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[Systolic blood pressures are not comparable when home blood pressure is measured with a wrist or an arm validated monitor].

OBJECTIVES: To compare home blood pressure values obtained with two validated OMRON (wrist or arm) monitors used sequentially in the same subject. METHODS: In 265 hypertensive subjects referred to hypertension specialists, a self measurement of blood pressure was performed sequentially with an OMRON M4-I (arm cuff, A/A, BHS validation) or OMRON RX-I (wrist cuff, B/B, BHS validation). Each patient recorded home blood pressure during two periods of 4 days with 3 measures in the morning and 3 in the evening. Order for use of each monitor was randomised. With wrist devices, subjects were advised to keep the arm at heart level during measurements. BP values were reported on a standardized document. Patients were asked by a questionnaire about the tolerance and feasibility of the 2 methods. RESULTS: In this population, aged 59 +/- 14 years, with 60% of men and a mean blood pressure of 152 +/- 21 / 86 +/- 14 mmHg, the home blood pressure values were 143 +/- 20/81 +/- 11 mmHg with the arm monitor and 135 +/- 10 / 80 +/- 11 mmHg with the wrist monitor. Mean SBP adjusted on age, initial blood pressure level and period order was significantly lower when home blood pressure monitoring has been recorded with a wrist monitor as compared to an arm monitor (p < 0.001). Self measurement of blood pressure was felt as easy in 92% with the arm monitor and in 96% with the wrist monitor (p < 0.05). Self measurement of blood pressure was felt as constraining in 14% with the arm monitor and in 7% with the wrist monitor (p < 0.01). The feasibility between the two devices was good with none of the value missing in 86% with the arm monitor and in 85% with the wrist monitor. The missing values were in 56% the fourth day. CONCLUSION: Despite the use of two validated monitors, mean SBP is significantly lower when home blood pressure monitoring is recorded with a wrist monitor as compared to an arm monitor. Uncertainty in the arm position with the use of wrist device could explain these results. When advising home blood pressure monitoring, care should be taken to recommend only the use of validated devices and to prefer the use of arm devices in order to avoid the uncertainty of an inadequate utilisation.

Adult↗

Validation of the Spanish version of the Phase III ISAAC questionnaire on asthma.

The prevalence of allergic diseases in childhood has increased significantly over the last decades. This increase seems to be closely associated with the way of life of western societies. The high prevalence differences on different regions may be due to linguistic and cultural reasons and not to real variations in prevalence. This is the reason why several authors felt the need to perform an objective validation of their versions. Our working group has published the results of the Phase I validation and now is publishing the Phase III validation in order to guarantee the reliability of this phase results. The study sample is formed by 366 children aged 3 to 17 years. The following steps were followed in this study: I. Assessment of the "Criterion validity" of the Spanish ISAAC-Bronchial Asthma questionnaire, evaluating the sensitivity, specificity, relative value, and positive and negative predictive values. 2. Determine the questionnaire reliability, analysing its "Inner consistency". 3. Statistical comparison between our ISAAC-Bronchial Asthma results and the ones obtained by other groups (external concordance and consistency), in order to prove the previously evaluated reliability. 4. Comparison between the ISAAC-Bronchial asthma questionnaire diagnostic ability and the standard diagnostic criteria universally used in clinical praxis. We could confirm that there is a high and very significant concordance between the questions aimed to detect children with asthma. In this sense, it is especially useful the question about "ever had wheezing" because of its high sensitivity (93.3%) and specificity (89.9%), that make it able to be used as initial screening test in a general population, and that has shown a high concordance percentage with the questions "ever had asthma" (98%), "wheezing with exercise" (75%), and "cough at night"(80%). The questions that give more information about the evolution and control of the asthmatic disease are "wheezing in the last 12 months", "number of attacks in the last 12 months", "wakening at night", "wheezing with exercise" and "dry cough at night in the last 12 months". The questions more related to asthma severity were "number of attacks in the last 12 months", "wakening at night", "stop speaking in order to breath", and "wheezing with exercise". We conclude that ISAAC-Asthma questionnaire Phase III is a useful tool for the assessment of childhood asthma due to its criterion validity, inner consistency and external concordance.

Adolescent↗

[Cross-cultural adaptation and validation of the Cambridge Depersonalisation Scale].

INTRODUCTION: The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research. METHODS: This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). RESULTS: 38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively). CONCLUSION: The Spanish version of the CDS has good reliability and validity, similar to the original instrument.

Adolescent↗

Validation of the critical-care pain observation tool in adult patients.

BACKGROUND: Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE: To validate the Critical-Care Pain Observation Tool. METHODS: A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS: The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS: The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.

