Critical Literature Review 1

Running head: Critical Literature Review

Critical Literature Review

Anthony Rhodes Clinical Psychology

Psy7610 - Tests and Measurements

Spring Quarter 2009

June 12, 2009

2911 Hamilton Blvd. 444

Sioux City, Iowa 51104

Telephone: 712-301-9258

Email: anthonyrhodes54@yahoo.com

Instructor: Dr. Rita Posner, Ph.D.

 Critical Literature Review 2

Abstract

The purpose of this literature review is to examine the validity of the MMPI-2 RF for

three ethnic groups: American Indian, Latino, and Vietnamese. Do the MMPI-2 RF scales

predict equally well for whites as well as other ethnic minority groups or is there inherent

ethnocentric bias based upon a Euro-American worldview? This author will investigate

research regarding the MMPI-2 RF test content, design and profile patterns of various ethnic

groups to determine if there exists a potential difference in interpretation of the control group and

ethnicity. Critical examination of ethnic, sexist or other problematic test content issues will be

discussed as they relate to psychological assessment and clinical diagnosis.

 Critical Literature Review 3

Table of Contents

Table of Contents .............................................................................................................................3

Introduction ......................................................................................................................................4
Article Summaries ...........................................................................................................................6
Evaluation of Psychological Measure ............................................................................................19
Conclusion .....................................................................................................................................23
References ......................................................................................................................................26
 Critical Literature Review 4

Critical Literature Review

Introduction

The testing instrument under consideration in this authors Critical Literature Review is

the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) authored

by Yossef S. Ben-Porath, PhD, and Auke Tellegen, PhD (Ben-Porath, Y. S., & Tellegen, A.,

2008). The test was published by the University of Minnesota Press in 2008. The MMPI and its

subsequent revisions: MMPI-2 and the MMPI-2 RF are structured personality tests that utilize a

criterion-based empirical strategy to gather and analyze test response data. The instrument is

currently being used to assist clinicians in diagnosing personality and mental disorders as well as

the selection of appropriate treatment methods.

The original MMPI was developed by S. R. Hathaway and J. C. McKinley in 1943 and

was considered a landmark assessment tool. It was the next step in refining structured

personality instruments by assuring test validation through empirical research in place of logical-

content assumptions. It employed the use of scales from group responses that had shown

characteristics of known psychopathologies. The test design developed norm studies based upon

comparisons of the selected criterion and control groups.

The MMPI-2 was developed in 1989 as a revision of the MMPI in an effort to broaden

the representative control group which had been a source of criticism of the original MMPI. The

MMPI-2 RF, the latest revision of the MMPI-2, builds on the strengths of its predecessor but

adds 9 additional validated Restructured Clinical Scales (RC) as well as 41 revised validated

scales. This author chose the MMPI-2 RF because of its widely accepted use by clinical

psychologists as a psychometrically validated aid in the assessment of personality and mental

disorders.
 Critical Literature Review 5

The purpose of this literature review is to examine the validity of the MMPI-2 RF for

three ethnic groups: American Indian, Latino and Vietnamese. Do the MMPI-2 RF scales

predict equally well for whites as well as other ethnic minority groups or is there inherent

ethnocentric bias based upon a Euro-American worldview? Test developers and clinicians can

display bias by minimizing group differences and failing to provide adequate validation studies

on the racially and culturally diverse populations they seek to serve. The outcome assessments

of such inadequacies can result in misdiagnosis and faulty treatment recommendations.

In the revision of the MMPI-2, no new norms were collected for the MMPI-2 RF.

American minorities were included in the normative sample of both the MMPI-2 and MMPI-2

RF, but in both cases no separate cultural norms were developed (Capella, 2009). Therefore,

since the MMPI-2 RF normative sample is drawn from the MMPI-2 and no changes regarding

cultural adaptations were developed, both instruments shall be referred to by the author with

respect to the consequences of systemic bias and its influence upon the psychological assessment

process.

As a future clinical psychologist, this author will investigate research regarding the

MMPI-2 RF test content, design and profile patterns of various ethnic groups to determine if

there exists a potential difference in interpretation of the control group and ethnicity. Critical

examination of ethnic or other problematic test content issues will be discussed as they relate to

psychological assessment and clinical diagnosis.

