한국판 캘리포니아 언어학습검사의 사병변별지표에 대한 연구
A study of Malingering Discrimination of Korean-California Verbal Learning Test: K-CVLT
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초록
본 연구에서는 한국판 캘리포니아 언어학습검사(Korean-California Verbal Learning Test: K-CVLT)의 사병변별력을 검토하였다. 연구대상은 세 집단으로, 외상 후 경도의 뇌손상을 입은 환자를 Slick, Sherman과 Iverson (1999)의 사병의 신경인지적 역기능 준거에 따라 사병집단(n=28)과 솔직집단(n=28)으로 분류하였고, 뇌손상이 없는 외상환자집단(n=27)을 포함하였다. 세 집단을 대상으로 K-CVLT의 수행에서 어떤 차이를 보이는지 원점수 및 표준점수를 토대로 살펴본 결과, 사병집단이 다른 두 집단에 비해 K-CVLT의 회상과 재인 측정치에서 뚜렷하게 저조한 수행을 보였고, 회상오류가 유의하게 많았다. 솔직집단과 뇌손상이 없는 외상환자집단 간에는 모든 변인에서 유의한 차이가 나타나지 않았다. 따라서 솔직집단과 뇌손상이 없는 외상환자집단을 비사병집단으로 정의하고, 사병집단과 비사병집단의 민감도, 특정도, 정확분류율을 검토하였다. 그 결과 특정도 .91이상에서 변별력(.61), 총오반응(.54), 단기지연 자유회상(.50), 장기지연 자유 및 단서회상(.50)이 단일 변인으로서 비교적 양호한 민감도를 보였고, 밀리스 공식(.64)과 Millis와 Volinsky(2001)가 제안한 6개의 모델들(.54∼.57)도 비교적 양호한 민감도를 보였다. 본 연구에서 사병탐지력이 높은 변인 및 지수별 절단점은 변별력 80이하, 총오반응 14이상, 단기지연 자유회상 4이하, 장기지연 자유회상 5이하, 장기지연 단서회상 6이하, 밀리스 공식 .52이하로 나타났다. 끝으로 본 연구의 의의와 제한점이 논의되었다.
Abstract
This study was designed to examine the effectiveness of Korean-California Verbal Learning Test (K-CVLT) for detecting malingering. The K-CVLT was administrated to three groups: malingering group(n=28) and effortful group(n=28) with mild traumatic brain injury which were classified according to the criteria for probable Malingering of Neurocognitive Dysfunction(MND) by Click, Sherman, and Iverson(1999), and patient group without brain injury(n=27). Comparison of the z-score and the raw score among the three groups showed that the malingering group performed significantly worse than the effortful group and the patient group without brain injury across a majority of K-CVLT variables and six composite K-CVLT malingering indicators. In contrast, no statistically significant differences between the effortful and the patient groups over all the variables of K-CVLT. Therefore, the study finalized into two groups: the malingering, and the non-malingering which includes the effortful and the patient groups. As a result, for examining the sensitivity, specificity, and classification accuracy between the malingering and the non-malingering groups, the recognition discriminability (.61), total intrusion(.54), short-delay free recall(.50), long-delay free & cued recall(.50), Millis formula(.64), and six malingering indicators(.54∼.57) by Mills & Volinsky(2001) showed good sensitivity while maintaining a specificity of at least .91. Especially, the examination had significant diagnostic validity when classified between the malingering and the non-malingering groups with recognition discriminability(≤80), total intrusion(≥14), short-delay free recall(≤4), long-delay free recall(≤5), long-delay cued recall(≤6), and Millis formula(≤.52). The clinical implications and the limitations of this study are also discussed.
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