Cardiac Surgical Procedures↗

Inter-species validation for domain combination based protein-protein interaction prediction method.

Domain Combination based Protein-Protein Interaction Prediction (DCPPIP) method is revealed to show outstanding prediction accuracy in Yeast proteins. However, it is not yet apparent whether the method is still valid and can achieve comparable prediction accuracy for the proteins in other species. In this paper, we report the validation results of applying the DCPPIP method for Fly and Human proteins. We also report the results of inter-species validation, in which protein interaction and domain data of other species are used as learning set. 10,351 interacting protein pairs are used for the validation for Fly, 2,345 protein pairs for Human. 80% of the data are used as learning sets and 20% are reserved as test sets. High prediction accuracies (Fly: sensitivity approximately 77%, specificity approximately 92%, Human: sensitivity approximately 96%, specificity approximately 95%) are achieved in both Fly and Human cases. Interactions of proteins in Human, Mouse, H. pylori, E. coli, and C. elegans are predicted and validated using the protein interaction and domain data in Yeast, Fly, and the combination of Yeast and Fly respectively. Again, good prediction accuracy is achieved when the test protein pair has common domains with the proteins in a learning set of proteins. A notion of Domain Overlapping Rate (DOR) among species is newly developed in this paper and the correlation between DOR and prediction accuracy is examined. According to out test results, there exists fairly obvious correlation between DOR and prediction accuracy.

Animals↗

Utility and validity of the self-administered SF-36: findings from an older population.

INTRODUCTION: The objectives of this study were to assess the utility and validity of the self-administered SF-36 and the effect of visual or cognitive impairment on these measures in an older population. MATERIALS AND METHODS: Attempt rates, completion rates and internal consistency (Cronbach alpha) were compared within the second cross-sectional, population-based Blue Mountains Eye Study (n = 3509, mean age 66.7 years, 57% women). RESULTS: The SF-36 was attempted by 3162 (90.1%) participants, of which 2470 (78.1%) completed all items and 2873 (90.9%) completed sufficient items for calculation of all dimensions. In a multivariate model adjusting for age, sex, and presenting visual and cognitive impairments, women (P = 0.011) and participants with visual or cognitive impairments (P < 0.0001) were less likely to attempt the questionnaire. Completion rates were significantly lower with increasing age (P < 0.0001), in men (P < or = 0.0005) and in those with cognitive impairment (P < 0.0001). A high level of internal consistency (Cronbach alpha > 0.85 for all dimensions) and construct validity was demonstrated, the latter distinguishing between those with and without medical conditions, disabilities or recent hospital admissions (P < 0.01). As the prevalence of visual or cognitive impairment was relatively low in this population, we found no apparent effect of these impairments on the validity of SF-36. CONCLUSIONS: Attempt and completion rates, but not internal consistency and construct validity, of the SF-36 were influenced by age, gender, and presenting visual and cognitive impairments. The overall high attempt and completion rates, internal consistency and construct validity suggest that the self-administered SF-36 is a suitable healthrelated quality of life (HRQOL) measure in similar older community-living populations.

Aged↗

Validation of expert systems: examples and considerations.

The problem of a medical expert system validation is generally complex. It requires a rigorous methodology of validation and must show proof of its practical competency in order to be used currently. Validation concerns the quality of conclusions provided by the system, the quality of the deductive process leading to these conclusions as well as the validity of its utilization. In this paper, some reflections, questions, and requirements are exposed that must be addressed to proceed to the validation of a knowledge base system in the field of medicine, especially the psychiatric field.

Computer Systems↗

Reliability and validity of NINCDS-ADRDA criteria for Alzheimer's disease. The National Institute of Mental Health Genetics Initiative.

OBJECTIVE: To assess interrater reliability and validity of NINCDS-ADRDA (National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association) criteria for Alzheimer's disease (AD). DESIGN: A multisite reliability and validity study in which clinicians from each site diagnosed 60 case summaries yielding a preconsensus estimate of reliability and validity. A consensus conference was conducted for each disagreement, leading to a postconsensus estimate of validity. The criterion standard was a diagnosis of AD by autopsy. SETTING: Three academic medical centers. SUBJECTS: A convenience sample of 60 detailed case summaries, 40 with AD and 20 with other dementing disorders. MAIN OUTCOME MEASURES: The kappa coefficient, sensitivity, and specificity. RESULTS: The kappa coefficient for preconsensus agreement on a diagnosis of probable or possible AD vs non-AD was 0.51; the sensitivity of a diagnosis of probable or possible AD for a pathological diagnosis of AD was 0.81, and the specificity was 0.73. The postconsensus sensitivity was 0.83, and the specificity was 0.84. CONCLUSIONS: The results support the reliability and validity of NINCDS-ADRDA criteria and show that the consensus process may improve diagnostic accuracy. The cases are reviewed with a focus on the sources of diagnostic disagreements and errors and possible changes that might improve the accuracy of the criteria.