The authors search strategy will consist of researching scholarly peer-reviewed journals

and publications through the Capella resource library. Specific databases such as

PsycARTICLES, ProQuest Psychology Journals and Sage Psychology will be utilized to

research resource materials.

 Critical Literature Review 6

Most studies have compared African Americans and Whites. It has been often reported

that African-American groups have had higher scores on the MMPI-2 scales in comparison with

White groups (Timbrook & Graham, 1994). However, according to Pritchard and Rosenblatt

(1980) when comparing mean differences between African-American and White samples, there

were no MMPI clinical scales on which significant racial differences occurred (as cited in

Timbrook & Graham, 1994). Therefore this author will focus research on other ethnic groups

where research has been limited.

Article Summaries

Study #1

A study by Velasquez et al. (2000) examined the dynamic linguistic equivalence of two

particular studies: English to Spanish and Spanish to Spanish in Latino populations for the

MMPI-2. Given the increase in a variety of Spanish speaking groups in the US population with

potential mental health issues, linguistics versions of MMPI-2 that are accurate and culturally

sensitive are essential to minimizing the possibility of bias. Linguistic equivalence is one area of

importance when examining the question of racial and cultural bias in the MMPI-2 and MMPI-2

RF to determine its multi-ethnic validity and effectiveness as an assessment tool. The article

substantiates the need for further investigation and research in making the MMPI-2 and MMPI-2

RF more multi-culturally effective as an assessment tool.

Method

Study 1. The Participants were 57 adult undergraduate students (42 women, 15 men)

from a major university in southern California. To be eligible to participate in this study, the

participants had to produce valid MMPI-2 protocols in both English and Spanish according to the

following criteria: cannot say = raw score < 30 and F raw < 20. Participants were administered
 Critical Literature Review 7

the MMPI-2 in English and the Inventario Multifasico de la Personalidad-2-Minnesota, Version

Hispana, which is considered to be the official U.S. Spanish translation. Because of time

limitations the participants were only administered the first 370 items under standard instructions

at an interval of 6 weeks. Some participants were administered the English-language MMPI-2

first and then Spanish translation second, or vice versa. The participants were predominantly

single (87%) and Mexican American or Chicano (80%). The average age of the sample was 24

years (SD = 7.88).

Study 2. The Participants were 27 adult undergraduate students (17 women, 10 men)

from the same university as mentioned in Study 1. The same eligibility criteria were used for

this study but also included Variable Response Inconsistency Scale (VRIN) > 74 T score.

Participants were administered two Spanish versions of the MMPI-2, the Version Hispana by

Garcia-Peltoniemi and Azan Chaviano, and the Inventario Multifasico de la Personalidad de

Minnesota-2 Espanol translated by Lucio and Reyes-Lagunes for use in Mexico. In this study,

the participants were administered all 567 items, which allowed for scoring on the validity,

clinical, content, and supplementary scales. Participants were administered the MMPI-2 under

standard instructions at an interval of 4 weeks. . The participants were predominantly single

(90%) and Mexican American or Chicano (85%). The average age of the sample was also 24

years ( SD = 5.96).

Results

The findings from Study 1 supported the authors expectations and appeared to be similar

to the results obtained by researchers who have evaluated bilinguals with the MMPI-2 in other

parts of the world. The mean reliability coefficient was considered to be moderately high,
 Critical Literature Review 8

suggesting linguistic comparability. Also, no statistically significant differences were found

between any of the scales. The findings confirmed that the Version Hispana, as a generic

version, can be used with Spanish-speaking Latinos in the United States with some degree of

confidence. The findings from Study 2, while indicating no scale score differences, did result in

a lower mean correlation coefficient. This suggested variable performance when Spanish-

speaking participants were administered two different Spanish translations of the MMPI-2.

Unlike Study 1, in which participants were required to respond to an English and Spanish

translation, the participants in Study 2 may have found this task to be less linguistically

challenging because both instruments were in Spanish.

