Millon Behavioral Medicine Diagnostic

Last Updated

February 12, 2024

Purpose

The Millon Behavioral Medicine Diagnostic (MBMD), formerly the Millon Behavioral Health Inventory (MBHI), is a 165-item true/false self-report assessment of psychosocial factors that may impact a patient's course of medical treatment. The MBMD is considered to be an update to the MBHI and may be preferable for use in medical settings (Wise & Streiner, 2010). The Millon Behavioral Health Inventory (MBHI), originally published in 1976, is a 150-item true/false self-report assessment designed to determine factors that may interfere with treatment adherence and influence health outcomes for patients in medical settings. Specifically, it focuses on psychological coping strategies and personality features of chronically ill populations.

Link to Instrument

Link to Purchase Instrument

Acronym MBHI; MBMD

Area of Assessment

Behavior
Communication
Depression
Life Participation
Mental Health
Negative Affect
Pain
Personality
Stress & Coping

Assessment Type

Patient Reported Outcomes

Cost

Not Free

Actual Cost

$181.50

Cost Description

Cost provided is for MBMD Pain Patient Q-Global Starter Kit. Other options for the MBMD include: Hand Score Starter Kit, $522.90; Hand Score Forms Bundle (print), $252.50; Bariatric Q-Global Starter Kit, $175.80; Bariatric Fax-In Starter Kit (Qty 10), $517,10. Test forms and reports, support materials, and training are also available.

CDE Status

Not a CDE—last searched on 2/13/2024.

Cardiovascular Disease

Immune System Disorders

Organ Transplant

Non-Specific Patient Population

Mental Health

Chronic Pain

Cancer

The MBMD is considered to be an update to the MBHI and may be preferable for use in medical settings (Wise & Streiner, 2010).
MBMD (2001)
• 165 items
• True or False response format
• The MBMD consists of 165 items and includes 29 content scales grouped into five Domains, three Response Patterns, and six Negative Health Habits:
-- Response Patterns (3): Disclosure, Desirability, Debasement
-- Negative Health Habits (6): Alcohol, Caffeine, Drugs, Inactivity, Eating, Smoking
-- Psychiatric Indicators (5): Anxiety-Tension, Depression, Cognitive Dysfunction, Emotional Lability, Guardedness
-- Coping Styles (11): 1) Introversion, 2A) Inhibited, 2B) Dejected, 3) Cooperative, 4) Sociable, 5) Confident, 6A) Nonconforming, 6B) Forceful, 7) Respectful, 8A) Oppositional, 8B) Denigrated
-- Stress Moderators (6): Illness Apprehension, Functional Deficits, Pain Sensitivity, Social Isolation, Future Pessimism, Spiritual Absence
-- Treatment Prognostics (5): Interventional Fragility, Medication Abuse, Information Discomfort, Utilization Excess, Problematic Compliance
-- Management Guides (2): Adjustment Difficulties, Psych Referral
MBHI (1976)
• 150 items
• True or False response format
• 20 scales with 4 categories:
-- 8 Coping Style Scales
-- 6 Psychogenic Attitude Scales
-- 6 Empirically Derived Scales during Test Development (3 psychosomatic correlate scales, pain treatment responsivity, life threat reactivity, and emotional vulnerability)
• Scores above 75 on any of the scale measures suggests presence of the characteristic that the scale is assessing
• Can be administered, scored, and interpreted online or via pencil and paper

Number of Items

165 (MBMD)

150 (MBHI)

Pen and paper or computer

20-25 minutes

Required Training

No Training

Required Training Description

Should be performed by a trained clinician with a doctoral degree.

Adult

18 - 85

years

Instrument Reviewers

Reviewed 4/30/2020 by rehabilitation psychology students Tracy Guan, Maria Medlyn, and Cynthia Smith under the direction of Timothy Tansey, PhD, Rehabilitation Psychology and Special Education Dept., School of Education, University of Wisconsin-Madison. Updated 2/12/2024 by Kevin Fearn, MS, Shirley Ryan Abilitylab.

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
Emotion

Professional Association Recommendation

None found—last searched on 2/13/2024.