Aged↗

Validation of a quality-of-life instrument for laryngopharyngeal reflux.

OBJECTIVES: To establish the reliability, validity, and responsiveness of a new, disease-specific assessment tool, the LPR-HRQL, which assesses patient-reported outcomes (PRO) with regard to health-related quality of life (HRQL) of patients with laryngopharyngeal reflux (LPR). DESIGN: A prospective, open-label, repeated-measures study. SETTING: Six centers in 4 states in the eastern United States. PATIENTS: Patients with LPR. INTERVENTIONS: Open-label treatment with 20 mg of omeprazole twice daily. Clinical and PRO HRQL data were collected. Several PRO instruments were administered to patients at each of several time points; these instruments included the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), a general HRQL tool; the Voice Handicap Index (VHI), a symptom-specific tool for assessing voice problems; and the QOLRAD instrument (Quality of Life in Reflux and Dyspepsia), used to assess the impact of gastroesophageal reflux disease. RESULTS: Factor analyses of the LPR-HRQL scales confirmed single dimensions for each. All LPR-HRQL items contributed to internal consistency of scales and had substantial variability permitting useful information. Substantial evidence of convergent and divergent validity with SF-36, VHI, and QOLRAD items was observed. Test-retest validity was adequate for the time interval tested. Changes in domain scores of the LPR-HRQL at 4 and 6 months documented its responsiveness. CONCLUSIONS: The LPR-HRQL displays reliability, validity, and responsiveness, has face validity, and is simple and not burdensome to administer, score, and analyze. Accordingly, it may be used to assist physicians and patients in understanding the HRQL burden of LPR and the impact of therapy.

Adult↗

Assessing the validity of an animal model of deficient sensorimotor gating in schizophrenic patients.

Psychiatric researchers need specific animal models to better understand the neurobiology of schizophrenia. Prepulse inhibition (PPI), the reduction in startle produced by a prepulse stimulus, is diminished in schizophrenic patients. Theoretically, deficient PPI in schizophrenic patients reflects a loss of sensorimotor gating that may lead to sensory flooding and cognitive fragmentation. In rats, PPI is disrupted by systemic administration of dopamine agonists or by manipulations of neural circuitry linking the limbic cortex, striatum, pallidum, and pontine reticular formation. This loss of PPI in rats may be a useful model for studying the neurobiology of impaired sensorimotor gating in schizophrenic patients. We assessed the face, predictive, and construct validity of this animal model. Face validity was supported: stimulus manipulations produced parallel changes in PPI in humans and rats, and the dopamine agonist apomorphine disrupted PPI in rats, mimicking PPI deficits in schizophrenics. Predictive validity was supported: the ability of antipsychotics to restore PPI in apomorphine-treated rats correlated with clinical antipsychotic potency (rs = .991) and D2-receptor affinity (rs = .893). Antipsychotics that restore PPI in apomorphine-treated rats include "typical" antipsychotics and the "atypical" antipsychotic clozapine. Construct validity was supported: PPI was disrupted in rats when dopamine was infused into the nucleus accumbens; this effect was blocked by haloperidol. The loss of PPI in dopamine-activated rats may be a valid animal model of sensorimotor gating deficits in schizophrenic patients. This model may help us understand the neurobiology of cognitive deficits in schizophrenic patients.

Acoustic Stimulation↗

Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model.