It appears from the test results that some of the participants may have struggled with

some of the idioms or sentence structures of the items. This finding indicated that idiomatic

adaptations of an instrument are needed because a particular language has many unique

idiomatic nuances. Given these findings future considerations for Mexican Americans to be

administered a Mexican adaptation is warranted. Puerto Ricans (living in the United States)

may be better served with a Puerto Rican adaptation.

Conclusion

The findings point toward the need for greater research on bilingualism and the

expression of psychopathology through instruments such as the MMPI-2 and MMPI-2 RF. An

examination of the research literature on Latinos indicates that this area of research has been

largely neglected in favor of studies that typically compare Latinos with other ethnic groups. It

is clear that language remains crucial in the understanding of Latinos' mental health issues. If

psychologists are to use standardized measures such as the MMPI-2 RF, they need to be fully
 Critical Literature Review 9

aware of both the strengths and limitations that currently exist. Given the fact that the Spanish

language continues to thrive among Latinos, even after numerous generations in the United

States it is essential that these measures be further evaluated for validity. Also, researchers

should consider the possibility of developing bilingual diagnostic measures in light of many

Latinos' equal use of both English and Spanish. The authors strongly encourage researchers to

consider investigations in this area of Latino mental health.

Study #2

A study of American Indians by Greene, Robin, Albaugh, Caldwell, & Goldman (2003)

examined the empirical correlates of the MMPI-2 scale scores in two American Indian tribal

groups. The article reflects substantial differences in scales between American Indians and the

MMPI-2 normative group. According to the author these differences do not necessarily reflect a

cultural test bias but behavior and symptoms characteristic of severe mental disorder in

American Indians in part caused by adverse health conditions and social stressors.

Method

The MMPI-2 was administered over a 5-year period (19901995) by trained local tribal

interviewers to a total of 297 Plains and 535 Southwestern tribal members. The two tribes

differed in terms of language, history, social and religious organization, cultural and geographic

location. Approximately 8% of the study participants were excluded from further analyses

because of their inability to meet validity criteria. Final analyses were performed for 239 (92

men, 147 women) Plains and 490 (209 men, 281 women) Southwestern tribal members; this

study sample was comparable to those of the overall group.

 Critical Literature Review 10

The Plains tribal members averaged 38.2 years of age (SD = 12.7), whereas the

Southwestern tribal members averaged 36.6 years of age (SD = 13.3). The members of both

tribes generally had a high school education or less (Plains = 71.2%, Southwestern = 67.6%), and

slightly over one-half of them were married (Plains = 51.2%, Southwestern = 53.3%). The

MMPI-2 was administered by trained local tribal interviewers. English is the predominant

language spoken in both tribal communities. Most of the 913 study participants from the two

tribes' total study sample were administered the MMPI-2 individually (87.7%); however, 112

members of the Plains tribe (12.2% of the tribes' total study sample) were administered the

MMPI-2 in 11 group sessions at various rural locations averaging 10 people per session.

All participants were in a family study on alcoholism. The clinical histories of the

participants were not used for selection. In addition, the participants were required to be adults

over 21 years of age and enrolled in, or eligible for, tribal membership (1/4th tribal ancestry).

Thus, all participants were recruited as community volunteers and were not referred from

treatment, educational, health, correctional, or other institutional entities. Individuals were

required to be at least 21 years of age and tribally enrolled.

Results

The authors conclude that because the potential correlates fell primarily into the

categories of symptoms of alcohol or drug use, antisocial behaviors, and depressive or negative

effect, there were a number of significant relationships with those MMPI-2 scales related to these

areas. There were a large number of significant correlates reflecting antisocial symptoms.

The absence of any potential correlates that assessed physical symptoms resulted in virtually no

correlates for Scales 1 (Hs), 3 (Hy), and HEA. Similarly there were few potential correlates
 Critical Literature Review 11

assessing extraversion-introversion and masculinity-femininity and few significant correlates for

Scales 5 (Mf), 0 (Si), and SOD. Although some of the correlates of the clinical and content scales

were similar in the American Indian men and women, those correlates assessing generalized

distress and negative effects such as crying, feeling guilty, having low energy, feeling

inadequate, and needing reassurance appeared to reflect gender differences.

