Use of the MMPI-2 in American Indians: II. Empirical correlates

R. W. Robin, R. L. Greene, B. Albaugh, A. Caldwell, and D. Goldman (2003) reported that members of 2 American Indian tribal groups had statistically significant higher T scores on several MMPI-2 clinical, content, and supplementary scales than did the MMPI-2 normative group. The present study investigated the empirical correlates of the MMPI-2 scales in these American Indian tribal members. There were a large number of significant correlates reflecting antisocial symptoms with Scales 4 (Psychopathic Deviate), 9 (Hypomania), Anger, and Antisocial Practices. There were even a larger number of significant correlates reflecting generalized distress and negative affect with Scales 7 (Psychosthenia), 8 (Schizophrenia), Anxiety, Obsessions, Depression, and Welsh Anxiety. The rationally derived MMPI-2 content scales generally had larger correlations with these constructs than the clinical scales. Thus, the differences reported by R. W. Robin et al. (2003), appear to reflect behaviors and symptoms that American Indians participants were experiencing rather than test bias.     

A cultural-contextual perspective on the validity of the MMPI-2 with American Indians

This study investigated the normative validity of the MMPI-2 with two distinct American Indian tribes. Differences occurred on 8 of the 13 basic validity and clinical scales (F, 1, 4, 5, 6, 7, 8, 9) between the MMPI-2 norms and both tribal samples. Elevated MMPI-2 scores of American Indians may not only reflect the possibility of psychological distress spurred by historical oppression and present adversity, but also an expression of a divergent worldview. Considering the context of the historical and social production of knowledge about American Indians, it is argued that researchers and practitioners, when interpreting MMPI-2 results for American Indians, should seriously consider their interpretive points of reference, which may be impacted by dominant cultural belief systems.     

The MMPI-2 With College Students

MMPI-2 responses of 515 male and 797 female college students from four universities were examined. College students were compared with the new MMPI-2 normative sample on the clinical and validity scales. The reliability of MMPI-2 scores of college students were compared with reliabilities of the MMPI-2 normative sample. The results indicated that college students respond to the MMPI-2 in a highly similar manner to the MMPI-2 normative sample. Mean score differences on the validity and clinical scales were within 1 to 3 T-score points on most scales, and the frequency distributions of the college students were highly similar to those of the MMPI-2 normative samples, Slight differences obtained on the Pt, Sc, and Ma scales may reflect the younger age of the college groups compared to the MMPI-2 normative groups. The MMPI-2 norms were shown to be appropriate for use with college subjects. Test-retest correlation coefficients obtained from college students who were administered the MMPI-2 on two occasions showed reliabilities comparable to those found for the MMPI-2 normative sample.     

A comparison of African American and White American veteran MMPI-2 profiles

The present study compared a matched sample of 180 African American and 180 White American veterans who completed the MMPI-2 as a part of their evaluation while receiving inpatient psychiatric treatment. Findings indicated no significant multivariate or univariate effects associated with race on the basic validity and clinical scales, a significant multivariate effect but no significant univariate effects associated with race across the supplementary scales. Overall the two groups had very similar mean profiles across the basic validity, clinical, and supplementary scales. Comparison of the two groups on the content scales yielded a significant multivariate and significant univariate effects with African Americans scoring higher on the FRS, BIZ, CYN, and ASP scales. Because the two groups differed in terms of frequency and type of drug abuse, follow-up 2 x 2 univariate analyses of variance were conducted for the FRS, BIZ, CYN, and ASP content scales comparing participants classified in terms of presence or absence of a primary or secondary drug abuse diagnosis by race. A significant main effect associated with drug abuse was obtained for ASP. Results are discussed and considered in light of earlier research on the MMPI-2 and race. Content scale differences are also discussed in terms of possible differences in worldview.     

MMPI-2 in the inpatient assessment of women with eating disorders

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) reveals similar patterns across all Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) eating-disorder diagnoses. In this study, 550 women with eating disorders completed the MMPI-2. The 3 highest mean elevations for all eating-disorder diagnostic groups occurred on the same scales in the same order: 2, 7, and 3. The modal code for all groups was 2-7/7-2. However, multivariate analyses using the 16 validity and clinical scales, as well as the 27 content and supplementary scales, indicated that the MMPI-2 also distinguishes among eating disorders, especially in that patients with restricting anorexia report less psychopathology than other groups. These results are compared with the results of past eating-disorder research that used the older MMPI (Hathaway & McKinley, 1983).     

