Personality Assessment Screener Research Articles

Paper 74: Psychopathology and Volitional Instability: Who should we be operating on?

Objectives:There has been a hesitation by surgeons to operate on shoulder instability patients with maladaptive psychopathological traits, especially those with volitional instability, as these may portend a poor prognosis. The purpose of this study was to investigate the prevalence of maladaptive psychopathological traits, volitional instability, and their effect on two-year outcomes in patients undergoing shoulder stabilization surgery.Methods:A prospective multi-center cohort study led by the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group targeted all subjects having surgical shoulder stabilization and collected patient-reported outcomes at baseline and at two years postoperatively. Psychopathological traits were assessed using the Personality Assessment Screener (PAS), a validated personality assessment tool. Longitudinal analyses were performed using multivariable regression models to determine predictors of two-year outcomes adjusting for confounders measured at index such as age, sex, smoking, BMI, volitional instability, and intraarticular pathology.Results:The cohort (n = 890) was 80% male with a median age of 21.5 years. The prevalence of psychopathological traits was 20%. While all patients improved between baseline and 2 years, with adjusted analyses, the presence of maladaptive psychological traits present at the time of index surgery were predictive of lower WOSI (p = 0.001), ASES (p = 0.016), SANE (p = 0.03), and SF-36 MCS (p = 0.001) scores as well as a higher risk of failure (p = 0.04) at two years. As a main effect, volitional instability was not a predictor of WOSI, ASES, SANE, SF-36 or failure at two years. However, all models allowed for the interaction between volitional instability and the PAS, and this interaction was significant for WOSI (p = 0.006), SANE (p = 0.03), and SF-36 MCS (p = 0.003) scores at two years. In other words, the effect of volitional instability on the WOSI, SANE, and SF-36 MCS scores depends on the value of the PAS, and with high PAS scores it is associated with worse outcomes. This data is depicted in Figures 1-3.Conclusions:While all patients improved, the presence of maladaptive psychopathological traits at the time of index surgery was a predictor of poorer outcomes at two years. Voluntary dislocators did similarly as non-voluntary dislocators up to a PAS score of ˜ 20, where above this they had worse WOSI, SANE, SF-36 MCS and higher failure rates at 2 years post-operatively.Figure 1.Adjusted effects of PAS score and volitional instability on WOSI score at 2 yearsFigure 2.Adjusted effects of PAS score and volitional instability by gender on predicted MCS Score at two yearsFigure 3.Adjusted effects of PAS score and volitional instability on probability of failure

The Personality Assessment Screener as a Predictor of Self-Injuring Thoughts and Behavior Crisis Events in a Male Prison Sample

Mental disorder is widespread in correctional settings, as is the potential for suicide and self-harm among detained individuals. The ability of the Personality Assessment Screener (PAS) to identify potential mental health problems has been the focus of recent research in corrections, but few studies have examined the prediction of crisis events related to self-injuring thoughts and behaviors. We explored the utility of repeated PAS administrations among men incarcerated in prison ( N = 270) to identify those at risk for a subsequent crisis event involving potential self-harm. Baseline PAS total scores predicted the odds of experiencing a crisis event (odds ratio = 3.76–4.46) and, importantly, changes in PAS total scores over time incrementally predicted such events beyond scores assessed at a single time-point, t(49) = –2.14, p = .037. These preliminary findings demonstrate promise for the PAS as an indicator of potential self-injuring crisis events when administered at intake and regular intervals throughout incarceration.

Path Analysis of the Mediating Roles of Personality, Distress, and Cognitive Flexibility in the Subjective Well-Being of Combat Veterans With Traumatic Brain Injury.

To determine the interrelationships among traumatic brain injury (TBI), maladaptive personality traits (MPT), psychological distress, and cognitive flexibility in the prediction of subjective well-being of post-9/11 veterans concurrently and over time. Five Veterans Affairs (VA) medical centers and 1 VA outpatient clinic in urban, suburban, and rural areas. Five hundred Operation Enduring Freedom/Operation Iraqi Freedom veterans at baseline (219 with TBI), 292 at 18-month follow-up (108 with TBI), drawn from a regional registry and clinic referrals. Path analysis of data from a prospective cohort study. Satisfaction with Life Scale, 36-ltem Short-Form Health Survey (SF-36) Health Scale, Personality Assessment Screener, Beck Depression Inventory-II, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist-Military, Trail Making Test, Part B, Delis-Kaplan Executive Function System (D-KEFS) Category-Switching Verbal Fluency, and D-KEFS Color-Word Interference Test. There was no direct effect of TBI on well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had significant direct effects on well-being at baseline and 18 months. Baseline model accounted for 66% of the variance in well-being; follow-up model accounted for 43% of well-being variance. Negative influence of distress significantly decreased from baseline to follow-up. Direct negative effect of MPT diminished slightly over 18 months; effect of cognitive flexibility increased. Significant relationships were estimated in prediction of distress by MPT, cognitive flexibility, and TBI. TBI predicted MPT. MPT, cognitive flexibility, and TBI had indirect effects on well-being. TBI had a positive indirect influence on distress. Total effects included 4 significant predictors of well-being at baseline and 18 months: distress, MPT, cognitive flexibility, and TBI. Experience of TBI alone did not predict subjective well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had direct effects on well-being at both time points. Interventions aimed at reducing distress and bolstering resilience and cognitive flexibility are recommended to increase subjective well-being in this population.

