Preliminary examination of symptom validity in veterans using the Rivermead post-concussion symptoms questionnaire

The Rivermead Post Concussion Symptoms Questionnaire (RPSQ) is commonly used post-concussive symptom measure. Simulation research has explored it as a symptom validity (SV) indicator. This project examined its use in a clinical sample using archival data from the Federal Interagency TBI Research Informatics System.

The sample (N = 133; mean age = 39.6; 96% male) included veterans with (n = 91) and without (n = 42) history of mild TBI. SV status was determined via MMPI-2-RF overreporting scales (Fr, Fpr, Fs, FBSr, and RBS). We created three SV outcome variables: possible (one or more scales in the possible overreporting range), probable (two or more scales in the possible overreporting range), and definite overreporting (one or more scales, ≥100 T). Discrimination was evaluated using area under the receiver operating characteristic curve (AUC) with RPSQ total score predicting criterion SV status.

RPSQ and MMPI-2-RF scores were not significantly different by mild TBI history. RPSQ total scores showed excellent discrimination in all three models (AUC = 0.84-0.85). RPSQ total score cutoffs that demonstrated acceptable specificity (≥ 90%) varied by criterion SV: possible (RPSQ ≥32), probable (RPSQ ≥35), and definite (RPSQ ≥37) overreporting.

Findings provide preliminary support for total score cutoffs on the RPSQ as SV indicators. Further research is warranted to cross-validate these cutoffs and extend findings to other populations.