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Bias is said to occur when validity is better for one group than another (e.g., when diagnoses are more valid for male or female clients). This article provides (a) a methodological critique of studies on race bias and gender bias in diagnosis and (b) a narrative review of results from studies with good internal validity. The results suggest that race bias occurs for the diagnosis of conduct disorder, antisocial personality disorder, comorbid substance abuse and mood disorders, eating disorders, posttraumatic stress disorder, and the differential diagnosis of schizophrenia and psychotic affective disorders. Other results suggest that gender bias occurs for the diagnosis of autism spectrum disorder, attention deficit hyperactivity disorder, conduct disorder, and antisocial and histrionic personality disorders. The way that symptoms are expressed (e.g., Black cultural expressions of depression) appears to have a significant effect on diagnoses. It may be possible to decrease bias by expanding the use of (a) mental health screening, (b) self-report measures including some psychological tests, (c) structured interviews, and (d) statistical prediction rules. Finally, evidence exists that (a) the diagnosis of personality disorders should be made using dimensional ratings and (b) training in cultural diversity and debiasing strategies should be provided to mental health professionals.

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Thirty years ago, Dawes, Faust, and Meehl (1989) argued that mental health professionals should routinely use statistical prediction rules to describe and diagnose clients, predict behaviors, and formulate treatment plans. Subsequent research has supported their claim that statistical prediction performs well when compared to clinical judgment. However, many of the things we thought we knew about statistical prediction have changed. The purpose of this literature review is to describe methodological advances in statistical prediction. Three broad areas are covered. First, while statistical prediction rules are valuable for criterion-referenced assessment (e.g., predicting violence, recidivism, treatment outcomes), they are valuable only for some norm-referenced assessment tasks (e.g., diagnosis but not describing personality and psychopathology). Second, statistical prediction is particularly prominent for the prediction of violence and criminal recidivism. Results from this area will be used to describe the validity of traditional clinical judgment, structured professional judgment, and statistical prediction. The results support the use of both structured professional judgment and statistical prediction. The effect of allowing professionals to override statistical predictions consistently led to lower validity. Third, issues in building statistical prediction rules are described, including the assignment of weights to predictors, the emergence of new statistical analyses (e.g., machine learning), and the role of theory. As research has progressed, statistical prediction has become one of the most exciting areas of psychological assessment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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Screening for public safety positions (e.g., police officers, fire fighters, military service members) is a difficult and challenging task. Notably, the military has been widely criticized because of the general lack of an empirically based system or program for mental health screening. The purpose of the present study is to describe the use of statistical prediction rules for this task. Prediction rules were derived and validated using U.S. Air Force (USAF) recruits in basic military training (N = 50,322). Items from the Lackland Behavioral Questionnaire were used as predictors. General attrition (discharge for any reason before completing term of service) and disciplinary offenses (including criminal charges) were used as outcomes. For trainees in the top 2% or 1% of the general attrition prediction rule, 63% and 68% were discharged before they completed their first 4 years. The base rate was 25%. Similarly, for trainees in the top 2% or 1% of the disciplinary offenses prediction rule, 35% and 39% had a significant disciplinary offense over the following 4 years. The base rate was 15.5%. The results suggest that we may be able to use biographical data inventories and statistical prediction rules to identify a small percentage of trainees in public safety fields with significant mental health or behavioral histories who are at elevated risk for general attrition and disciplinary offenses. (PsycINFO Database Record

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Results are presented for the largest study (N = 53,692) ever conducted on the 25-item Connor-Davidson Resilience Scale (CD-RISC), a popular measure of resilience. We examined the internal consistency of the CD-RISC items and associated mean resilience levels within a sample of enlisted basic trainees in the United States Air Force. In addition, the predictive validity of the CD-RISC Total Score was examined for real-life military outcomes, including attrition from service and mental health diagnosis. The CD-RISC items demonstrated strong internal consistency. Item-level examinations of scores revealed that most trainees reported relatively high resilience. Results indicated that resilience measured at the beginning of military service is a significant predictor of (a) attrition from service and (b) obtaining a mental health diagnosis within 6 months of entry. Implications and future directions are discussed. (PsycINFO Database Record

