comparative validity of mmpi-2 scores of american and caucasian mental health center clients

7/30/2019 Comparative Validity of Mmpi-2 Scores of American and Caucasian Mental Health Center Clients

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Psychological Assessment1997, Vol. 9, No, 4, 464 -470

Copyright 1997 by the American Psychological Association, inc.I040-3590/97/S3.00

Comparative Validity of MMPI-2 Scores of African American andCaucasian Mental Health Center Clients

John L. McNulty, John R. Graham, Yossef S. Ben-Porath, and L.A.R. SteinKent State University

The comparative validity of Minnesota Multiphasic Personality Inventory2 (MMPI-2) scores forAfrican American ( = 123) and Caucasian (n = 561) clients from a community mental healthcenter was investigated by contrasting mean MMPI-2 scores and correlations between those scoresand conceptually related therapist rating scales for the 2 groups. The African American men scoredsignificantly higher on the Lie scale and Fears content scale than did their Caucasian counterparts,and the African American women scored higher than Caucasian women on Hypomania. Caucasianwomen scored higher on the Low Self Esteem content scale. Correlations between MMPI2 scoresand patient description form ratings were not significantly different between racial groups, indicatingthat the differences in MMPI-2 mean scale score elevations reflect actual differences in clientpsychopathology. There was no evidence of test bias in the current study. Suggestions are made foradditional research.

Since the Minnesota Multiphasic Personality Inventory(MMPI; Hathaway & McKinley, 1943) was published morethan 50 years ago, the appropriatenessof its use with minorityethnic groups has been widely studied and reviewed (Dahl-strom &Gynther, 1986; Dahlstrom, Lachar, &Dahlstrom, 1986;Greene, 1987; Gynther, 1972, 1979, 1981, 1989; Gynther &Greene, 1980; Pritchard & Rosenblatt, 1980). Timbrook andGraham (1994) indicated that much of the debate had centeredaround differences in mean scale scores, with some arguingthat mean differences reflect an overpathologizing of minorities(e.g., Gynther & Green, 1980). Although reviewers have foundresearch reporting significant differences between AfricanAmericans and Caucasians on Scales 4 (Psychopathic Deviate),8 (Schizophrenia), 9 (Hypomania) and the Infrequency (F)scale (Dahlstrom & Gynther, 1986; Graham, 1993; Greene,1987), and Scale 7 (Psychasthenia) and the Lie (L) scale(Pritchard & Rosenblatt,1980), for the most part there has beenan inconsistent pattern of differences (Timbrook & Graham,1994).

With respect to the Minnesota Multiphasic Personality Inven-tory2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, &Kaemmer, 1989), Timbrook and Graham (1994) found signifi-cantly higher mean scale scores for African Americans thanCaucasians on Scale 8 for men and Scales 4, 5 (Masculinity-Femininity), and 9 for women in the MMPI-2restandardizationsample. Frueh, Smith, and Libet (1996) found higher scores forAfrican Americans in a sample of patients with combat-relatedposttraumatic stress disorder onScales6 (Paranoia)and 8. Ben-

John L. McNulty, John R. Graham, Yossef S. Ben-Porath, and L.A.R.Stein, Department of Psychology, Kent State University.

Portions of this article were presented at the 31st Annual MMPI-2and MMPI-A Symposium in Minneapolis, Minnesota, in June 1996.

Correspondence concerning this article should be addressed to JohnL. McNulty, Department of Psychology, Kent State University, Kent,Ohio 44242. Electronic mail may be sent via the Internet to jmcnultykent.edu.

Porath, Shondrick, and Stafford (1995) found in a forensiceval-uation sample significantly higher Cynicism (CiW) and Antiso-cial Practices (ASP) content scale scores for African Americans.Again, no consistent pattern of mean scale differences isapparent.

After identifying some methodological problems inpreviouslypublished MMPI research, Greene (1987) concluded that therewere more findings of no mean differences between AfricanAmericans and Caucasians than there wereof differences. Further-more, of the studies in which significant differences were found,one third had differences of less than 5 T-score points. Greene(1987) suggested that such differences, although statistically sig-nificant, were not clinically meaningful. Because many of thestudies did not control for demographic variables, it was not clearwhether some of the differences in MMPI scores could be attrib-uted to such variables (Greene, 1987).

