Major depression – a study on the validity of clinicians’ diagnoses in medicolegal assessment

Major depression ranges among the most frequently diagnosed psychiatric disorders. Accordingly, diagnoses of depression are often underlying insurance, compensation or disability claims. This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. For all of them, a diagnosis of major depression had been established by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report, 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem often confounded by improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and also by response bias.     

A Bayesian Item Response Theory Approach to Symptom Validity Detection: Evaluating Psychological Screening Inventory-2 Response Profile Likelihoods

Invalid data in forensic assessment are most often indicated by excessive endorsement of psychiatric symptoms. Although this method of identifying invalid profiles is generally effective, it does not make use of all conditional dependencies in data. Modern psychometric methodologies can be used to identify aberrant response profiles through model-based indices known as person fit statistics. Specifically, the likelihoods of examinees' response profiles can be compared against observed or simulated likelihoods that are derived from empirical models of emotional and psychiatric functioning. This study demonstrates how person fit indices based on item response theory models can be used to detect misfitting response profiles in forensic assessment. Archival data from the Psychological Screening Inventory-2 (R. I. Lanyon, 2010a) were evaluated with Bayesian estimation and posterior predictive model checking to compare the response profile log-likelihoods of 74 forensic participants with 1,046 normative participants. Results suggest 61 % of forensic examinees but only 5 % of normative examinees had misfitting data. Misfitting “fake bad” forensic profiles appeared to be associated with overly discrepant endorsement of symptoms, and misfitting “fake good” forensic profiles appeared to be associated with overly narrow endorsement of symptoms. The high rate of misfit among forensic examinees challenges the appropriateness of basing interpretations of forensic data on reliability and validity coefficients from normative samples. However, because aspects of the methodology are still untested in forensic and clinical assessment (e.g., the use of priors in this study), future research is needed to evaluate its appropriateness for clinical practice.     

The Self-Report Symptom Inventory (SRSI): a New Instrument for the Assessment of Distorted Symptom Endorsement

Self-report instruments to detect distorted symptom reporting play a crucial role in clinical and forensic psychology. Most of the instruments currently available for this purpose only list implausible symptoms, which makes them easily identifiable as symptom validity tests. We developed the Self-Report Symptom Inventory (SRSI), combining five self-report scales of genuine symptoms with five pseudosymptom scales to screen for distorted symptom reporting in various domains (e.g., depression, post-traumatic stress). With a preliminary questionnaire version, we collected data in a heterogeneous sample (N?=?239) and performed an item selection, resulting in the final 107-item version. This version was evaluated in civil forensic patients, inmates of a prison, and a population-based sample; N?=?387). Data show that (a) SRSI pseudosymptom scores correlate highly (≥.80) with other instruments tapping distorted symptom endorsement, notably the Structured Inventory of Malingered Symptomatology; (b) High SRSI pseudosymptom scores tend to correlate with underperformance; and (c) The psychometric features of the SRSI are satisfactory, with internal consistency for the total scales >.90 and retest reliability >.85. The instrument appears to be a promising tool for examining symptom exaggeration, but further work is required, in particular cross-validation with other samples and different methods.     

What Lies Beneath: Exploring Links Between Asylum Policy and Hate Crime in the UK

This paper explores the link between increasing incidents of hate crime and the asylum policy of successive British governments with its central emphasis on deterrence. The constant problematisation of asylum seekers in the media and political discourse ensures that ‘anti-immigrant’ prejudice becomes mainstreamed as a common-sense response. The victims are not only the asylum seekers hoping for a better life but democratic society itself with its inherent values of pluralism and tolerance debased and destabilised.     

Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints (n = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls (n = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls (n = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population (N = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.     

Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability

Posttraumatic stress disorder (PTSD) is arguably prone to malingering due to its subjective and heterogeneous nature. Various factors can influence PTSD symptom profiles including trauma type and trauma exposure. However, it is unknown whether trauma exposure influences malingered PTSD symptom profiles. We used a malingering simulation design with trauma type controlled to compare (1) PTSD symptom profiles (Posttraumatic Stress Checliklist-5; PCL-5) at the syndrome, symptom cluster, and individual symptom levels and (2) symptom validity profiles (Structured Inventory of Malingered Symptomatology; SIMS) at the overall and subscale level, as a function of direct and indirect trauma exposure. Seventy-three participants were randomly assigned to either the direct (“witnessed” trauma) or indirect (“learned about” trauma) condition. Participants were coached about symptoms and instructed to simulate PTSD. PCL-5 profile analyses revealed that simulators in the direct exposure group reported greater overall PTSD severity. Significant differences were found on cluster D (changes in cognition and mood) and individual symptoms including intrusive thoughts, amnesia, difficulty experiencing positive emotions, and risk-taking. No differences were identified for any other symptom scores nor for the symptom validity profile, except for the SIMS total score (direct: M?=?33.0, SD?=?12.8, indirect: M?=?26.5, SD?=?13.9, t(71)?=?2.06, p?=?.043, d?=?.48). These findings indicate that trauma exposure can influence malingered PTSD profiles at the syndrome, symptom cluster, and individual symptom levels (small effects), but, with one exception for a summary score, it does not produce a detectable difference on symptom validity testing. This study may provide insight for clinicians into the how malingered PTSD profiles can manifest as a result of direct and indirect trauma exposure; however, further research is strongly indicated.     

The Detection of Feigned Psychiatric Disorders Using the MMPI-2-RF Overreporting Validity Scales: An Analog Investigation

Individuals who are motivated to feign psychological problems to achieve a desired outcome (e.g., insanity defense) may overreport symptoms of psychopathology, with type of pathology being dependent on the setting. In the current investigation, we examined the utility of the overreporting validity scales (infrequent responses [F-r], infrequent psychopathology responses [F_P-r], infrequent somatic responses [Fs], and symptom validity [FBS-r]) on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath and Tellegen 2008) to detect research participants instructed to simulate one of three mental disorders: major depressive disorder (MDD), schizophrenia (SCH), or post-traumatic stress disorder (PTSD). The restructured clinical (RC) and overreporting validity scale scores of bona fide psychiatric patients with a primary diagnosis of either MDD, SCH, or PTSD were compared to two groups of simulators—naïve (i.e., undergraduate students with no training in mental disorders) and sophisticated (i.e., individuals with advanced training in psychopathology or personal experience with the disorder asked to overreport symptoms). Examination of the RC Scale profiles revealed that the sophisticated simulators produced symptom profiles more similar to the profiles of the psychiatric patients than did the naïve simulators. For the overreporting validity scales, the sophisticated simulators were less likely to be detected as feigning compared to the naïve simulators; overall, the validity scales were able to distinguish patients from simulators and accurately classify most of the simulators regardless of their level of “symptom” sophistication. Examination and comparison of the validity scales revealed that across disorders and level of research participant symptom sophistication, the F_P-r scale best differentiated simulators from patients.     

Changing the support system for asylum seekers

The issues of asylum and the treatment of asylum seekers have once again hit the headlines in the UK. The recent problems in Kosovo in the former Yugoslavian territory have made the problem of dealing with asylum claims more acute. The past arrangements for asylum seekers have been inadequate and piecemeal and have developed as a result of changes made in 1996 and the subsequent intervention by the judiciary. The cost to the British taxpayer of the pre-1999 Act asylum arrangements has been over 500 million per year, 80 per cent of which has been spent on accommodating and supporting asylum seekers. There is also a huge backlog of cases and current figures are indicative of a system that is unable to cope. It is in the light of these problems that the Government has passed the 1999 Immigration and Asylum Act. This Article examines the changes that will be made to UK asylum law by the 1999 Act and assesses the problems that may be caused by those changes in the areas of housing and other forms of assistance and the effect that these may have on families and children seeking asylum in the UK.     