For example, the construct of crying was correlated with most of the clinical scales in

men and none of these scales in women. The American Indian men reported changes in appetite,

sleep difficulties, loss of interest in things, and lack of energy as significant correlates of most of

the individual content scales, and particularly for the scales ANX, OBS, DEP, WRK, and TRT that

are general markers for negative emotionality and distress on the MMPI-2. The American Indian

women reported being pessimistic, needing reassurance, having low energy, and feeling resentful

or angry as the significant correlates of these same scales. The American Indian men were

unlikely to describe their general distress in terms of being pessimi stic or needing reassurance,

and the American Indian women did not report loss of interest in things, sleep difficulties, or

changes in appetite as manifestations of their distress.

Conclusion

The authors conclude that clinicians using the MMPI-2 with American Indians should not

quickly dismiss elevations on these scales as reflecting test bias. Rather, these differences appear

to accurately reflect the behaviors and symptoms that American Indian study participants were

experiencing.
 Critical Literature Review 12

Study #3

A study by Hall, Bansal & Lopez (1999) reviews the extant research over 31 years of the

comparisons of MMPI/MMPI-2 validity and clinical scale scores of male and female European

Americans and of male and female ethnic minorities. The study concludes that differences

among European Americans, African Americans and Latino Americans are negligible and the

results indicate functional equivalence.

Method

The studies included in the PsycInfo database from 19671998 that directly compared

ethnic minority groups with European Americans on the MMPI or MMPI-2 were considered.

Male and female participants' data were analyzed separately because combined analyses may

obscure potential gender differences. Studies in which adolescents were administered the MMPI

were considered for inclusion. At least 10 between-groups studies comparing European

Americans versus another male or female ethnic group were required to qualify for inclusion in

these analyses. This resulted in the identification of 25 usable studies of male African Americans

versus European Americans, 12 usable studies of female African Americans, and 13 usable

studies of male Latinos versus male European Americans.

Results

The studies revealed that male African Americans exhibited higher scores than male

European Americans on 7 MMPI/MMPI-2 scales, lower scores on 5 scales, and no difference on

1 scale. Female African Americans exhibited higher scores than female European Americans on
 Critical Literature Review 13

8 scales, lower scores on 4 scales, and no difference on one scale across studies. Latino

Americans exhibited higher scores across studies than male European Americans on 3 scales and

lower scores on 10 scales.

Conclusion

The general conclusion of this study was that MMPI/MMPI-2 differences among

European Americans, African Americans, and Latino Americans are minor. The MMPI and

MMPI-2 apparently do not unfairly portray African Americans and Latino Americans as

pathological.

Study #4

A study by Pace, Robbins, Choney, Hill, Lacey & Blair (2006) examined the normative

validity of the MMPI-2 for American Indians from a contextualized and holistic framework.

This study is an in-depth look at the issue of cultural bias of the MMPI-2 by comparing the

overall normative sample to two distinct representative community-based Oklahoma tribes

across 13 validity and clinical scales. The results appear significantly different than Green et al.

(2003) above.

Method

One hundred and seventy-one (N = 171) adult participants comprising of 84 Eastern

Woodland Oklahoma (EWO) and 87 Southwest Plains Oklahoma (SWPO) American Indians

were anonymously surveyed through pencil and paper inventories and questionnaires. The

average age of the male and female participants was 36.1 in the SWOP tribe and 35.4 in the

EWO tribe. Participants completed a standard demographic form, a brief mental health history
 Critical Literature Review 14

screening form, the Life Perspective Scales and the MMPI-2. The LPS is a 41-item theoretically

driven acculturation instrument that measures level of traditionals among American Indians.

Each item has a Likert scale format with anchors of 1 = Never and 5 = Most of the Time.

