Performance validity tests (PVTs) and symptom validity tests (SVTs) detect inaccuracies in examinee-completed measures, though methods for assessing the accuracy of informant reports—which may be inaccurate due to examinee deception, motivation for external incentives (e.g., disability payments), or attempts to validate examinee experiences—remain underexplored. We used a sample of 72 veteran-informant dyads undergoing evaluation of possible epilepsy-related neurocognitive disorder to assess the association between examinee response invalidity (i.e., performance and/or symptom invalidity) and informant report measures. Examinees completed PVTs, SVTs, cognitive, and self-report measures. Informants completed measures on examinee functioning and their own caregiver burden. Performance invalidity was defined as failure on two or more PVTs. Symptom invalidity for psychopathology symptom reports (SVT-P) and cognitive/somatic symptom reports (SVT-CS) were separately defined via above-threshold scores on two or more SVT criterion. Independent samples t tests demonstrated the associations of the PVT, SVT-CS, and SVT-P groups with informant-report measures. Informants for examinees with performance invalidity reported worse functioning in the examinee than informants for examinees in the valid performance group (medium-large effect sizes). Symptom validity status (for both SVT-CS and SVT-P) was meaningfully but less strongly related to informant-reported examinee functioning (small–medium effect sizes). Neither performance nor symptom invalidity was meaningfully related to informant-reported caregiver burden (negligible effect sizes). Informant reports for examinees with response invalidity should be interpreted with caution.

Objective Health literacy is a strong psychosocial determinant of health disparities and has been found to relate to various aspects of health-related technology use. With the increased implementation of neuropsychological services performed via telehealth during the coronavirus disease 2019 pandemic, the relationship between health literacy and comfort with teleneuropsychology warrants further investigation. Method The present study examined 77 Veterans participating in neuropsychological evaluations as a part of standard clinical care. The sample was diverse in terms of age ethnicity, and psychiatric and neurocognitive diagnoses. In addition to a fixed-flexible neuropsychological battery, the Brief Health Literacy Screening Tool (BRIEF) was administered to evaluate health literacy. Self-reported comfort with the teleneuropsychological evaluation was assessed using an informal 10-point scale, and qualitative comfort responses were also recorded. Results Independent samples t-tests revealed older adults were more likely to participate in the evaluation via telephone than with VA Video Connect. Although health literacy was not related to telehealth modality, it was correlated with comfort with the teleneuropsychological evaluation (r = .34, p < .01), although it is notable that average comfort levels were high across modalities (M = 8.16, SD = 2.50). Conclusions Findings support the notion that teleneuropsychological services may feasibly be implemented with a diverse group of patients, although flexibility with modality may be necessary. Those performing these services should also be aware that patients with lower health literacy may feel less comfortable with teleneuropsychology as they seek to build rapport and optimize evaluation engagement.

Introduction The healthy soldier effect (HSE) describes a phenomenon of enduring health and lower mortality among veterans due in part to initial screening procedures and health care access. Although early data were supportive of a broad HSE among former military members, more recent investigations have suggested a possible attenuation of the effect with older age. The present study aimed to provide an update of the HSE using an expansive Veterans Health Administration (VHA)–wide sample with a particular focus on age and sex effects. Materials and Methods Mortality data for veterans within the VHA were obtained from the VHA Support Service Center program office and compared to mortality data from the general U.S. population spanning FY2014 to the second quarter of FY2020. The standardized mortality ratio (SMR) was calculated for the overall sample and for age- and sex-specific cohorts. Mortality rate ratios were also calculated and compared across sexes. Results Lower SMRs were observed in veterans compared to the general U.S. population (SMR 0.866). This effect was most prominent in younger and very old veterans, although a higher mortality was seen in the 55- to 64-year age cohort (SMR 1.371 for males and 1.074 for females). The HSE in females was lower than that in males in the <55-year age group but became higher in older cohorts. Conclusions This is the largest investigation to date examining the HSE in U.S. veterans and includes younger veterans from more recent military eras. Higher mortality among the 55- to 74-year age groups merits further investigation, as does the relatively higher mortality among older female veterans. Our findings have implications for the provision of health care and preventative care to these veterans most at risk for higher mortality.

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