Prevalence of overreporting on symptom validity tests in a large sample of psychosomatic rehabilitation inpatients

Abstract Objective: Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectations may play a significant role in clinical patients. We studied the prevalence of noncredible symptom report in patients treated for minor mental disorders in an inpatient setting. Method: Five hundred and thirty seven clinical inpatients of a psychosomatic rehabilitation center were studied (mean age: 50.2 years; native speakers of German). They were referred for treatment of depression, anxiety, somatoform disorder, adjustment disorder, and neurasthenia. Results of two symptom validity tests (Structured Inventory of Malingered Symptomatology, SIMS; Self-Report Symptom Inventory, SRSI) and the Beck Depression Inventory–II (BDI–II) were analyzed. Results: At screening level, 34.5% and 29.8% of the patients were found to presumably overreport symptoms on the SIMS and SRSI, respectively. At the standard cut score of the SRSI (maximum false positive rate: 5%), the proportion of diagnosed overreporting was 18.8%. SIMS and SRSI pseudosymptom endorsement correlated at .73. Highly elevated depressive symptom claims with BDI–II scores above 40, found in 9.3% of the patients, were associated with elevated pseudosymptom endorsement. Moreover, extended times of sick leave and higher expectations of disability pension were associated with elevated pseudosymptom endorsement. Conclusions: The prevalence of symptom overreporting in some clinical patient groups is a serious, yet underinvestigated problem. The current estimates yielded a high prevalence of distorted, noncredible symptom claims in psychosomatic rehabilitation patients. The challenges arising to health professionals working in such settings are immense and need more consideration.