CONTEXT: A predictive model of mortality in heart failure may be useful for clinicians to improve communication with and care of hospitalized patients. OBJECTIVES: To identify predictors of mortality and to develop and to validate a model using information available at hospital presentation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 4031 community-based patients presenting with heart failure at multiple hospitals in Ontario, Canada (2624 patients in the derivation cohort from 1999-2001 and 1407 patients in the validation cohort from 1997-1999), who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. MAIN OUTCOME MEASURES: All-cause 30-day and 1-year mortality. RESULTS: The mortality rates for the derivation cohort and validation cohort, respectively, were 8.9% and 8.2% in hospital, 10.7% and 10.4% at 30 days, and 32.9% and 30.5% at 1 year. Multivariable predictors of mortality at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher urea nitrogen level (all P<.001), and hyponatremia (P<.01). Comorbid conditions associated with mortality included cerebrovascular disease (30-day mortality odds ratio [OR], 1.43; 95% confidence interval [CI], 1.03-1.98; P =.03), chronic obstructive pulmonary disease (OR, 1.66; 95% CI, 1.22-2.27; P =.002), hepatic cirrhosis (OR, 3.22; 95% CI, 1.08-9.65; P =.04), dementia (OR, 2.54; 95% CI, 1.77-3.65; P<.001), and cancer (OR, 1.86; 95% CI, 1.28-2.70; P =.001). A risk index stratified the risk of death and identified low- and high-risk individuals. Patients with very low-risk scores (< or =60) had a mortality rate of 0.4% at 30 days and 7.8% at 1 year. Patients with very high-risk scores (>150) had a mortality rate of 59.0% at 30 days and 78.8% at 1 year. Patients with higher 1-year risk scores had reduced survival at all times up to 1 year (log-rank, P<.001). For the derivation cohort, the area under the receiver operating characteristic curve for the model was 0.80 for 30-day mortality and 0.77 for 1-year mortality. Predicted mortality rates in the validation cohort closely matched observed rates across the entire spectrum of risk. CONCLUSIONS: Among community-based heart failure patients, factors identifiable within hours of hospital presentation predicted mortality risk at 30 days and 1 year. The externally validated predictive index may assist clinicians in estimating heart failure mortality risk and in providing quantitative guidance for decision making in heart failure care.

Aged↗

The role of a pre-scored multi-attribute health classification measure in validating condition-specific health state descriptions.

It is common to find specially constructed condition-specific health state descriptions used as the basis for benefit assessment in cost-utility analysis. For this approach to be valid it is necessary to have valid descriptors of health states. Yet the evidence demonstrating descriptive validity has been neglected in economic evaluation. This paper reports on the validity, reliability and feasibility of obtaining values from specially constructed condition-specific descriptions of breast cancer screening by mapping these descriptions into a pre-scored multi-attribute health classification measure (the EuroQol instrument) and comparing the values obtained with those derived from a time trade-off exercise. In doing so, it highlights the importance of descriptive validity in explaining why different valuation methods produce different results. Four descriptions typically associated with ex post true negative, false positive, true positive and false negative breast screening results were considered.

Adult↗

The validity of psychometric instruments for detection of dementia in the elderly general population.

OBJECTIVE: To compare the validity of different instruments for screening and diagnosis of dementia and to provide threshold scores for these purposes, ie screening focusing on a high sensitivity and diagnosis focusing on a high specificity. SETTING: 287 subjects from a general population sample who had completed more than one of these psychometric tests. METHODS: The performances of the Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-Infarct Dementia and Dementias of Other Aetiology according to ICD-10 and DSM-III-R, the Mini-Mental State Examination, the Blessed Dementia Rating Scale, the Global Deterioration Scale, the Verbal Fluency Test, the Word list Learning Task, the Trail Making Test and the Labyrinth Test were compared using receiver operating characteristics analysis. RESULTS: The validity of composite instruments for the discrimination of dementia and cognitive health was higher than the validity of individual tests. However, some cognitive tests, ie verbal fluency and immediate recall of words, reached a high validity, making them useful and short screening instruments for dementia. CONCLUSION: There is no perfect instrument for screening and diagnosis of dementia. Different threshold scores for different purposes were provided in the present study. Recommendations for improving the validity of the Delayed Word List Learning Task for discriminating dementia and cognitive health include the expansion of list length and shortening of delay.

Aged↗

Validation of cough-induced leak point pressure measurement in the evaluation of pharmacological treatment of stress incontinence.

To improve routines in clinical practice and research, it is important that new tests are thoroughly evaluated before they gain widespread application. This includes establishing the reliability and validity of the new test. The purpose of this study was to establish the construct and criterion validity of cough-induced leak point pressure (CILPP) measurement. Data on CILPP, maximum urethral pressure (MUP), and a short-term pad test from a phase-I trial of a new pharmacological agent (LS 4416), developed for the treatment of stress incontinence, was used to test the validity of CILPP. Fifteen post-menopausal women with stress incontinence were studied. Phenylpropanolamine (PPA) was used as a positive control. Administration of PPA produced a statistically significant increase in MUP and CILPP. There was a significantly better effect of treatment, expressed as an increase in MUP at 1.5 hr, when PPA was used than with placebo or LS 4416. When CILPP was used to detect change after therapy, PPA produced a significantly greater increase in CILPP than did placebo (least square mean of difference 17.25, P = 0.0202). There was a moderate but statistically significant correlation between CILPP and the short-term Pad Test. Construct validity was demonstrated by the ability of CILPP to detect limited improvement in patients with stress incontinence. Criterion validity was established by the correlation of CILPP to a short-term Pad Test. We propose that, thanks to its greater methodological qualities, leak point pressure measurement should be adopted as a standard method to ascertain the effect of treatment in patients with stress incontinence. Neurourol. Urodynam. 18:591-602, 1999.