Results

For the SWPO tribe, scales L, F, 1, 4, 6, 8, and 9 were all significant elevated 5T points

above the mean of 50, while scales 5 and 7 reached statistical significance (.004) and almost

reached the 5T criteria in elevation above the mean of 50. For the EWO tribe, scales F, 1, 6, 8,

and 9 were significant and elevated 5T above the mean of 50, while scales 4, 5, and 7 reached

statistical significance (.004) and almost reached the 5T criteria in elevation above the mean of

50. Thus for both the EWO and SWPO tribes, a total of 8 of the 13 basic validity and clinical

scales of the MMPI-2 were at or near 5T points above the standard mean of 50 for the normative

sample. The only difference between the results for these two tribal samples is that the SWPO

elevated the L scale more than 5T above the mean of 50 while the EWO tribe did not. Both tribes

had slightly non significantly lower than average K scores and both were near the normative

mean of 50 on scales 2, 3, and 0. Lower educational levels resulted in higher scores on L in the

EWO sample, but not the SWPO sample. Acculturation status did not affect scores for the

SWPO sample. However, lower acculturation resulted in higher scores on F and 8 for the EWO

sample, which may support the hypothesis that acculturation stress may be more acute for less

assimilated American Indians.

Conclusion

The authors conclude that other studies such as Greene et al. (2003) are correct in

assuming elevated American Indian norms reflect something about the distress and challenges
 Critical Literature Review 15

faced by American Indian people. In addition, the authors argue that these results must also be

understood in light of the historical oppression and racism enacted against American Indians

along with the ensuing disadvantages created by forced assimilation, poverty, unemployment,

inadequate health care, and broken social structures. The authors conclude that the very

assumptions that are presupposed in the MMPI-2 (and mainstream psychology) may in some

cases render it inadequate or even harmful when applied to American Indians.

Study #5

A study by Butcher, Cheung & Kim (2003) examined the use of the MMPI-2 in other

countries throughout Asia. Linguistic and sociocultural dynamic equivalence is compared to the

normative group of the Euro-American context in which the MMPI-2 testing instrument was

developed. The article offers research on the instruments current usage in Asian countries and

the difficulties encountered in equivalency, validity and cultural bias. This article reflects

specifically on the challenges of producing a cross cultural test adaptation for effective use in

other cultures.

Conclusions

Several factors have made the MMPI-2 adaptable for international applications. The

revised MMPI-2 item pool is more culturally appropriate and more standardized today than they

were in the past. There are fewer idiosyncratic versions of the MMPI-2 in existence and

available MMPI-2 translations have been more carefully adapted than earlier test translations.

Therefore, research in different countries can be more comparable. These improvements in

instruments and the application of equivalent and comparable procedures make it possible for
 Critical Literature Review 16

cross-cultural researchers to conduct objective research in psychopathology using self-reported

symptoms.

Significant limitations on using the MMPI-2 in Asian countries were also noted by the

authors. Although many translators developed separate in-country norms for the test translation

in the country of intended use, some of the existing versions do not have separate norms and

need to rely upon the U.S. norms as a standard of comparison. Some, such as the Philippines and

Thailand do not have separate in-country norms because use of the English language versions

has been established as an effective tradition. In some countries, such as Korea, where separate

norms appear to be needed, a normative study has not yet been completed. The authors advocate

the need for norms to be established in various Asian countries so broad-based research can

become easier to conduct.

Study #6

In a study by Dong & Church (2003), the authors had two goals: 1) to investigate the

cross-cultural equivalence and validity of the Vietnamese translation of the Minnesota

Multiphasic Personality Inventory-2 (MMPI2, Tran, 1996) and 2) to determine whether the

MMPI2 can be a useful tool in the psychological assessment of Vietnamese refugees, many of

whom exhibit psychological symptoms associated with experienced traumas. The authors state

that between 1975 and 1982, about 1.4 million Southeast Asian refugees fled their homelands

after the fall of Saigon. Today, Southeast Asians comprise the largest refugee group in the

United States, and Vietnamese account for 65% of this group (American Council for

Nationalities Service, 1985; Mattson, 1993 as cited in Dong & Church, 2003).

Method
 Critical Literature Review 17

The initial sample consisted of 143 adult Vietnamese refugees. All of the participants

were born in Vietnam and migrated to the United States. 73 were men and 70 were women.

Mean age was 41.2 years (SD = 14.3). Of the 73 men, 23 were veterans of the Vietnamese army.