Effects of acculturation on the MMPI-2 scores of Asian American students

The use of the MMPI-2 (Butcher, Dahlstron, Graham, Tellegen, & Kaemmer, 1989) with minorities has been questioned due to potential misinterpretations related to cultural differences. This study examined acculturative differences among Asian American college students and their scores on the validity and clinical scales. A sample of Asian American students (n = 90) was assigned to groups based on acculturation level. Analysis of variance tests indicated that low-acculturated, bicultural, and high-acculturated Asian Americans yielded different profiles. Compared to a matched White student sample, low-acculturated Asian Americans scored significantly higher on 9 scales, and bicultural Asian Americans had 6 significantly different scores. These differences were clinically interpretable with a range from 6.46 to 21.65 T-score points. High-acculturated Asian Americans did not differ from Whites. Cultural variables to be considered when interpreting Asian American profiles are discussed.     

A comparison of MMPI-2 validity in African American and Caucasian psychiatric inpatients

This study investigated ethnic differences on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in 229 African American and 1,558 Caucasian psychiatric inpatients. Mean differences were found on several MMPI-2 validity and clinical scales. These were generally consistent with differences between the groups, indicated by the available extratest criterion data. To identify potential bias, the authors conducted 65 step-down hierarchical multiple regression analyses, predicting conceptually relevant clinical criteria from either MMPI-2 clinical or content scales for each gender. A number of MMPI-2 scales evidenced bias reflecting minor underprediction of psychopathology in African Americans. It is important to note that, in almost all cases, the magnitude of these differences was small and not clinically significant.     

An evaluation of the MMPI-2 and MMPI-a true response inconsistency (TRIN) scales

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) True Response Inconsistency (TRIN) scales are measures of acquiescence and non-acquiescence included among the standard validity scales on these instruments. The goals of this study were to evaluate the effectiveness of these scales in detecting varying degrees of acquiescence and non-acquiescence and to evaluate cutoff scores for clinical use. After the removal of invalid protocols from the MMPI-2 and MMPI-A normative samples, each normative sample was randomly divided in half. For each measure, one half of the normative sample served as a comparison group and the other half was modified with increasing degrees (10%, 20%, 30%, 40%, and 50%) of randomly inserted true or false responses. The results for a 9.1% base rate of acquiescence or non-acquiescence provide support for TRIN cutoff scores at or near those presented in the MMPI-A and MMPI-2 manuals.     

Couples in marital distress: a study of personality factors as measured by the MMPI-2

This study examines the relationship between Minnesota Multiphasic Personality Inventory-2 (MMPI-2) measured personality characteristics and marital distress and provides empirical validation for using the MMPI-2 with a marital therapy population. Studied were 150 couples in marital therapy and 841 normal couples who participated in the MMPI-2 restandardization study. The MMPI-2, a biographical form, a partner rating form, and the Dyadic Adjustment Scale (DAS) were administered to all couples. The marital counseling group resembled previous marital counseling samples studied with the MMPI and scored significantly higher than the normative sample on several MMPI-2 scales. Relationships between the DAS and MMPI-2 clinical and content scale scores are reported. The Psychopathic Deviate (Pd) clinical scale and Family Problems (FAM) content scale were the most powerful group discriminators and strongest correlates of the DAS; their use as indices of marital distress is tested. The meaning of Pd as an index in assessing personality factors in marital distress is explored.     

The MMPI-2: A Contemporary Normative Study of Midwestern Family Medicine Outpatients

For more than 60 years it has been known that profiles from the Minnesota Multiphasic Personality Inventory (MMPI), obtained from medical patients, are elevated when scores are plotted using general population norms. These elevations have been most apparent on the neurotic triad (NTd), the first 3 clinical scales on the MMPI profile. More than 45 years have passed since a nonreferred, normative sample of MMPIs was established from 50,000 consecutive medical outpatients. We present comparable but contemporary normative data for the revised MMPI (MMPI-2) based on a nonreferred sample of 1,243 family medicine outpatients (590 women; 653 men). As true for the original MMPI, contemporary medical outpatients have profiles that are significantly different, clinically and statistically, from the general population norms for the MMPI-2. This is particularly evident in elevations on the NTd. New normative tables of uniform medical T (UMT) scores were developed following the procedures used to create the uniform T scores for the MMPI-2. Measures of internal consistency are reported; test-retest reliability was established over a mean of 3.7 weeks, and results characterizing the stability of the validity and clinical scales are presented.     

