Presentation M P21

M P21 (Poster Presentation):
Development of an instrument assessing symptom exaggeration in patients receiving disability benefits secondary to mental health disorders

Presented by: Shanil Ebrahim


Ebrahim S1,2,3,4, Bance S5, Montoya L6, Mulla2, Kamal El Din M7, Malachowski C8, Guyatt GH1,9, Busse JW1,2

  1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
  2. Department of Anesthesia, McMaster University, Hamilton, Canada
  3. Department of Medicine, Stanford University, Stanford, USA
  4. Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Canada
  5. Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education
  6. University Health Network, Toronto, Ontario, Canada
  7. Ain Shams University, Faculty of Medicine, Cairo, Egypt
  8. Department of Rehabilitation Science, University of Toronto, Toronto, Ontario Canada
  9. Department of Medicine, McMaster University, Hamilton, Canada



Symptom exaggeration is a significant issue in patients receiving disability benefits secondary to mental health disorders. Measures designed to detect exaggeration of symptoms are valuable for informing more accurate diagnoses, which can impact claim decision-making, both for disability claim approval and patient management. Our objectives were: 1) to complete a systematic review to identify measures that assess symptom exaggeration in mental health disorders, and 2) using the results from the review, develop an instrument assessing symptom exaggeration in individuals receiving disability benefits secondary to mental health disorders.


We completed searches of MEDLINE and PSYCInfo from inception of each database to June 2013, to identify primary studies evaluating symptom exaggeration among patients with mental health disorders. Teams of reviewers completed title and abstract screening of citations, full text review of potentially eligible articles, data extraction, and quality assessment of eligible studies. Findings from our review and input from content experts (psychologists, methodologists, occupational therapists, chiropractors and insurance administrators) informed the development of a summary instrument.


We identified 8435 unique citations; 102 studies were eligible. Studies reported on 55 different instruments to assess symptom exaggeration; 42% of studies used the MMPI-2. Quality of studies ranged from low to moderate. Development of the instrument is in progress. Items that comprise our summary instrument will be presented at WDPI 2014 in September.


Multiple instruments are available to assess symptom exaggeration among patients presenting with mental illness; however, very few instruments have shown ideal psychometric properties. We are hopeful that our instrument will facilitate the testing and development of a novel tool with superior sensitivity and specificity for detecting symptom exaggeration.

Schedule Details

Monday September 29
12:45 - 13:45 Poster Viewing
Session: Disability measurement