Internalizing Symptoms are Differentially Associated with Higher Likelihood of Failure on Memory-Based Embedded Performance Validity Tests

Abstract Minimal research has investigated whether patients with internalizing symptoms have a higher likelihood of failing embedded memory-based performance validity tests (PVTs). We examined the likelihood of embedded PVT failure in those with and without invalid internalizing symptom profiles and with and without valid neurocognitive performance, while controlling for cognitive impairment. Cross-sectional data from a mixed clinical sample of outpatient neuropsychological referrals were analyzed. Multiple Poisson regressions assessed the likelihood of failures on the total count of embedded PVT failures and multiple logistic regressions assessed relationships between internalizing symptoms and likelihood of failing content-specific memory-based embedded PVTs. In the broad sample, higher anxiety and lower positive emotion scores were significantly related to a higher number of memory-based embedded PVT failures. Conversely, higher levels of dysfunctional negative emotions were associated with a lower number of PVT failures. In the valid sample, patterns remained generally stable. In patients with cognitive impairment, only higher levels of dysfunctional negative emotions remained significantly associated with lower likelihood of PVT failure. As hypothesized, findings suggest differential relationships between certain internalizing symptoms and failures on memory-based embedded PVTs. Patients with greater anxiety symptoms may have a higher risk of failing embedded PVTs due to variable attention and learning, as well as lower response certainty when anxiety symptoms are present. A more complicated relationship emerged between those with other types of internalizing symptoms. Further research is needed to understand why certain internalizing symptoms may interfere with valid/credible test engagement, while others may support valid performance.