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We comment on the meta-analysis by Mihura, Meyer, Dumitrascu, and Bombel (2013), which examined the validity of scores in Exner's Comprehensive System (CS) for the Rorschach. First, we agree there is compelling evidence that 4 categories of cognitive scores-the "Rorschach cognitive quartet"-are related to cognitive ability/impairment and thought disorder. We now feel comfortable endorsing the use of these scores in some applied and research settings. Second, we conducted new meta-analyses (k = 44) for the 4 noncognitive Rorschach scores with highest validity in the Mihura et al. findings. Unlike Mihura et al., we included unpublished dissertations (although we did not attempt to exhaustively unearth all unpublished studies), calculated correlations instead of semipartial correlations, and used the Rorschach International Norms for a larger proportion of comparisons. Our validity estimates for the Suicide Constellation and Weighted Sum of Color were similar to or even higher than those of Mihura et al., although we concluded that support for the Suicide Constellation is limited and that Weighted Sum of Color probably does not measure its intended target. Our validity estimates for Sum Shading and the Anatomy and X-ray score were much lower than those of Mihura et al. We conclude that their meta-analysis accurately reflects the published literature, but their exclusion of unpublished studies led to substantial overestimates of validity for some and perhaps many Rorschach scores. Therefore, the evidence is presently insufficient to justify using the CS to measure noncognitive characteristics such as emotionality, negative affect, and bodily preoccupations.

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In a recent article in this journal, Poston and Hanson (2010) reported a meta-analysis of 17 studies on the use of psychological assessment as a therapeutic intervention (PATI) and concluded that "psychological assessment procedures--when combined with personalized, collaborative, and highly involving test feedback--have positive, clinically meaningful effects on treatment" (Poston & Hanson, 2010, p. 203). Although extant data suggest that PATI can sometimes exert positive effects, Poston and Hanson's (2010) meta-analysis may overstate the magnitude of these effects because the authors (a) included several studies that combined assessment with treatment components that are irrelevant to PATI, sometimes rendering it impossible to attribute any observed effects to PATI per se and (b) excluded numerous nonsignificant results. Moreover, the studies Poston and Hanson (2010) reviewed neglected to rule out Barnum effects as alternative explanations for client improvement, raising the possibility that PATI works for reasons other than those proposed by its advocates. We conclude that Poston and Hanson's (2010) review leaves a number of lingering questions concerning the treatment utility of PATI unanswered.

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Using 65 items from a mental health screening questionnaire, the History Opinion Inventory-Revised (HOI-R), the present study compared three strategies of scale construction-(1) internal (based on factor analysis), (2) external (based on empirical performance) and (3) intuitive (based on clinicians' opinion)-to predict whether 203,595 U.S. Air Force trainees would be discharged early for mental health or behavior-related reasons within a 4-year follow-up period. The external strategy significantly outperformed the internal strategy, which in turn outperformed the intuitive strategy. For all strategies, predictive accuracy was consistently higher when items and scales were scored using empirically derived weights rather than unit weights. These findings suggest that the external strategy of scale construction provides the highest accuracy when sample sizes are large and the aim is to predict a specific behavioral event. However, the internal strategy also yields valid results and can be a reasonable choice when outcome data are unavailable.

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Gacono and Meloy (2009) have concluded that the Rorschach Inkblot Test is a sensitive instrument with which to discriminate psychopaths from nonpsychopaths. We examined the association of psychopathy with 37 Rorschach variables in a meta-analytic review of 173 validity coefficients derived from 22 studies comprising 780 forensic participants. All studies included the Hare Psychopathy Checklist or one of its versions (Hare, 1980, 1991, 2003) and Exner's (2003) Comprehensive System for the Rorschach. Mean validity coefficients of Rorschach variables in the meta-analysis ranged from -.113 to .239, with a median validity of .070 and a mean validity of .062. Psychopathy displayed a significant and medium-sized association with the number of Aggressive Potential responses (weighted mean validity coefficient = .232) and small but significant associations with the Sum of Texture responses, Cooperative Movement = 0, the number of Personal responses, and the Egocentricity Index (weighted mean validity coefficients = .097 to .159). The remaining 32 Rorschach variables were not significantly related to psychopathy. The present findings contradict the view that the Rorschach is a clinically sensitive instrument for discriminating psychopaths from nonpsychopaths.

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Military medical personnel preparing for deployment to Iraq (N = 328) participated in a survey concerning predeployment risk and resilience factors. Participants reported exposure to an average of 2.5 potentially traumatic events before deployment and 76% (n = 229) reported at least two current concerns about predeployment stressors. Military personnel also endorsed a series of positive appraisals of the military, the mission, and their unit. Fairly low levels of post-traumatic stress disorder symptoms before deployment were reported and positive affect was significantly higher than reported negative affect. Post-traumatic stress disorder symptoms that were present before deployment were most strongly associated with risk factors, whereas positive affect was most strongly associated with resilience factors. Predeployment negative affect was associated with a combination of risk and resilience factors. These findings have implications for possible interventions and preparation of medical personnel before military deployment. A better understanding of the factors related to risk and resilience in military medical personnel will allow for improved screening, educational, training, and clinical programs aimed at increasing resilience before military deployments.