Emotional Reactions to and Support for Immigrant Policies: Attributed Responsibilities to Categories of Asylum Seekers

Dutch participants were asked about their support for immigrant policies aimed at public assistance, opportunities, and rights for asylum seekers. In two studies, the degree of support was examined as a consequence of feelings of anger and sympathy toward asylum seekers. In the first study, both emotions were independently related to support for immigrant policies. Anger had a strong negative effect and sympathy a positive one. In the second experimental study, the effects of these emotional responses on support for immigrant policies were examined for two categories of asylum seekers: political refugees who have little choice but to migrate and so called economic refugees who themselves chose to migrate. These two categories feature in public debates and differ in the perceived responsibility of asylum seekers for leaving their home country. It was found that for political refugees only feelings of sympathy affected policy support, whereas for economic refugees only feelings of anger predicted policy support. In both studies, national identification was negatively related to support for immigrant policies and it did not moderate the effects of anger and sympathy. There was some evidence that anger mediated the relationship between national identification and policy support.     

Rights and Rhetoric: The Politics of Asylum and Human Rights Culture in the United Kingdom

No assessment of the state of human rights today could be complete without some consideration of the situation of asylum seekers and the political trends behind it. Four years after the implementation of the 1998 Act, asylum seekers are perhaps more denigrated in rhetoric and harsh practice than they were even before the first promise that rights would be 'brought home' for all 'people' in the United Kingdom. This piece looks at the undermining of the very concept of asylum, dehumanizing policies such as forced destitution, and attacks on access to legal process for those making asylum claims. It goes on to consider judicial attempts at coping with the arena in which high politics and fundamental rights seem in greatest tension. Finally it considers potential implications for the broader aspiration of building a human rights culture in this country.     

Legally Queer: The Construction of Sexuality in LGBQ Asylum Claims

Using court decisions, interviews with legal actors, and ethnographic observations, this paper analyzes the development of sexual identity classifications for sexual minorities seeking asylum in the United States and argues that the adjudication of such claims works to consolidate and regulate sexual identities but also creates possibilities for recognizing marginalized queer identities. Asylum seekers must prove their sexual identities, and immigration officials must classify claimants as belonging to a protected group. At the inception of queer asylum law in 1990, protected categories were highly circumscribed, but the indeterminacy of the law allowed advocates and asylum seekers to challenge existing categories and stake out new claims based on their sexualities. Against the backdrop of extant criticisms of the asylum process for queers, this paper suggests that the way asylum law has been elaborated, adapted, and interpreted, particularly in approximately the past decade, offers possibilities for making unique identity claims that are not recognized in existing scholarship.     

Unmasking Deviance: The Visual Construction of Asylum Seekers and Refugees in English National Newspapers

This paper explores the visual representation of asylum seekers and refugees delineating how English newspaper imagery constructs such groups as deviant and dangerous. A qualitative visual analysis of nine of the major national newspapers demonstrates how mediated images of asylum seekers focus upon three distinct ‘visual scenarios’ in the discovery of deviance, which collectively demonstrate how the social portrayal of the criminal immigrant fuses the otherness of the stranger with the otherness of the deviant. First, the faceless and de-identified stranger enables the construction of a panoply of feared subjects. Second, stigma is implicitly illustrated, deviance obliquely intimated and ‘spoiled identities’ constructed. Third, the mask is removed, the asylum seeker is identified and their deviant status confirmed. Such a process is reinvented, repeated and reworked in news stories, with deviance becoming increasingly engrained and entrenched in the image of the asylum seeker. This paper details how the repetition of specific visual scenarios in newspaper reporting contribute to the construction of ‘noisy’ panics about asylum seekers and asylum seeking. Moreover, it argues that such imagery is key to the construction of asylum as an issue of security, which necessitates a policy approach that is exclusionary in nature.     

Refugee status determination in Australia: breaking the rules?

This article looks at the asylum regime in Australia. In particular, it evaluates the procedures that are used to assess claims for asylum and the extent to which they meet international refugee and human rights standards. The article discusses four key issues in the adjudication programme: the appointment of decision-makers to tribunals that hear refugee applications, the accessibility of the review process by asylum seekers, questions relating to the efficiency of the procedures used and the mandatory detention system. It is argued that whereas Australia is party to the main international treaties that seek to protect refugees and asylum seekers, its asylum law and policy is in many ways inconsistent with international norms. To conclude, the author proposes the observance of human rights and refugee standards by asylum states. This revised version was published online in July 2006 with corrections to the Cover Date.     