Detection of a Cry for Help on the MMPI-2: an analog investigation

We compared Minnesota Multiphasic Personality Inventory (MMPI-2) results from 2 groups of mildly to moderately disturbed psychiatric outpatients (N=60) answering under either Standard or Cry for Help instructions. Results from previously completed intake MMPI-2 protocols were obtained for each participant. The two groups were comparable on intake MMPI-2 variables and demographic characteristics. Analysis of feedback data from the second, experimental observation indicated that the two groups had equivalent self-estimates of understanding of their role and success in simulating their role. Significant differences were found between the two groups on their experimental MMPI-2 protocols. The Cry for Help group had significantly higher scores on F, F-K, Fb, Ds2, and Fp scales as well as significantly lower scorns on the K scale. The Cry for Help group also had significantly higher scores on all clinical scales with the exception of 5, which was not tested. Cutting scores derived by Rogers, Sewell, and Ustad (1995) for the detection of a Cry for Help in outpatients were cross-validated with fairly positive results. Although these results are promising, particularly in light of the shrinkage expected on cross-validation, further research is needed in this area.     

MMPI-2 profile code types and measurement error

We studied simulated MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) code type stability and change expected with measurement error for 12 MMPI-2 well-defined mean code type profiles. Profile scores for the 2 scales defining the code type were systematically varied to represent target code type profiles at 9 different levels of T-score profile definition. We randomly generated samples of 50 simulated, estimated true score profiles at each level of profile definition for each code type around the estimated true scores for each scale at each level of profile definition. Two sets of simulated profiles were developed. The first simulation was based on the reported means, test-retest reliabilities, and the standard errors of measurement for the MMPI-2 normative group. The second simulation was based on the means, standard deviations, and estimated retest stability for a clinical group of psychiatric patients. We calculated frequencies and percentages of simulated profiles with the highest estimated true scores on the same 2 scales as the original code type profile. Percentages of simulated profiles with the same 2 highest scales as the original code type profiles increased from 27% to 37% for the 3-point level of definition, 37% to 49% for the 5-point definition, 46% to 61% for 7-point definition, 63% to 78% for 10-point definition, 78% to 89% for 13-point definition, 83% to 93% for 15-point definition, and greater than 90% for profile definition greater than 15 points.     

The Consistency Between Scores of the Harris-Lingoes Subscales of the MMPI and MMPI-2

This study investigates the consistency between scores of the Harris-Lingoes subscales of the Minnesota Multiphasic Personality Inventory (MMPI) and the MMPI-2. College students (200 men and 200 women) were randomly assigned to either the original to original condition, where they took the MMPI twice, or the original to revised condition, where they took the MMPI and MMPI-2. Results indicate relative consistency in the item and normative changes between the Harris-Lingoes subscales of the MMPI and MMPI-2. These results suggest that the recommendation of a clinical significance score of T > 65 for the MMPI-2 scales should not be applied to the Harris-Lingoes subscales.     

MMPI-2 scores of patients with insomnia

Although the MMPI-2 has been employed since 1989, to date no study has been reported on its use with patients with insomnia. The MMPI-2 was administered to 104 insomnia patients. The T scores of all the MMPI-2 scales fell below the cut-off score of T = 65. Although the group profile was within the normal range, the percentages of patients who had MMPI-2 scores above T = 65 for each scale indicated that a substantial portion of the insomnia patients obtained elevated scores, particularly in the Hs, D, Hy, and Pt scales. Thus, the results suggest that many of the insomnia patients exhibit psychological distress and would benefit from brief psychological interventions, such as sleep hygiene education and relaxation training. In view of the large number of insomnia patients who obtained abnormal MMPI-2 scores, a psychological measure such as the MMPI-2 remains an important assessment tool in identifying insomnia patients who may need extensive psychotherapeutic intervention.     