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Comments on the original article "Plate tectonics in the classification of personality disorder: Shifting to a dimensional model," by T. A. Widiger and T. J. Trull. The purpose of this comment is to address (a) whether psychologists know how personality traits are currently assessed by clinicians and (b) the reliability and validity of those evaluations. Although Widiger and Trull argued that the shift to a dimensional model will improve the diagnosis of personality disorders, we can also expect that it will lead to improvements in evaluating personality traits.

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The Shedler-Westen Assessment Procedure-200 (SWAP) is a Q-sort instrument designed to assess personality pathology on the basis of clinician ratings. On the basis of research with the SWAP, its creators have proposed a group of 12 personality disorder (PD) diagnoses that can be used to replace or modify current Axis II categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The authors discuss conceptual and empirical issues that require clarification before this proposal can be properly evaluated. They identify problematic psychometric features of the SWAP, including its unrepresentative normative sample, its reliance on a fixed skewed distribution, and anomalies in its T-score approach to diagnoses. In addition, a review of research on SWAP-based PD categories indicates that important information regarding diagnostic coverage, validity, and temporal stability is presently lacking. The authors conclude that research evidence is currently insufficient to justify the use of SWAP-based PD categories to guide revision of the DSM.

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To evaluate the value of computer-administered interviews and rating scales, the following topics are reviewed in the present article: (a) strengths and weaknesses of structured and unstructured assessment instruments, (b) advantages and disadvantages of computer administration, and (c) the validity and utility of computer-administered interviews and rating scales. Computer-administered evaluations are more comprehensive and reliable and less biased than evaluations routinely conducted in clinical practice. Also, the use of continuous monitoring systems, which increasingly entail the use of computer administration, has been related to improved treatment outcome. However, the use of computer-administered interviews and rating scales will sometimes lead to false positive diagnoses, and for this reason, it is recommended that computer assessment be combined with clinical judgment.

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The controversy surrounding the Rorschach is updated, and an analysis of its dynamics is offered. Results on normative data and validity are reviewed, followed by a summary of, and rebuttal to, arguments made by Rorschach advocates. We argue that the current controversy can be traced, at least in part, to two unwarranted beliefs. First is the belief that informal impressions and popularity provide dependable evidence for evaluating validity. Second is the belief that Rorschach scores with low individual validity are likely to yield much higher levels of validity if they are interpreted in combination with each other, or with other sources of information, by experts. After presenting historical background information, we show how several arguments made recently in defense of the test reflect these two beliefs, even though they are contradicted by research findings. We conclude that a variety of other divisive conflicts in clinical psychology are related to the inappropriate weight placed on informal and unsystematic impressions relative to systematic research.

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When clinical psychologists make judgments, are they likely to be correct or incorrect? The following topics are reviewed: (a) methodological advances in evaluating the validity of descriptions of personality and psychopathology, (b) recent findings on the cognitive processes of clinicians, and (c) the validity of judgments and utility of decisions made by mental health professionals. Results from research on clinical judgment and decision making and their relationship to conflicts within the field of clinical psychology are discussed.

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Results from studies on incremental validity are described for (a) interviews, (b) personality inventories, (c) projective techniques, and (d) brief self-rated and clinician-rated measures. In some of the studies (clinical judgment studies), psychologists were given increasing amounts of information. In other studies (statistical prediction studies), increasing amounts of assessment information were entered into a statistical prediction rule. Although relatively little research has been conducted on incremental validity, results that have been obtained tend to favor the use of interviews, personality inventories (e.g., the Minnesota Multiphasic Personality Inventory--2; J. N. Butcher, W. G. Dahlstrom, J. R., Graham, A. Tellegen, & B. Kaemmer, 1989), and brief self-rated measures (e.g., the Anxiety Sensitivity Index, S. Reiss, R. A. Peterson, D. M. Gursky, & R. M. McNally, 1986). Results are generally less encouraging for projective techniques.

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Are neurological disorders overdiagnosed in older adults? Previous reports suggest that age bias may lead to diagnostic inaccuracies for older adult clients. In the present study, the average test scores for community-dwelling 38-year-old and 74-year-old individuals were presented as the results for a 38-year-old client and a 74-year-old client, respectively. Neuropsychologists did not make diagnoses of neurological disorder or dementiafor either of the clients. The results from this study indicate that age bias is not as serious a problem among neuropsychologists as many psychologists once believed.

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