Dahlstrom, Lachar, and Dahlstrom (1986) reviewed severalstudies across normal, criminal, and psychiatric populations.After concluding that there was little support for bias againstAfrican Americans, they offered several thoughtful commentsconcerning possible influences on scale score differences. AsGreene (1987) would also note, methodological problems, suchas varying definitions of ethnicity, and the role of moderatorvariables, such as socioeconomic status (SES) and age, wereoften not considered. At lower SES levels, African Americansdiffered from Caucasians primarily on Scales F, 8, and 9;whereas at higher SES levels, the differences disappeared (Dahl-strom et al., 1986). Furthermore, younger individuals are oftenmore sociable, impulsive, cynical, and mistrustful of authority;whereas older persons are not so rebellious, competitive, oralienated. Dahlstrom et al. (1986) reported that it is primarilythe youngermen and womenwho show the differences that havebeen ascribed toAfrican Americans in general. Features that donot apply with equal accuracy to all members of a minoritygroup should not be attributed solely to membership in thatgroup. Similarly, scale score differences stemming from adapta-tional difficulties arising from educational limitations, lack of

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A COMPARATIVE STUDY 465

occupational skills and training, and lower income are not evi-dent in minority members who have opportunities equivalent tothose of Caucasians.

Dahlstrom et al. (1986) suggested that test-taking competen-cies affected by lower education levels result in generally higherMMPI scores. They indicated further that conditions precedingentry into the mental health system may contribute to observedscale differences. The alienation and suspicion that are oftenattributed to African Americans may prolong the period priorto treatment seeking, leading to greater pathology at the time oftreatment. In criminal justice samples, differences in the wayAfrican Americans areprocessed through the system mayleavelasting perceptions, beliefs, and expectations, altering attitudesthat are subsequently reflected in score differences.

Dahlstrometal.'s (1986) comments concerning criminal pop-ulations are supported by Ben-Porath et al. (1995). They sug-gested that differences between African Americans and Cauca-sians on the CYN and ASP content scales were meaningful andreflected attitudinal differences such as greater skepticism ofpeoples' motives.

Researchers (Pritchard &Rosenblatt, 1980; Timbrook &Gra-ham, 1994)have emphasized that a comparison of means acrossracial groups is not sufficient to indicate whether scores forone group are biased. Studies examining the relation betweenMMPI-2 scores and extratest criteria are needed to determinewhether mean score differences between racial groups indicatetest bias or reflect actual differences in symptomatology andpersonality characteristics that are deserving of treatment con-sideration. As Dahlstrom et al. (1986) and Ben-Porath et al.(1995) suggested, mean differences could result for a varietyof reasons that cannot be discounted as instances of bias.

Little research, though, had been conducted to determinewhether MMPI scores were comparatively valid for minoritygroups and Caucasians (Greene, 1987; Pritchard & Rosenblatt,1980; Timbrook & Graham, 1994). Earlier reviews of predictiveaccuracy (Greene, 1987; Pritchard & Rosenblatt, 1980) con-cluded that the MMPI was equally valid for use with AfricanAmericans and Caucasians. Timbrook and Graham (1994), us-ing a subset of African American and Caucasian participantsfrom the MMPI-2 normative sample matched for age, educa-tional background, and family income, found no differentialaccuracy in the prediction of relevant extratest characteristics,even though African Americans had higher mean scores onScales 4, 5, 8, and 9. They called for additional research thatincluded MMPI-2 scales they could not evaluate, as well asusing different populations such as psychiatric inpatients, psy-chotherapy outpatients, substance abuse patients, or forensicsamples.

The purpose of the current study was to extend Timbrookand Graham's (1994) research by analyzing die comparativevalidity of MMPI-2 scale scores in a sample ofAfrican Ameri-can and Caucasian clients of a mental health center. If the rela-tions between MMPI-2scale scores and relevant extratest crite-ria differ between racial groups, racial group membership canbe said to function as a moderator variable, reflecting evidenceof test bias.

MethodParticipants

Data were collected at a large community mental health center innortheast Ohio. As is the case in most community mental health centers,

a variety of treatment programs was available to the clients, includingpartial (day) hospitalization and individualor group outpatient counsel-ing or therapy. A specialized program was available for dual-diagnosisclients involving individual counseling; group education or therapy; fam-ily education or counseling; support groups; and referral to AlcoholicsAnonymous, Narcotics Anonymous, or Al-Auon. Another specializedprogram was available for persons referred by the courts because offamily or child abuse, and a diversion program for first-time shopliftersalso was available. A staff of 55 mental health professionals includedpsychologists, psychiatrists, registered nurses, licensed professional clin-ical counselors, social workers, and certified chemical dependencycounselors.

