Emily D. Gottfried

The clinical utility of the MMPI-2-RF Suicidal/Death Ideation Scale.

Suicide is a major public health concern, with over 100 individuals dying by suicide per day in the United States alone. Therefore, suicide risk assessment is an essential aspect of mental health care. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008-2011; Tellegen & Ben-Porath, 2008) has a Suicidal/Death Ideation (SUI) scale consisting of 5 items that describe recent suicidal ideation or behaviors. Although this scale has clear face validity, few studies have examined the clinical utility of this scale. The purpose of the current study was to examine associations between the SUI scale and other established measures of suicidal ideation and behavior, including the Depressive Symptom Inventory Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997), Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991; Beck, Steer, & Ranieri, 1988), self-report of lifetime suicide attempts, and clinician ratings of suicide risk. Participants were 998 therapy- and assessment-seeking outpatients. Analyses indicated that the SUI scale was positively associated with other self-reported measures of suicidal ideation and behavior. Significant differences in SUI scale scores also emerged among the clinician rating categories of suicide risk. The SUI scale was able to predict previous suicide attempts over and above age, gender, and other MMPI-2-RF scales related to depression. Finally, relative risk ratios for suicide attempts indicate increased risk of suicidality, with higher T scores on the SUI scale. Overall, findings suggest that the MMPI-2-RF SUI scale may be a useful tool for identifying individuals at risk for suicidal ideation and behavior in clinical settings.

The role of intelligence on performance on the Inventory of Legal Knowledge (ILK)

Previous research has shown that individuals with intellectual disabilities perform in the feigning range on malingering measures even when other data suggest that they are performing optimally. However, few studies to date have gone beyond intellectual disabilities and studied the full range of intelligence. Additionally, there are no data available examining the relationship between intelligence and performance on the Inventory of Legal Knowledge (ILK). The relationship between intelligence and performance on malingering tests is important because individuals with intellectual deficits may be incorrectly identified as malingering on these tests. The current study used a sample of state psychiatric hospital residents, adjudicated incompetent to proceed, and a sample of undergraduate university students to examine the relationship between intelligence and performance on the ILK. Results indicated three items on the ILK are correlated with intelligence and total scores were moderately correlated. Participants were further broken into groups using categorical ranges of Intelligence Quotient (IQ). Results were mixed regarding the relationship between ranges of IQ and performance on the ILK. Future directions and implications of this study are discussed.

Reading the Road Signs: The Utility of the MMPI-2 Restructured Form Validity Scales in Prediction of Premature Termination

This study examined the utility of the Minnesota Multiphasic Personality Inventory–2 Restructured Form (MMPI-2-RF) Validity Scales in prediction of premature termination in a sample of 511 individuals seeking services from a university-based psychology clinic. Higher scores on True Response Inconsistency–Revised and Infrequent Psychopathology Responses increased the risk of premature termination, whereas higher scores on Adjustment Validity lowered the risk of premature termination. Additionally, when compared with individuals who did not prematurely terminate, individuals who prematurely terminated treatment had lower Global Assessment of Functioning scores at both intake and termination and made fewer improvements. Implications of these findings for the use of the MMPI-2-RF Validity Scales in promoting treatment compliance are discussed.

The impact of judge-defendant communication on mental health court outcomes.

Previous research has shown that mental health courts have been successful in reducing the rates of recidivism among mentally ill offenders. However, none of these studies, to date, have examined exactly what aspects of the courts reduce these rates of recidivism and what makes them successful. The current study utilized a sample of 291 mentally ill criminal offenders participating in a mental health court to examine whether those participants who were addressed by and communicated with the judge had a reduction in recidivism rates and the severity of new charges in comparison to those who did not. The hypotheses regarding greater judge-defendant communication and recidivism were not supported. This suggests that communication in and of itself is not sufficient to reduce recidivism. Future research of a qualitative nature is essential to identify if the frequency, tone, and valence of the communication results in improved outcomes. In addition, these results may indicate a necessity for more stringent training and guidelines for the maintenance of Mental Health Courts. Results of the current study suggested differences between genders, such that females were spoken to by the judge more frequently than were men.