Aged↗

Self-assessed health-related quality of life in men who have completed radiotherapy for prostate cancer: instrument validation and its relation to patient-assessed bother of symptoms.

The purpose of this study was to develop a psychometrically reliable and valid questionnaire to assess the disease-specific dimensions of health-related quality of life (HRQOL) in the urinary function (UF), bowel function (BF), and sexual function (SF) domains of prostate cancer (PCa) patients treated with radiation therapy. Patients were given a six-page questionnaire using Likert-type questions assessing three HRQOL dimensions during their follow-up visits after completing radiotherapy. Scales created from an earlier study were utilized and tested for reliability and validity. In addition, we assessed the relationship between these dimensions and the degree to which a decreased HRQOL increases the degree to which patients feel bothered about their symptoms. There are two scales within each dimension: BF, Urgency and Daily Living; UF, Urgency and Weakness of Stream; SF, Interest/Satisfaction and Impotence. Internal-consistency reliability coefficients (Cronbach's alpha) for the proposed scales range from 0.48 to 0.92, and all item-scale correlations and divergence correlations validate the use of the scales, ranging from 0.49 to 0.89. The validity of these scales is also confirmed by the rising median scores with rising reported levels of patient-perceived "bother." The different dimensions have differing quantitative influences on patients. We have developed a prostate-specific HRQOL instrument that is an adequate and suitable tool for measuring HRQOL along three distinct dimensions for patients who have completed radiotherapy for PCa. Psychometric standards for reliability and validity were met for the proposed scales. Moreover, positive correlations were found between these dimensions and how bothered patients were by their symptoms, suggesting important relationships that should be followed in PCa patients after radiotherapy. Certain scales have strong influences on patient-perceived "bothersomeness" of symptoms, such as loss of control of BF, urgency of BF, urgency of urination, and level of interest/satisfaction in sex. Compared to our earlier study on patients being treated with radiotherapy for PCa, this study produced very similar results. With some modification, the same questionnaire could be used for both groups of patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 163-172 (2000).

Adult↗

How valid are the subscales of the Multiscore Depression Inventory?

Investigated subscales of the Multiscore Depression Inventory for construct and concurrent validity. A hierarchical cluster analysis based on the responses of 263 students provided support for the construct validity of Irritability, Energy Level, Guilt, Instrumental Helplessness, Social Introversion, and Cognitive Difficulty. The separation of Low Self-Esteem and Pessimism was supported only partially, while Learned Helplessness and Sad Mood combined in a single cluster. The graph-theoretic advantages of the cluster analysis permitted speculation about the relationship among the subscales. Factor-analytic examination of the same data demonstrated comparable evidence of construct validity for most scales. Concurrent validity was demonstrated on a sample of 89 students, with significant relationships obtained for all subscales with respective criterion measures, with the exception of Learned Helplessness, which had a low, but significant, correlation with its criterion. Discriminant validity was demonstrated by low correlations between the subscales and socially desirable responses.

Depressive Disorder↗

The validity of MMPI subtle and obvious items in psychiatric patients.

This study was designed to assess the validity of four clinical scales with and without subtle items; and the relative validity of obvious and subtle items. Criteria were questionnaire, mental status, diagnostic, and drug treatment measures; subjects were 73 psychiatric inpatients. Across criteria, the results indicated that the validity of the full scales was not improved by the removal of subtle items; and with the exception of the PD scale, subtle items generally were found to be of similar convergent validity and possibly superior discriminant validity. These findings have implications for psychometric theory and test construction strategies.

Adolescent↗

Differential validity of the MMPI-2 Subtle and Obvious scales with psychiatric inpatients: scale 2.

The construct and concurrent validity of the MMPI-2 Scale 2 Subtle and Obvious scales were examined for a group of 67 psychiatric inpatients. Validity coefficients for the Obvious scale were uniformly greater than those for the Full and Subtle scales. Subtle scale validity coefficients were negative and attenuated the validity of the Full clinical scale. Use of Obvious items resulted in more accurate prediction of assessed suicide risk, while inclusion of the Subtle items did not add any useful information in the prediction of assessed suicide risk or psychiatric diagnosis. It is recommended that future research that uses the MMPI-2 basic clinical scales examine the differential validity of the Subtle and Obvious scales.

Adolescent↗