The sampleused inthis study was a subset of a larger samplecollectedby Graham, Ben-Porath, and McNulry (in press). The larger sampleincluded all persons seeking services at the mental health center fromApril 1991 through December 1992. African American and Caucasianclients who produced valid MMPI-2 profiles (defined as having 30 orfewer items omitted, Variable Response Inconsistency [VRIN] scale Tscore equal to or less than 80, Thie Response Inconsistency [TRfN] rawscore greater than 5 and less than 13, F raw score less than 28 for menand 30 for women, and f-back [Fb] raw score less than 24 for menand 25 for women) and for whom therapist ratings were available wereidentified as candidates for this study. Of the participants in the largersample, 684 met these criteria and were included in the current study.The sample consisted of 123 African Americans (81 women and 42men) and 561 Caucasians (336 women and 225 men).

Data regarding the participants' demographic characteristics, mentalhealth history, and mental status are presented in Tables 1 and 2. Theonly significant differences were found between African American andCaucasian men on the marital status and current medications variables.TheAfrican American male participants were less likely to be currentlymarried and more likely to have never been married than the Caucasianmen. Significantly more African American than Caucasian men werecurrendy taking antipsychotic medications. For both men and women,there were no differences between races in age, years of education,employment status, current level of functioning, previous treatment, or

Table 1Demographic Characteristics of the Sample

Men Women

VariableAfrican African

Caucasian American Caucasian American(n = 225) (n = 42) (n = 336) (n = 81)

AgeMSD

Years of educationMSD

Marital status (%)'MarriedWidowedDivorcedSeparatedNever married

Employment status (%)Full timePart timeUnemployedDisabledOther

33.4810.4512.222.08

222

229

452713438

15

33.109.76

11.901.9150

121964191449118

32.7110.1712.212.07

243

2610372115455

14

33.8810.3012.381.86

163

2814401213567

12' Difference issignificant for men, xz(4, N =267) = 13.857,p < .008.


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466 McNULTY, GRAHAM, BEN-PORATH, AND STEIN

Table 2Mental Health History and Status of the Sample

Men

VariableCurrent level of functioning (Axis V)

MSD

Previous psychiatric hospitalizations(%)

Previous outpatient treatment (%)Current medications (%)

AntipsychoticAntidepressantLithiumAntianxietyOther

Any Axis I diagnosis (%)Specific Axis I diagnoses (%)

Adjustment disordersDepressionAnxiety disordersSubstance abuse/dependence

Any Axis II diagnosis (%)

Caucasian(n = 225)

63.3010.4125453

1446

12992621181530

AfricanAmerican(n = 42)

62.937.74

233710"

707

221002917101021

Women

Caucasian(n = 336)

62.859.04

26603

182

1417

1003726171032

AfricanAmerican(n = 81)

64.658.99

31531

1959

191003030115

25 Difference is significant, x2(l, N = 267) = 4.671, p < .031.

current Axis I or Axis II diagnoses. There were no differences for thewomen on marital status or on any of the current medication variables.

tion, marital status, employment status, race), selected information con-cerning mental health history, and diagnostic impressions.

InstrumentsMMPI-2. TheMMPI-2, a revised and updated version of the origi-

nal MMPI, is a 567-item personality inventory. The MMPI-2 includesthe validity and clinical scales of the original MMPL as well as newcontent, supplementary, and validity scales. The internal consistenciesand test-retest reliabilities of the MMPI-2 scales are acceptable andare reported in the test manual (Butcher et ah, 1989) along with somevalidity information.

Patient description form. The patient description form (PDF) wasdeveloped specifically by Graham, Ben-Porath, and McNulty (in press)for their outpatient study. Its 187 items are rated on a 5-point Likertscale (1 = not at all to 5 = very high} by therapists who are asked todescribe the personality and symptomcharacteristicsof their clients. Theitems represent a comprehensive list of MMPI and MMPI-2 extratestdescriptors reported by Friedman, Webb, and Lewak (1989); Graham(1990); and Greene (1991). The list was compiled by extracting all ofthe profile descriptors contained in these three sources and eliminatingthose that were redundant or inconsistent.

