences between individuals seeking treatment and those not seeking treatment for anorexia. Participants were 148 women recruited from three online sources. They completed a personality measure derived from the five-factor model and the Eating Attitudes Test-26. Results indicated that individuals with anorexia who were not seeking treatment scored lower on Agreeableness and Conscientiousness than both individuals seeking treatment and a control group. Also, individuals with anorexia in general tended to score lower on Extraversion and higher on Neuroticism than individuals in a control group. These results suggest that being open about treatment options, increasing successes, motivation, and organization, and highlighting the seriousness of anorexia could be beneficial in getting individuals with anorexia to seek and continue in treatment.

Gaze pattern variations among men when assessing female attractiveness.

Pilot data from eye-tracking research suggest that each male participant has his own gaze pattern, usefully regarded as an individual difference, when viewing female targets whom they are rating for attractiveness. Gaze patterns appear to be consistent within a given male participant across a variety of target models, and these individual differences may override characteristics of the model in determining fixation points, body region focus, and other eye-tracker variables. The goal of the present study was to elucidate these variations of gaze pattern by assessing the extent to which systematic "types" of gaze patterns exist among a group of male participants. Latent class analysis was used to place 60 men into groups based on their gaze pattern. A two-cluster solution produced the most interpretable analysis, and groups formed by this clustering were significantly different from each other on variables of interest. Cross validation of this solution across three additional female models resulted in some support for generalization, though exceptions were noted.

Personality traits associated with occupational 'burnout' in ABA therapists.

BACKGROUND: Applied behaviour analysis (ABA) therapists typically work one-to-one with children with autism for extended periods of time, which often leads to high levels of job-related stress, lower levels of job satisfaction, increased frequency of occupational 'burnout' and higher than average job turnover (Journal of Autism Development, 39, 2009 and 42). This is particularly unfortunate, in that these vulnerable clients need stability and consistency in care, both of which are empirically related to clinical outcomes (Journal of Autism Development, 39, 2009 and 42). It is reasonable to assume that some individuals, by virtue of their personal characteristics, are better suited to this type of work than are others. METHOD: The purpose of the this study was to investigate associations between personality traits, using the five-factor model of personality, and key job-related variables, including burnout and job satisfaction, in a sample of therapists (n = 113) who work one-to-one with individuals diagnosed with autism. RESULTS: Significant correlations were found between Neuroticism and all three subscales of burnout (Exhaustion, Cynicism and Professional Efficacy). Extraversion and Conscientiousness were significantly negatively correlated with Cynicism and positively correlated with Professional Efficacy. Agreeableness was positively associated with Professional Efficacy. Job satisfaction was correlated positively with Extraversion and negatively with Neuroticism. Level of perceived personal and professional support partially mediated the effect of personality traits on job satisfaction. CONCLUSIONS: These results may help to identify job applicants who are dispositionally less suited to this type of work, as well as currently employed therapists who are in need of support or intervention.

The M5-PS-35: a five-factor personality questionnaire for preschool children.

The Five-factor theory of personality (FFT) has pervaded personality research in recent years. Although many reliable and valid measurement instruments exist for use with adults, adolescents, and even elementary-age children, there is a lack of available 5-factor measurement tools for use with preschool children. This article expands on previous work developing the M5-PS, a rating form for preschool children designed to be completed by classroom teachers or caregivers. A total of 621 children were rated by their teachers on the 90-item working form of the M5-PS. Through a combination of empirical and rational scale refinement methods, the number of items has been reduced to 35, yielding a revised instrument, the M5-PS-35, with substantially improved construct validity and scale internal consistency. Potential changes in external validity were evaluated by comparative reanalysis of an existing data set.

Evaluating the college sophomore problem: the case of personality and politics.

College sophomores feature prominently in social scientific research but are frequently criticized for providing unrepresentative, invalid, and unreliable data. Using the case of personality and politics, the present authors evaluated those critiques, concluding that college sophomores are not representative of the general adult population on all 5 factors of personality. Despite this limitation, analyses show that the relationship between personality and political opinions is virtually identical for college students and a comparison group of adults. Further, a range of reliability statistics suggests that college students provide reliable data on personality. College students are not a panacea for the problems of participant recruiting, but they should not be discounted as unreliable and invalid, either. In many cases, the so-called "college-sophomore problem" is not a problem.

Relative practical utility of the Minnesota Multiphasic Personality Inventory-2 Restructured Clinical Scales versus the Clinical Scales in a chronic pain patient sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical (RC) Scales comprise the core of the new MMPI-2 Restructured Form. They were developed to retain the familiar clinical descriptive characteristics of the original basic scales while correcting a number of major psychometric shortcomings. The resulting scales are intended to be more unidimensional and unique, with improved convergent and discriminant validity. These improvements should be most evident in client samples where the traditional scales yield global and diffuse elevations, interpretively very challenging to the clinician. In the present study the RC Scales were compared to the traditional Clinical Scales in differentiating depressed (n = 239) versus nondepressed (n = 77) neuropsychology outpatients, all of whom experienced chronic pain, and most also reported other syndromes. Multiaxial diagnoses were assigned by practicing clinicians using a variety of data sources, including MMPI-2 Clinical Scales but not the RC Scales. Whereas both sets of scales achieved good overall classification rates of about 85%, the RC Scales did so using significantly fewer scales, yielding a more focused, efficient, and clinically useful profile. In the depressed group, 7 of the 8 basic scales (which exclude Scales 5 and 0) were clinically elevated, whereas only 2 of the 8 RC Scales were elevated (in addition to the demoralization scale RCd). These findings offer significant implications for the psychological assessment of chronic pain patients.

Empirical correlates and expanded interpretation of the MMPI-2-RF Restructured Clinical Scale 3 (Cynicism).

The recent release of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has received much attention from the clinical psychology community. Particular concerns have focused on Restructured Clinical Scale 3 (RC3; Cynicism). This article briefly reviews the major criticisms and responses regarding the restructuring of Clinical Scale 3. The primary purpose of the article is to provide expanded interpretive perspectives on RC3 by correlating it with a selection of external variables that are conceptually related. Forty undergraduate volunteers completed the MMPI-2-RF as well as measures of Machiavellianism, alienation, faith in people, and locus of control. Results showed strong correlations between RC3 and Machiavellianism (.47) and alienation (.60), with item-level information that may extend existing interpretive statements to include, not just a cynical view of others, but a willingness to intentionally lie, cheat, deceive, and manipulate (i.e., Machiavellianism).

Confirmatory factor analysis of the M5-50: an implementation of the International Personality Item Pool item set.

Goldberg's International Personality Item Pool (IPIP; Goldberg, 1999) provides researchers with public-domain, free-access personality measurement scales that are proxies of well-established published scales. One of the more commonly used IPIP sets employs 50 items to measure the 5 broad domains of the 5-factor model, with 10 items per factor. The M5-50 (McCord, 2002) is a specific ordering and presentation of this 50-item set. Using data from a sample of 760 faculty, staff, and students at a midsized university, the authors assessed the reliability and construct validity of the M5-50. Cronbach's alphas on the 5 scales ranged from acceptable to excellent. Confirmatory factor analysis indicated reasonably good model fit. Researchers who wish to measure personality would be well advised to consider using the M5-50.