Temporal stability and dynamic convergence of the Personality Assessment Screener in a prison sample.

Although the Personality Assessment Screener (PAS; Morey, 1997) has garnered substantial research interest, the measure's temporal stability and sensitivity to change have remained largely uninvestigated. The present study employs a dynamic approach to investigating the convergent and discriminant validity of the PAS by examining relationships between temporal changes on the PAS and changes on external criterion measures, thereby exploring the extent to which changes on the PAS offer meaningful information regarding changes in psychological functioning. Data were obtained from a public dataset funded by the United States Department of Justice in which male inmates were administered various psychological measures at 5 time points spanning the course of a year. The PAS demonstrated appreciable stability across all testing intervals and the full study period, and temporal changes on the PAS correlated as expected with changes on both conceptually similar and distinct external criterion measures. These findings offer evidence to suggest that temporal variations across testing intervals are not fully explained by error, as conceptualized in classical test-retest analyses, but rather may indicate meaningful changes in functioning. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study.

Background:Understanding predictors of pain is critical, as recent literature shows that comorbid back pain is an independent risk factor for worse functional and patient-reported outcomes (PROs) as well as increased opioid dependence after total joint arthroplasty.Purpose/Hypothesis:The purpose of this study was to evaluate whether comorbid back pain would be predictive of pain or self-reported instability symptoms at the time of stabilization surgery. We hypothesized that comorbid back pain will correlate with increased pain at the time of surgery as well as with worse scores on shoulder-related PRO measures.Study Design:Cross-sectional study; Level of evidence, 3.Methods:As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative PRO scores, and radiologic and intraoperative findings were recorded for patients undergoing surgical shoulder stabilization. Patients were also asked, whether they had any back pain.Results:The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years). Patients with comorbid back pain (158 patients; 15.8%) were significantly older (28.1 vs 23.4 years; P < .001) and were more likely to be female (25.3% vs 17.4%; P = .02) but did not differ in terms of either preoperative imaging or intraoperative findings. Patients with self-reported back pain had significantly worse preoperative pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index) (P < .001), more frequent depression (22.2% vs 8.3%; P < .001), poorer mental health status (worse scores for the RAND 36-Item Health Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment Screener) (P < .01), and worse preoperative expectations (P < .01).Conclusion:Despite having similar physical findings, patients with comorbid back pain had more severe preoperative pain and self-reported symptoms of instability as well as more frequent depression and lower mental health scores. The combination of disproportionate shoulder pain, comorbid back pain and mental health conditions, and inferior preoperative expectations may affect not only the patient’s preoperative state but also postoperative pain control and/or postoperative outcomes.

Examining the utility of the Personality Assessment Screener in three criminal justice samples.

Many individuals in forensic/correctional settings experience significant mental health problems, yet effective screening tools to identify such difficulties are in relatively short supply. This study investigates the clinical utility of the Personality Assessment Screener (PAS; Morey, 1997), a 22-item self-report measure of risk for emotional and behavioral dysfunction, across three archival criminal justice samples (incarcerated sex offenders, prison inmates housed in general population and psychiatric units, and jail detainees). The PAS is derived from the Personality Assessment Inventory (PAI; Morey, 1991, 2007), a more comprehensive measure of emotional and behavioral disturbances that is widely used in forensic/correctional settings. The PAS total score effectively identified those with clinically significant elevations on the PAI and also significantly correlated with various criterion measures tapping psychological dysfunction. Existing interpretive ranges and labels used to describe PAS scores in general clinical settings were problematic, however, and may require revision for use in these contexts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Concurrent validity of the personality assessment screener in a large sample of offenders.