Participants arrived in the United States during the following time periods: 19751979, n = 30,

21%; 19801989, n = 57, 40%; 19901999, n = 56, 39%. Ages on arrival in the United States

were as follows: 49 years old, 7%; 1019 years old, 24%; 2029 years old, 32%; 3139 years

old, 12%; 4049 years old, 12%; 5059 years old, 10%; and 60 or older, 3%. Most participants

(n = 121, 85%) were currently employed, with 21% unskilled, 52% skilled, 26% professional,

and 1% not reporting their occupation. About 30% of the sample were college graduates or had

attended some 4-year college. Participants were recruited at four community colleges, two

universities, Silicon Valley Technical School, and the Vietnamese Refugee Resettlement

Program, all in California. Another 50% had attended or completed community college or

technical school. The remainder had attended or graduated from high school. Three validity

scales (L, F, and K) and the 10 basic clinical scales were scored from the first 370 items of the

MMPI2. Only these 370 items were administered because of time constraints. The remaining

197 items are scored for various supplemental, content, and research scales.

Results

As anticipated, both men and women, on average, exhibited moderate elevations on

Scales F and 8 findings and tendencies to report somatic complaints. In addition, both men and

women showed moderate elevations (i.e., T scores around 60 or higher) on Scales L, 2, and 7. If

taken at face value, the authors suggest that this represents naive defensiveness or limited insight

(L), moderate dissatisfaction or adjustment difficulties (F), somatic complaints (Scale 1),

depression (Scale 2), anxiety (Scale 7), and social alienation (Scale 8) in the sample as a whole.
 Critical Literature Review 18

The authors suggest that since the sample consists of refugees, most of whom have had some

exposure to traumatic experiences, these mean elevations may be regarded as typical rather than

calling into question the validity of the Vietnamese MMPI2.

Conclusion

Several results lead us to conclude that the Vietnamese MMPI2 functions in a

reasonably equivalent and valid manner in a sample of first-generation Vietnamese refugees.

Thus, we believe that the instrument has the potential to be a useful tool in the psychological

assessment of Vietnamese refugees, if not Vietnamese people more generally. Researchers who

investigate the cross-cultural equivalence and validity of different language versions of the

MMPI2 generally examine mean profiles based on U.S. norms (Butcher, 1996 as cited in Dong

& Church, 2003). Elevated scores do not necessarily imply that the instrument lacks

equivalence in the new cultural group, but large mean T-score differences might raise concerns

about nonequivalence. In the present Vietnamese sample, moderate elevations (i.e., T scores

around 60 or higher) were observed on a number of scales. The authors believe that these

moderate elevations reflect valid assessments of symptom patterns rather than an invalid cultural

measurement. Yet the authors still suggest that until additional studies are conducted with the

Vietnamese MMPI2, clinical practitioners should remain cautious in their use of the MMPI-2.
 Critical Literature Review 19

Evaluation of Psychological Measure

Evaluation of the test administration procedures varied with each of the following

studies:

In Study #1, Velasquez et al. (2000), participants were administered the MMPI-2 in

English and the Inventario Multifasico de la Personalidad-2-Minnesota, Version Hispana, which

is considered to be the official U.S. Spanish translation. Because of time limitations the

participants were only administered the first 370 items under standard instructions at an interval

of 6 weeks. Some participants were administered the English-language MMPI-2 first and then

Spanish translation second, or vice versa. In Study #2, Greene, Robin, Albaugh, Caldwell, &

Goldman (2003), The MMPI-2 was administered over a 5-year period (19901995) by trained

local tribal interviewers to a total of 297 Plains and 535 Southwestern tribal members.

In Study #3, the study included the PsycInfo database from 19671998 that directly

compared ethnic minority groups with European Americans on the MMPI or MMPI-2 were

considered. In Study #4, Pace, Robbins, Choney, Hill, Lacey & Blair (2006), one hundred and

seventy-one (N = 171) adult participants comprising of 84 Eastern Woodland Oklahoma (EWO)

and 87 Southwest Plains Oklahoma (SWPO) American Indians were anonymously surveyed

through pencil and paper inventories and questionnaires.

In Study #5, Butcher, Cheung & Kim (2003), the authors reviewed the standardized

normative data of the MMPI-2 in several Asian countries to survey their validity for each

cultural setting. In Study #6, Dong & Church (2003), administered the MMPI-2 to a sample

consisted of 143 adult Vietnamese refugees. All of the participants were born in Vietnam and
 Critical Literature Review 20

migrated to the United States. 73 were men and 70 were women. Mean age was 41.2 years (SD

= 14.3).