Considerations

The MBHI has limitations around its normative sample and redundancy across scales
Scant research available to support empirical efficacy of MBHI
Supported for cautionary clinical use with pain patients
- Cautionary use is also recommended with adolescents and geriatric populations as normative data on these groups is lacking
Recommended that the MBHI be supplemented with additional assessments. Multiple methods of assessment are always best.
Cautious use of the MBHI is recommended with pain patients due to the overlap between constructs measured within scales (r = 0.70-0.92 for most of the Psychogenic Attitudes, Psychosomatic Correlates, and Prognostic Index scales) and the scant literature supporting its usage and efficacy (Labbé et al., 1989).
MBHI may be limited in detecting accurate responses and change over time due to unambiguous wording and nature of scales, which can lead to social desirability response bias- e.g. patients wanting to respond in ways that mask emotional distress or psychopathy (Lee-Riordan & Sweet, 1994).
Significant scale overlap may lead to similar answers across the assessment (Lee-Riordan & Sweet, 1994).
The overly transparent and unambiguous items may lead to respondents’ social desirability bias (Rustad, 1985).
The MBMD is considered to be an update to the MBHI and may be preferable for use in medical settings (Wise & Streiner, 2010).
Higher Scale B (Recent Stress) scores may indicate an attempt to minimize emotional or mental health symptoms while higher Scale F (Somatic Anxiety) scores may signal the potential for exaggerated symptoms or malingering (Lee-Riordan & Sweet, 1994).

Cut-Off Scores

Chronic Pain: (Fishbain et al., 2001; n = 185, male = 95; Chronic pain patients with myofascial pain syndrome)

Base rate of 75 with scores of 75 or greater indicating presence of the characteristic that the scale is measuring.

Normative Data

Chronic Pain: (Labbé et al., 1989; n = 247 (132 male, 115 female); Mean Age = 47.0 (males) and 50.8 (females)—age difference was not significant)

Scores for chronic pain patients and the normative population (controls) were not significantly different on most MBHI scales. However, some differences did exist for the male and female groups:
- Female pain patients were less likely to exhibit a cooperative coping style than female controls (p < 0.05)
- Female pain patients were more likely to indicate the psychogenic attitudes of future despair and somatic anxiety than female controls (p < 0.05)
- Male pain patients were more likely to exhibit an introversive coping style (p < 0.05) and less likely to demonstrate cooperative (p < 0.05) or sociable (p < 0.01) coping styles
- Male pain patients were more likely to indicate the psychogenic attitudes of premorbid pessimism and somatic anxiety than male controls (p < 0.05), as well as future despair (p < 0.01)

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Chronic Pain: (Murphy, Sperr, & Sperr, 1986; n = 20, mean age = 51.7 years (11.4), mean duration of pain = 14.2 years, male neurosurgery patients)

The MBHI was not able to predict pain-related behaviors that occurred during the year following the assessment (p < 0.10)
- A good MBHI prognosis was associated with an increased number of pain-related hospitalizations as well as more prescriptions for narcotics relative to patients with a poor MBHI prognosis.
- The authors noted that the predictive validity may have been limited by the small sample size and that with a larger number of patients, the marginally significant relationships between the MBHI and the medical outcomes may have reached significance.

Chronic Pain: (Sweet et al., 1985; n = 52, male = 26, mean age = 41.0 years, age range = 22 to 80 years, average total number of months of chronic pain = 47.8, average number of months of current pain for which the patient presented for treatment = 24.2)

The Allergic Inclination scale was the only MBHI scale that significantly predicted treatment outcomes (f = 9.28, p = 0.004), although the Introversive (f = 3.82, p = 0.057 and Cooperative (f = 3.91, p = 0.055 scales approached significance.

Chronic Pain: (Gatchel et al., 1985; n = 23 (headache patient group that suffered from weekly vascular or combination vascular-tension headaches for more than one year and did not respond successfully to pharmacotherapy), n = 24 (other chronic pain group), n = 21 (normal controls); headache patients administered one of three behavioral treatment programs)