Mental health problems are disproportionately prevalent in forensic and correctional settings, and there have been numerous attempts to develop screening tools to evaluate individuals in such contexts. This study investigates the clinical utility of the Personality Assessment Screener (PAS; Morey, 1997), a brief self-report measure of risk for emotional and behavioral dysfunction, in a large mixed-gender offender sample (N = 1,658). The PAS is a 22-item measure derived from the Personality Assessment Inventory (PAI; Morey, 1991, 2007), a more comprehensive self-report instrument widely used to assess for psychological disturbances among forensic and correctional populations. We examined the ability of the PAS to concurrently predict clinically significant elevations on the PAI and several other indicators of symptomatology and dysfunction. Collectively, results suggest that PAS total and element (subscale) scores show considerable promise in screening inmates for serious problems with emotional and behavioral functioning, though interpretive ranges used to categorize PAS scores in clinical and community settings may require revision for criminal justice populations. We discuss the applied value of the PAS for detecting specific areas of dysfunction relevant to risk management (e.g., aggression, suicidality) and for concentrating resources on offenders with the most immediate and severe need for psychological services. (PsycINFO Database Record

Supplemental Material for Concurrent Validity of the Personality Assessment Screener in a Large Sample of Offenders

Supplemental Material for Concurrent Validity of the Personality Assessment Screener in a Large Sample of Offenders

Childhood Abuse Is Associated With Worse Survival Following Lung Transplantation.

Psychosocial factors can impact lung transplant outcomes. However, it is currently unknown whether abuse survivorship influences lung transplant survival. To characterize the abuse history of adult lung transplant patients and determine whether such history is associated with mortality. Adult lung transplant recipients evaluated from 2000 to 2004. The main outcome was post-lung transplantation survival. The secondary outcomes included demographic, transplantation, or psychological assessment differences between those with a history of abuse survivorship and those without. Thirty-three lung transplant recipients (35.5% male, median age: 55 years) were included. A history of abuse survivorship was common (24.2%) and was associated with decreased survival following lung transplantation (P = .003). There was no difference in sex, marital status, or smoking history between abuse survivors and those who denied being the victim of abuse. Abuse survivors had a higher Personality Assessment Screener total score, a measure of maladaptive personality traits (P = .02). Abuse survivorship is common in lung transplant patients and associated with increased posttransplant mortality and increased maladaptive personality traits. This preliminary evidence suggests that lung transplant patients should be screened for abuse history and provided with appropriate treatment of survivorship issues to potentially improve their health outcomes from transplantation.

Personality Assessment Screener, Childhood Abuse, and Adult Partner Violence in African American Women Using Primary Care.

This study assessed the relationship between psychopathology with the Personality Assessment Screener (PAS) and childhood physical and sexual abuse and adult physical and sexual partner violence in a primary care sample of 98 urban-dwelling African American women. Patients completed the PAS, the Childhood Trauma Questionnaire, and the Conflict Tactics Scale. The PAS total score significantly correlated with all measures of childhood and adult abuse. Stepwise regression analyses revealed that PAS element scores of Suicidal Thinking and Hostile Control significantly predicted a history of childhood physical abuse; Suicidal Thinking, Hostile Control, and Acting Out significantly predicted a history of childhood sexual abuse; Suicidal Thinking, Negative Affect, and Alienation significantly predicted current adult partner physical violence; and Psychotic Features, Alcohol Problems, and Anger Control significantly predicted current adult sexual partner violence. The PAS appears to be a useful measure for fast-paced primary care settings for identifying patients who need a more thorough assessment for abuse.

Impact of growing up with a chronically ill sibling on well siblings' late adolescent functioning.

The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (M age = 18.78, SD = 0.83), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted.

Personality Assessment Screener in a Primary Care Sample of Low-Income Urban Women

The diagnostic efficiency of the Personality Assessment Screener (PAS; Morey, 1997) total score was evaluated using selected scales from the Patient Health Questionnaire (Spitzer, Kroenke, & Williams, 1999), the fourth edition of the Personality Diagnostic Questionnaire (Hyler, 1994), and the Alcohol Use Disorders Identification Test (Saunders, Aasland, Babor, DeLaFuente, & Grant, 1993) as reference standards. Complete data were collected from 110 women seeking treatment at an urban family medicine training clinic. Total PAS scores were effective in identifying patients with mood disorders, cluster B personality disorders, and alcohol use disorders, but the optimum cut scores were higher than the cut score of 19 recommended by Morey (1997). The 10 PAS element scores showed good convergent and discriminant correlations with the reference measures. These findings support the utility of the PAS to screen for major forms of psychopathology in an urban primary care setting.