Burdensomeness, Belongingness, and Capability Assessing the Interpersonal–Psychological Theory of Suicide With MMPI-2-RF Scales

Given the emerging body of literature demonstrating the validity of the interpersonal–psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale–based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

The Utility of MMPI-2-RF Substantive Scales in Prediction of Negative Treatment Outcomes in a Community Mental Health Center:

This study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) substantive scales in the prediction of premature termination and therapy no-shows while controlling for other relevant predictors in a university-based community mental health center, a sample at high risk of both premature termination and no-show appointments. Participants included 457 individuals seeking services from a university-based psychology clinic. Results indicated that Juvenile Conduct Problems (JCP) predicted premature termination and Behavioral/Externalizing Dysfunction and JCP predicted number of no-shows, when accounting for initial severity of illness, personality disorder diagnosis, therapist experience, and other related MMPI-2-RF scales. The MMPI-2-RF Aesthetic-Literary Interests scale also predicted number of no-shows. Recommendations for applying these findings in clinical practice are discussed.

The Relationship between Feigned Psychiatric Symptoms and Feigned Lack of Legal Knowledge among a Multi-Site Sample of Forensic Inpatients

ABSTRACT The accurate assessment of feigning is a cornerstone of forensic evaluations. This study examined two feigning strategies defendants may use for the purpose of being found not competent to stand to trial: feigning psychiatric symptoms and feigning lack of legal knowledge. Participants included 203 forensic inpatients undergoing competency to stand trial assessments at two state hospitals. Each participant was administered the Miller Forensic Assessment of Symptoms Test and the Inventory of Legal Knowledge. Results indicated that there was a significant relationship between these two types of feigning (manual cut scores: χ2 (1, 203) = 23.02, p < .001) and the presence of one feigning strategy increased his or her risk for engaging in the other feigning strategy (e.g., using the manual cut scores, participants shown to be feigning psychiatric symptoms were 2.23 times more likely to feign lack of legal knowledge than those not feigning psychiatric symptoms). This article provides evidence of an increased risk of defendants employing a second feigning strategy when it is determined they are already using one strategy. These results encourage forensic evaluators to be cognizant of the nature of feigning and various strategies employed by individuals undergoing evaluations of competency.

The Associations Between the Minnesota Multiphasic Personality Inventory-2-Restructured Form and Self-Reported Physical and Sexual Abuse and Posttraumatic Symptoms in a Sample of Incarcerated Women

ABSTRACT This study examined the impact of posttraumatic symptoms and self-reported abuse on the MMPI-2-RF among female inmates (N = 212). Posttraumatic symptoms were related to demoralization and internalizing dysfunction. MMPI-2-RF scales related to behavioral and externalizing problems, conduct problems, anxiety, anger, fear, guilt, unusual beliefs, somatic complaints, ineffectiveness, stress, family problems, and social isolation were associated with posttraumatic symptoms and abuse. Findings indicate that the MMPI-2-RF has utility for examining the impact of abuse and posttraumatic symptoms in incarcerated women. Using a standardized instrument to examine the effects of trauma provides useful information for treatment management and planning.

Mental Disorders Among Criminal Offenders: A Review of the Literature

This article examines mental illness among adult, juvenile, male, female, jail, and prison inmates. It also explores the way in which mental health diagnoses impact offending and violent behavior. A review of literature pertaining to differences between the genders and age of offenders suggests that psychiatric disorders are more common among criminal offenders than the population at large. Furthermore, it appears that many mentally ill offenders do not receive sufficient treatment during their incarcerations and that barriers inherent to incarceration prevent adequate treatment of mental illnesses.

Retrospectively Assessing for Feigning in Criminal Responsibility Evaluations: Recommendations for Clinical Practice

ABSTRACT Evaluating for feigning, the intentional production or misrepresentation of psychological symptoms or cognitive impairments, is an essential component of every forensic evaluation (Rogers, Jackson, Salekin, & Neumann, 2003). One strategy of feigning that has largely been overlooked in the field of forensic psychology and psychiatry is retrospectively feigning symptoms in the context of criminal responsibility evaluations. Specifically, this involves a defendant who is not currently feigning symptoms, but is reporting experiencing a number of symptoms of mental illness at the time of the crime. Although there are numerous measures designed to detect current feigned psychological symptoms or cognitive impairments, little research has been devoted to the proper evaluation of retrospective feigning. Because this concept has been overlooked and underresearched, this paper offers suggestions and best-practice guidelines for evaluating retrospective feigning in the context of criminal responsibility evaluations.