Date of Award

Winter 12-15-2021

Document Type


Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)


Clinical Psychology

First Advisor/Committee Member

jacob a bentley

Second Advisor/Committee Member

martha l glisky

Third Advisor/Committee Member

keyne c law


Concussion is one of the most common conditions seen within rehabilitation and neuropsychology. Given that many concussions are diagnosed following litigation-associated injuries, it is unsurprising that malingered neurocognitive deficit (i.e., deliberate underperformance on cognitive instruments in the interest of secondary gain) has dominated the concussion literature. Although the identification of malingering is essential to ethical assessment, its presence or absence is not the sole determinant of performance validity as a whole. Rather, performance validity is a broad construct involving effort, which refers to examinees’ investment in performing at capacity levels; emerging research suggests this can be affected by psychological factors unrelated to secondary gain. The present study builds on this concept by examining whether perceived injustice significantly predicts effort scores on the Word Memory Test among 52 individuals who met validity standards during testing, and whether this relationship is moderated by depressive symptoms. Preliminary analyses indicated that only perceived injustice was significantly correlated with performance validity in a matrix which included demographics, depression, and litigation status. Follow-up logistic regression showed that depression significantly predicted perceived injustice, and separate quantile regression analysis demonstrated that perceived injustice, particularly aspects of perceived injustice associated with feelings of blame and unfairness, significantly predicted performance validity among this sample’s lowest effort quantile. Depression was not found to moderate this relationship. Post-hoc analyses indicated that depression was significantly associated with effort, but only at its highest quantile. In summary, this study provides evidence that perceived injustice and depression influence performance validity in distinct ways among a non-malingering sample. Clinical implications, study limitations, and future research directions are discussed.