In several of the above test administrations some underlying circumstances regarding the

control group must be noted. Among the American Indian studies the MMPI-2 was administered

immediately and over a five year period. In the comparison study of ethnic groups to European

Americans a longitudinal study comprising 31 years was conducted. In the Vietnamese study

test administrations were conducted in several hours and in the Latino study over a 6 week

period.

It is important to note that modifications because of time constraints were made for the

MMPI-2 in the Latino study (Study #1) (Velasquez et al., 2000) and the Vietnamese (Dong &

Church, 2003) research study and the complete MMPI-2 assessment was not administered. The

Standard text indicates that modifications involving some aspect of a test that was originally

developed for use with a target population have the potential to affect the psychometric qualities

of the test (AERA, APA, & NCME, 1999). Any test modifications adopted should be

appropriate for the individual test taker, while maintaining all feasible standardized features

(Standard 10.10 as cited in AERA, APA, & NCME, 1999).

It appears that the test modifications were not administered because of inherent linguistic

limitations or disabilities but because of time constraints. A question arises as to the validity of

such a practice in light of the standards referenced above. Construct underrepresentation simply

means that the test lacks important constructs that can accurately measure the content (Kaplan,

R. M., & Saccuzzo, D. P., 2009). In a cross cultural study of this importance and magnitude, test
 Critical Literature Review 21

modifications because of time constraints seems unwarranted and may have had a bearing on the

validity of the test results.

An effort was made by the researchers in the Latino study (Velasquez et al., 2000) to

accommodate linguistic equivalency by administering MMPI-2 in English and Spanish.

However, it must be noted that bilingual examinees present special challenges to test usage. An

individual who knows two languages may not test well in either one (AERA, APA, & NCME,

1999). Proficiencies in written and spoken languages can often differ as well.

The findings in Study #1 control group from the Latino study indicated that the mean

reliability coefficient was considered to be moderately high, suggesting linguistic comparability.

However, the findings from Study 2, while indicating no scale score differences, did result in a

lower mean correlation coefficient. This suggests variable performance when Spanish-speaking

participants were administered two different Spanish translations of the MMPI-2. Unlike Study

1 in which participants were required to respond to an English and Spanish translation, the

participants in Study 2 may have found this task to be less linguistically challenging because

both instruments were in Spanish (Velasquez et al., 2000).

Understanding a persons type of bilingualism is important here but no reference or

details have been mentioned regarding the Latino study groups. As a result, researchers

determined there may have been idiomatic differences that accounted for test score variances

(Velasquez et al., 2000). This author takes note that in each of the above ethnic studies trained

bilingual translators could have been useful in the test administrations.

In each of the above ethnic studies the psychometric properties of normative sampling

and errors of measurement appear to be sound. However, the issue of validity or bias may have a
 Critical Literature Review 22

bearing on the reliability of test administrations. Only the Latino study mentions psychometric

properties of test-retest correlation coefficients. The lack of psychometric property data in other

studies raises questions of the usefulness of the findings. It appears from the recommendations

of cautious use of the MMPI-2 by the researchers of the Latino, Vietnamese and American

Indian populations that validity and reliability issues may exist.

The Vietnamese (Dong & Church 2003), and American Indian studies (Pace, Robbins,

Choney, Hill, Lacey & Blair 2006) appeared to render moderately high scale elevations for the

MMPI-2. For the Vietnamese study, mean T scores for the low-trauma group were below 59 for

most scales, whereas Scales F, 1, and 8, but not 3, were moderately elevated (5964). In

addition, Scale 2 was moderately elevated (T = 61). Overall, the low-trauma group reported mild

dissatisfaction (F) and depression (Scale 2), some somatic complaints (Scale 1), and perhaps

mild social alienation (Scale 8). In contrast, the high-trauma group exhibited moderate

elevations (T = 5966) on all of the expected scales (Scales F, 1, 2, 7, and 8), with the exception

of Scale 3. In addition, Scales L, 6, and 0 were moderately elevated (T = 5963).