The Exclusion of (Failed) Asylum Seekers from Housing and Home: Towards an Oppositional Discourse

‘Housing’– the practical provision of a roof over one's head – is experienced by users as ‘home’– broadly described as housing plus the experiential elements of dwelling. Conversely, being without housing, commonly described as ‘homelessness’, is experienced not only as an absence of shelter but in the philosophical sense of ‘ontological homelessness’ and alienation from the conditions for well‐being. For asylum seekers, these experiences are deliberately and explicitly excluded from official law and policy discourses. This article demonstrates how law and policy is propelled by an ‘official discourse’ based on the denial of housing and the avoidance of ‘home’ attachments, which effectively keeps the asylum seeker in a state of ontological homelessness and alienation. We reflect on this exclusion and consider how a new ‘oppositional discourse’ of housing and home – taking these considerations into account – might impact on the balancing exercise inherent to laws and policies concerning asylum seekers.     

The provenance of émigrés: the validity of measuring knowledge of places

Establishing the origin of those seeking asylum is essential but difficult as asylum seekers often cannot corroborate their origin claim with documents. The aim of the present study was to assess whether asking knowledge questions, sketch questions and impossible questions are valid methods to determine the veracity of an origin claim. Participants (N?=?105) from Tilburg (truth-tellers), Maastricht (partial liars) and Gothenburg (full liars) were asked to convince an interviewer that they originated from Tilburg. Half of them prepared and half of them did not prepare themselves for the interview. They were asked 10 knowledge questions typically asked to assess the credibility of origin claims, 4 impossible questions and 1 sketch question. Participants from Tilburg answered more questions correctly than participants from Maastricht and Gothenburg. Performance also improved with preparation. Even though the results did provide some support for the validity of assessing claims about origin by asking knowledge questions, the differences between the groups were modest, and it was impossible to correctly identify all truth-tellers and liars. Changing the output modality from verbal answering to sketching contributed to the credibility assessment of origin claims, whereas impossible questions were not discriminatory.     

Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach

Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24–30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.     

Asylum seeker with AIDS loses fight against relocation within the UK

An English court has upheld the decision to relocate an asylum seeker living with AIDS from London to Leeds. The court decided that the public interest in housing asylum seekers where accommodation is available outweighed the woman's interest in remaining in London, where she had an established support network, including medical care. The government has undertaken not to implement the order until her application for asylum is ruled on.     

North Korean Refugees and International Refugee Law

The severe food crisis of the 1990s forced thousands of NorthKoreans to leave their country in search of food. Most of themcrossed the border into China, to which the Government of thePeople's Republic of China (the PRC) responded by forcibly repatriatingdefectors to North Korea, thus placing many of them at riskof being subjected to inhumane and degrading treatment and,at times, even death. This article provides an overview of thesituation of North Korean asylum seekers and analyses the legalprotection available to North Korean defectors under internationallaw. The article focuses specifically on the situation of NorthKoreans in mainland China and China's obligations under internationalhuman rights and refugee law. The aim of the article is to contributeto the elaboration of durable solutions for the plight of NorthKorean asylum seekers and to develop a range of recommendationsfor law reform and policy change.     

The Detention of Asylum Seekers as a Crime of Obedience

This article deals with discretionary decisions made by British immigration officers about whether to detain asylum seekers. It takes as its point of departure the remarkable variety of views and practices reported by front line decision-makers interviewed at British ports (Weber and Gelsthorpe 2000; Weber and Landman 2002). The discussion begins by drawing historical parallels between the pre-Holocaust era and the present day hostility towards asylum seekers, which forms the wider context for official decision-making. It notes the failure of structural analyses to account for individual differences in rule-following and draws on theoretical perspectives developed by American social psychologists Kelman and Hamilton (1989) to explore the individual dynamics of conformity and dissent. In the concluding section, theoretical connections are made between the idea of discretionary detention as a crime of obedience, and contemporary discussion about state crime and governmentality. The underlying message of this article is as much a normative as an analytical one. While recognizing the practical limitations of individual conscience, the discussion ends, as it begins, by celebrating the emancipatory potential of dissent in the face of populist policies that sanction harm against targeted groups.