High levels of psychological distress in MSM are independent of HIV status

This study assessed psychological distress (PD) in men who have sex with men (MSM) accessing primary health clinics in Australia. Relationships between PD, HIV status and substance use were explored. A cross-sectional convenience sample of 250 MSM completed the Personality Assessment Screener (PAS). One-third (n = 83) scored in the PAS clinically significant range, suggesting significant mental health symptoms. Negative Affect (27 per cent clinically significant), Suicidal Thinking (29 per cent clinically significant) and Amphetamine use significantly positively correlated with PD. There were no significant differences between HIV diagnostic groups on PD. A third of MSM displayed PD. Psychological screening may provide valuable information for improving the psychological well-being of MSM, regardless of their HIV status.

Validity of the Personality Assessment Screener in Veterans Referred for Psychological Testing

Screening for psychopathology is desirable in many settings where routine administration of full assessment batteries is not practical or cost efficient. The Personality Assessment Screener (PAS) is a 22-item self-report subset of Personality Assessment Inventory (PAI) items that was designed to screen for respondents who would be likely to achieve a clinically significant PAI profile. In this study, the PAS demonstrated classification rates in a sample of veterans referred for psychological evaluations that were similar to those described in initial validation studies. In addition, the three-item Negative Affect element of the PAS demonstrated impressive reliability and sensitivity given its brevity. These results support the use of the PAS as a screening tool to indicate clinically significant PAI profiles among veterans.

Axis I Screens and Suicide Risk in Jails

Mental health professionals conducting screenings in jail settings face formidable challenges in identifying inmates at risk for major depression and suicide. Psychologists often rely on correctional staff to provide initial appraisals of those inmates requiring further evaluation. In a sample of 100 jail detainees, the effectiveness of two specialized screens (the Referral Decision Scale and Mental Disability/Suicide Intake Screen or MDSIS) and one general screen (Personality Assessment Screener or PAS) was evaluated. For suicidal ideation, the MDSIS composite score evidenced promise (sensitivity = 1.00; specificity = 0.71). In ruling out major depression, the PAS Negative Affect subscale was useful for the inmate participants.

Psychological profiles among women with vulvar vestibulitis syndrome: a chart review

The purpose of this study was to assess the prevalence and type of psychological distress in women with vulvar vestibulitis syndrome (VVS), A retrospective chart review was conducted of all women receiving a diagnosis of VVS referred to a tertiary care facility during a two-year period. Brief psychological questionnaires, including the Personality Assessment Screener, Fear of Negative Evaluation Scale, Golombok-Rust Inventory of Sexual Satisfaction, and the Phobia Rating Scale were administered.Fifty-consecutive cases were reviewed along with 12-15 month follow-up data for 41 cases. Phobic anxiety to vaginal touch or entry was significantly higher in women with VVS than normative data. Fear of Negative Evaluation was a strong associated feature, and for 30% approached clinically significant levels. Twenty-six percent showed a moderate, while another 26% showed a mild clinically distressed profile. Negative affect and social withdrawal were among the most frequently endorsed variables. Improvement in allodynia and intercourse were both related to these psychological variables, and a multiple regression analysis supported the use of psychological instruments in addition to standard medical assessment.A subgroup of women with VVS display clinically significant broad based psychological distress that warrants additional assessment. The use of psychological questionnaires in addition to medical assessment of women with VVS may provide valuable information predictive of treatment needs and response.

An evaluation of a six‐week intervention designed to facilitate coping with psychological stress

Community dwelling Korean adults (N = 40) coping with the stress of severe mental illness were randomly assigned to a six-week differentiation furthering intervention (experimental) or a directed problem-solving treatment program (control) and administered pre- and posttreatment measures including the Morey Personality Assessment Screener (PAS) and Group Embedded Figures Test (GEFT). As predicted, the experimental group showed greater improvement on 6 out of 10 mental health subscales (PAS) and on the GEFT than the controls. For the entire sample, differentiation gainers showed more improvement on three PAS subscales compared with the no change or loss in differentiation groups. A three-month follow-up showed greater attendance at mental health appointments for the experimental group over controls and for total sample differentiation gainers over nongainers. Implications are discussed of this empirically tested model of a community intervention to facilitate coping with stress and enhancing competence.

Associations between the Holden Psychological Screening Inventory and the Personality Assessment Screener in a nonclinical sample.

Associations between two screening inventories of psychopathology were investigated using a sample of 156 first-year undergraduates. Analyses supported the reliability and validity of all Holden Psychological Screening Inventory scales, but only of some of the Personality Assessment Screener scales. Orthogonal dimensions of Depression, General Distress, and Antisocial Tendencies represented the common latent structure of the two inventories.