Resch Zachary J, Webber Troy A, Bernstein Matthew T, Rhoads Tasha, Ovsiew Gabriel P, Soble Jason R
Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.
Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Neuropsychol Rev. 2021 Jun;31(2):331-348. doi: 10.1007/s11065-021-09477-5. Epub 2021 Jan 12.
The Victoria Symptom Validity Test (VSVT) is a performance validity test (PVT) with over two decades of empirical backing, although methodological limitations within the extant literature restrict its clinical and research generalizability. Chief among these constraints includes limited consensus on the most accurate index within the VSVT and the most appropriate cut-scores within each VSVT validity index. The current systematic review synthesizes existing VSVT validation studies and provides additional cross-validation in an independent sample using a known-groups design. We completed a systematic search of the literature, identifying 17 peer-reviewed studies for synthesis (7 simulation designs, 7 differential prevalence designs, and 3 known-groups designs). The independent cross-validation sample consisted of 200 mixed clinical neuropsychiatric patients referred for outpatient neuropsychological evaluation. Across all indices, Total item accuracy produced the strongest psychometric properties at an optimal cut-score of ≤ 40 (62% sensitivity/88% specificity). However, ROC curve analyses for all VSVT indices yielded statistically significant areas under the curve (AUCs; .73-81), suggestive of moderate classification accuracy. Cut-scores derived using the independent cross-validation sample converged with some previous findings supporting cut-scores of ≤ 22 for Easy item accuracy and ≤ 40 for Total item accuracy, although divergent findings were noted for Difficult item accuracy. Overall, VSVT validity indicators have adequate diagnostic accuracy across populations, with the current study providing additional support for its use as a psychometrically sound PVT in clinical settings. However, caution is recommended among patients with certain verified clinical conditions (e.g., dementia) and those with pronounced working memory deficits due to concerns for increased risk of false positives.
维多利亚症状效度测试（VSVT）是一种具有二十多年实证支持的表现效度测试（PVT），尽管现有文献中的方法学局限性限制了其临床和研究的可推广性。这些限制中最主要的包括对VSVT中最准确指标以及每个VSVT效度指标内最合适的临界分数缺乏共识。当前的系统评价综合了现有的VSVT验证研究，并使用已知群体设计在独立样本中提供了额外的交叉验证。我们对文献进行了系统检索，确定了17项同行评审研究进行综合分析（7项模拟设计、7项差异患病率设计和3项已知群体设计）。独立交叉验证样本包括200名因门诊神经心理评估而转诊的混合临床神经精神科患者。在所有指标中，总项目准确率在最佳临界分数≤40时产生了最强的心理测量学特性（灵敏度62%/特异度88%）。然而，所有VSVT指标的ROC曲线分析得出曲线下面积（AUC）具有统计学意义（.73 - 81），表明分类准确性中等。使用独立交叉验证样本得出的临界分数与之前的一些研究结果一致，支持简单项目准确率的临界分数≤22，总项目准确率的临界分数≤40，尽管在困难项目准确率方面发现了不同的结果。总体而言，VSVT效度指标在不同人群中具有足够的诊断准确性，当前研究为其在临床环境中作为一种心理测量学上合理的PVT的使用提供了额外支持。然而，对于某些已确诊临床疾病（如痴呆症）的患者以及那些因工作记忆缺陷明显而存在假阳性风险增加问题的患者，建议谨慎使用。