Using acombined empirical-rational approach,25 scales were devel-oped to assess the major content dimensions of the PDF.1 Of these scales,13were included in the current study. Those 13PDF scales are (followedby coefficient alpha based on the original, larger sample for men andwomen, respectively) Somatic Symptoms (.92, .91), Depressed (.86,.87), Angry Resentment (.92, .90), Antisocial (.90, .87), Anxious (.87,.87), Insecure (.87, .91), Agitated (.69, .75), Introverted (.84, .86),Psychotic Symptoms (.80, .87), Aggressive (.82, .77), Critical-Argu-mentative (.91, .90), Passive-Submissive (.85, .86), andFamily Prob-lems (.89, .90).

Intake form. An intake form was designed for the larger study (Gra-ham et ah, in press) and completed by a trained intake worker on thebasis of a personal interview with each client.2 Data from the intakeform included in this study were demographic information (age, educa-

ProcedureIntake forms were completed at the time clients requested services.

Each client completed the MMPI-2 shortly after his or her intake inter-view (median number of days between intake and completion of theMMPI-2 was 7 days). After the third therapy session, each client'stherapist completed the PDF. Therapists were unaware of the results ofthe MMPI-2 at the time the PDF was completed. The median elapsedtime between administration of the MMPI-2 and the completion of thePDF was 38 days.

Data AnalysesMean scores were computed by race within gender for the MMPI-2

validity, clinical, and content scales and for the 13 PDF scales includedin theseanalyses. Although differences in meanscale scores alone cannotaddress the issue of bias, clinically meaningful differences of 5 or morer-score points (Greene, 1987) can provide valuable information con-cerning the relative level of functioning of the two racial groups at thetime the assessments were made, assuming the scales are unbiased.

The detection of bias, or more generally stated, the influence of moder-ator variables, is accomplished by analysis of the potential for errors inprediction rather than comparison of mean scores across groups (Tim-brook &Graham, 1994). Baron and Kenny (1986) have recommendedthat this be accomplished by testing the significance of differences be-tween independent variable and dependent variable correlation coeffi-cients. A statistically significant difference in correlation coefficientsbetween African Americans and Caucasians would suggest that race

1 A copy of the PDF and the list of items included in each of the 24scales are available from the authors.

2 A copy of the intake form is available from the authors.


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A COMPARATIVE STUDY 467

functions as a moderator that alters the relationship between the indepen-dent and dependent variables.

The detection of at least a moderate effect size (Cohen, 1988) wasconsidered appropriate for this study. A power analysis indicated thatalthough there was sufficient power to conduct racial group mean scorecomparisons separately by gender, there was insufficient power to detecta moderate effect size in the correlational analyses. Consequently, datafor men and women were combined in the correlational analyses.

A correlation for a particular MMPI-2 and PDF scale pair was com-puted if the two scales were judged a priori to be conceptually related.We reviewed previously reported descriptors for each of the MMPI-2clinical and content scales (Butcher &Williams, 1992; Graham, 1993)and paired each scale with one or more PDF scales judged to haverelevant content. MMPI-2 and PDF scales that could not be suitablymatched were not included in the correlational analyses. In addition, ifthe correlation between the MMPI-2/PDF pair was not statisticallysignificant for at least one of the two study groups (African Americanor Caucasian), the pair was dropped from further analysis. For each ofthe two study groups, the MMPI-2/PDF correlation was transformedinto a Fisher's z, and the Z statistic and associated two-tailed probabilityfor the difference was computed.

ResultsTable 3 reports means, standard deviations, and effect sizes

for each of the MMPI-2 validity, clinical, and content scales,and for the PDF rating scales included in the study. A potentialproblem concerned missing ratings for some of the PDF scales.For the study sample, the percentage of missing PDF scale scoresranged from 18.6% (for the Aggressive scale) to 2.3% (forthe Introverted scale). For the PDF Psychotic Symptoms andInsecure scales, there was a significant difference in the numberof missing scores between the Caucasian and African Americanwomen: 3.3% vs. 11.1%, respectively, for Psychotic Symptoms,X 2 ( 1 , A T =417) = 8.78,p = .003; 3.6% vs. 14.8% for Insecure,x2

(1, N =417) = 15.21, p < .001. Given the relatively lowrate of missing scale scores and the general lack of significantdifferences, the results of the mean comparisons should not bematerially affected.

Corrections for familywise error were made separately forthe validityand clinical scales, content scales, and PDF scales,resulting in significance levels of p < .004, p < .003, andp

comparative validity of mmpi-2 scores of american and caucasian mental health center clients

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