In both American Indian study (Pace, Robbins, Choney, Hill, Lacey & Blair 2006;

Greene, Robin, Albaugh, Caldwell, & Goldman (2003), There were a large number of significant

correlates reflecting antisocial symptoms with Scales 4 (Pd), 9 (Hypomania [Ma]), ANG, and

ASP. There were even a larger number of significant correlates reflecting generalized distress

and negative affect with Scales 7 (Pt), 8 (Sc), ANX, OBS, DEP, LSE, WRK, TRT, and A.

Elevated scores do not necessarily imply that the instrument lacks equivalence in the

cultural group, but large mean T-score differences might raise concerns about nonequivalence. In

the present Vietnamese and American Indian samples, moderate elevations (i.e., T scores around
 Critical Literature Review 23

60 or higher) were observed on a number of scales. Although the test results must be considered

in light of the traumatic background of the sample group, the results may indicate that the

normative assumptions that are presupposed by mainstream psychology regarding the MMPI-2

may in some cases render it inadequate or even harmful when applied to ethnic groups that are

free of psychopathological disorders. Efforts to validate the MMPI-2 with the above ethnic

groups must go beyond normative and traditional validation studies to address the issues

discussed of interpreting ethnicity within their own experiences and perspectives.

Conclusion

In an increasingly multicultural society, ethnic differences in psychopathology could

have far reaching implications. One of the most important implications of ethnic differences

would be the need for culture-specific models of psychopathology, assessment, and treatment.

Cultural differences often persist across ethnic groups even among those who are highly

acculturated. One distinct difference for example in which ethnic groups in the United States

differ is collectivism. Ethnic minority persons sometimes have a relatively collectivist

orientation and therefore require different assessments to accurately diagnose and provide

treatment solutions in clinical psychology. However, if assessment tools do not have well-

established psychometric properties they are not useful in clinical samples. Moreover, few

scales have been designed to measure ethnic identity across multiple ethnic groups (Hall, Bansal

& Lopez, 1999).

The MMPI-2 and the MMPI-2 RF are the most widely used personality instrument and its

applicability and limitations with ethnic minority populations need to be more fully investigated.

The above studies of American Indian, Latino, and Vietnamese testing results indicate that
 Critical Literature Review 24

linguistic and validity equivalence evidence seems to be lacking. In order to reduce bias one

must examine if the following areas exist: language that may contain different meanings for

different groups, use of stereotypes, language that is considered offensive or demeaning,

religious language or references that are characteristic of particular groups, a particular bias for a

specific geographical region and the implication of a particular socioeconomic status (Kaplan, R.

M., & Saccuzzo, D. P., 2009).

It appears that the further research in Latino, American Indian, and Asian cultural

populations is necessary for the MMPI-2 RF to have fundamentally sound construct equivalence

for these and other ethnic populations. Two of the above studies indicated that the MMPI-2 and

MMPI-2 RF differences among European Americans, African Americans, and Latino Americans

are minor. The MMPI and MMPI-2 apparently do not unfairly portray African Americans and

Latino Americans as pathological or present any construct validity issues (Hall, Bansal & Lopez

1999). However, as already noted other studies in this literature review indicated caution in the

use of MMPI-2 RF with American Indians, Latinos and Vietnamese ethnic groups.

As a clinical psychologist, I would recommend using the MMPI-2 RF with caution

except when used by mental health workers who are familiar with acculturation issues and

capable of holistic and contextual interpretations. Furthermore, it is imperative that a clinician

understand as in the case of American Indians, the unique medical history, their tribal

affiliation(s) and traditional beliefs.

If identifiable groups differ in their average levels of measured versus unmeasured job

relevant characteristics then fairness is a concern at the group and individual level (AERA, APA,

& NCME, 1999). According to the Standards text, when test outcomes affect the life chances or
 Critical Literature Review 25

educational opportunities of test takers and mean differences are found to exist along subgroups

an investigation should be undertaken (AERA, APA, & NCME, 1999). From the results of this

review it appears caution should be used as well in the use of the MMPI-2 in determining job

appropriateness or mental competency among the aforementioned ethnic groups.

 Critical Literature Review 26

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