Four-Month Test-Retest Reliability of the MMPI-2 With Normal Male Clergy

This investigation examined the test-retest coefficients and absolute score changes with the Basic, Supplementary, and Content scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants were 111 active male clergy who were not receiving mental health services at the time of their participation and who completed the MMPI-2 on two occasions separated by 4 months. A repeated measures multivariate analysis of variance for the three groups of scales revealed nonsignificant changes in mean T scores. In general, the test-retest coefficients obtained were similar to those reported in the MMPI-2 manual by Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer (1989) and by Spiro, Butcher, Levenson, Aldwin, and Bosse (1993). Increases or decreases of 3 to 6 T-score points were observed for the majority of the scales, and instances in which T-score changes exceeded 10 points were observed on every scale. In sum, the test-retest reliability of the majority of MMPI-2 scales, as represented in this nonclinical sample, appears acceptable and compares favorably with the original MMPI.     

Confidence intervals for the MMPI-2

The confidence intervals for the Minnesota Multiphasic Personality Inventory (MMPI-2) clinical scales were investigated. Based on the clinical scale reliabilities published in the MMPI-2 manual, estimated true scores, standard errors of measurement for estimated true scores, and 95% confidence intervals centered around estimated true scores were calculated at 5-point MMPI-2 T-score intervals. The relationships between obtained T-scores, estimated true T-scores, scale reliabilities, and confidence intervals are discussed. The possible role of error measurement in defining scale high point and code types is noted.     

Personality and aging: a study of the MMPI-2 among older men

We examined whether separate norms for older men are necessary for the revised Minnesota Multiphasic Personality Inventory (MMPI-2). Scores from 1,459 men in the Normative Aging Study (NAS) (age: M = 61.27, SD = 8.37) were contrasted with those from 1,138 men from the MMPI Restandardization Study (age: M = 41.71, SD = 15.32). Results showed that scores on the MMPI-2 validity, clinical, and content scales for the NAS men were highly similar to those from the MMPI-2 Restandardization sample. There were also few differences between the two groups at the item level. Within-sample analyses revealed some differences between age groups. However, the magnitudes of these differences were small and may represent the single or combined effects of cohort factors and age-related changes in physical health status rather than age-related changes in psychopathology per se. We concluded that special, age-related norms for the MMPI-2 are not needed for older men.     

Psychometric evaluation of the MMPI-2 Restructured Clinical scales in two Dutch samples

In this article, we evaluate internal validity, internal consistency, and test-retest reliability of the MMPI-2 Restructured Clinical (RC) scales in the Dutch MMPI-2 normative sample (N = 1,244) and a Dutch outpatient psychiatric sample (N = 1,066). We pay special attention to a critique regarding construct drift of RC3 and the redundancy of the RC scales with existing MMPI-2 scales. The results indicate that the RC scales in both samples show comparable or better internal consistencies than the Clinical scales. Also, in both samples, the RC scales demonstrate lower scale-level intercorrelations than the Clinical scales. As to the structural characteristics, principal component analysis of the RC scales provided a clearer pattern than an analysis of the Clinical scales. Furthermore, mean raw scores on the RC scales for men in the Dutch normative sample corresponded highly with those in the U.S. normative sample except for RC2 and RC4. Less correspondence was found for women. Overall, we conclude that the RC scales show satisfactory reliability and promising internal validity in our Dutch samples. We suggest that U.S. validation studies on the RC scales may be generalized to the Dutch-language version of the MMPI-2 RC scales.     

MMPI-2 characteristics in a chronic pain population

This study investigated the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) characteristics of 209 chronic pain patients in an inpatient pain treatment program. Patients completed the MMPI-2, Zung Self-Rating Depression Scale, and Oswestry Low Back Pain Disability Questionnaire. Participants in this sample were matched with comparison participants from the MMPI-2 normative sample on the demographic variables gender, age, and ethnicity. Chronic pain patients reported higher levels of general maladjustment and affective distress than did the normative control group, including more anxiety, depressive symptomatology, and somatic complaints. The MMPI-2 basic scales Hypochondriasis, Depression, and Hysteria were the most useful discriminating factors between chronic pain patients and normal controls, and the content scales Health Concerns and Depression showed significant elevations for the chronic pain group. The 1-3/3-1, 1-2/2-1, and 2-3/3-2 code types accounted for more than two thirds of all two-point classifications for the chronic pain group, and four cluster analysis types classified nearly half of all of these protocols.