No significant correlations found at the two-week pretreatment assessment between any MBHI scale and any of the four headache rating measures: 1) daily number of headaches, 2) duration of headaches, 3) intensity of headaches, and 4) all medications taken.
Adequate to Excellent correlations (r = 0.41-0.71, p < 0.05) found at two-week post-treatment assessment for the number of headaches rating measure for MBHI scales: Inhibited Style, Sensitive Style, Recent Stress, Premorbid Pessimism, Future Despair, Somatic Anxiety, Allergic Inclination, Gastrointestinal Susceptibility, Pain Treatment Responsivity, Life Threat Reactivity, and Emotional Vulnerability.
Adequate correlations ( r = 0.42-0.53, p < 0.05) found at two-week post-treatment assessment for the hours of headaches measure for MBHI scales: Sensitive Style, Somatic Anxiety, Pain Treatment Responsivity, and Emotional Vulnerability
Adequate correlation (r = 0.42, p < 0.05) between the Emotional Vulnerability scale and the number of medications taken.
No significant correlations between the average intensity of headaches and any of the MBHI scales.
The Emotional Vulnerability scale was the most predictive of the MBHI scales and correlated significantly (p < 0.05) with number of headaches (r = 0.71), the hours of headache (r = 0.42), and the medications taken (r = 0.42).

Construct Validity

Concurrent validity:

Lower Back Pain: (Lee-Riordan & Sweet, 1994; n = 60, male = 44, mean age = 47.2 (13.3), subjects sought treatment at multidisciplinary pain clinic, low-back pain of at least 6 months duration as primary complaint, mean duration of pain = 75.9 (108.2) months, pain rated as it usually occurs from 1 = mild to 5 = unbearable)

Excellent negative correlations between MBHI scales and the Minnesota Multiphasic Personality Inventory (MMPI) K scale (p < 0.001):
- Premorbid Pessimism (r = -0.63)
- Future Despair (r = -0.64)
- Social Alienation (r = -0.61)
- Allergic Inclination (r = -0.64)
- Cardiovascular Tendency (r = -0.70)
- Life Threatening Reactivity (r = -0.64)
- Emotional Vulnerability (r = -0.68)
Adequate negative correlations between MBHI scales and the MMPI K scale (p < 0.001):
- Chronic Tension (r = -0.50)
- Somatic Anxiety (r = -0.40)
- Gastrointestinal Susceptibility (r = -0.59)
- Pain Treatment Responsivity (r = -0.56)
Excellent positive correlations between MBHI scales and the Minnesota Multiphasic Personality Inventory (MMPI) F scale (p < 0.001):
- Future Despair (r = 0.61)
- Pain Treatment Responsivity (r = 0.67)
- Life Threatening Reactivity (r = 0.65)
Adequate positive correlations between MBHI scales and the MMPI F scale (p < 0.001):
- Premorbid Pessimism (r = 0.59)
- Social Alienation (r = 0.58)
- Somatic Anxiety (r = 0.32)
- Allergic Inclination (r = 0.59)
- Gastrointestinal Susceptibility (r = 0.49)
- Cardiovascular Tendency (r = 0.59)
- Emotional Vulnerability (r = 0.56)
Excellent correlations between MBHI Pain Treatment Responsivity Scale (PP) and MBHI Coping Styles (p < 0.001)
- Positively correlated with Inhibited Style (r = 0.72) and Sensitive Style (r = 0.79)
- Negatively correlated with Sociable Style (r = -0.67) and Confident Style (r = -0.62)
Adequate to Excellent positive correlations between MBHI Pain Treatment Responsivity Scale (PP) and other MBHI scales (p < 0.001):
- Premorbid Pessimism (r = 0.72)
- Future Despair (r = 0.80)
- Social Alienation (r = 0.69)
- Allergic Inclination (r = 0.62)
- Gastrointestinal Susceptibility (r = 0.55)
- Cardiovascular Tendency (r = 0.71)
- Life Threatening Reactivity (r = 0.75)
- Emotional Vulnerability (r = 0.76)

Discriminant validity:

Chronic Pain: (Gatchel et al., 1985; n = 23 (headache patient group), n = 24 (other chronic pain group), n = 21 (normal controls)

Four MBHI scales significantly differentiated between the headache pain group and the other chronic pain group:
- Inhibited Style: (F(1,67) = 4.49, p < 0.05)
- Sensitive Style: (F(1,67) = 4.76, p < 0.05)
- Chronic Tension: (F(1,67) = 10.01, p < 0.01)
- Allergic Inclination: (F(1,67) = 4.22 p < 0.05)

Content Validity

Based on 2,113 medical patients (Millon et al.,1982)
The Reliability Check of the MBHI suggested a valid profile (Sweet et al., 1985). This measure detects whether or not respondents may be responding in random fashion. If a respondent indicates “Yes” to any of the Reliability Check items their profile is labeled “questionable” and considered unreliable. If their score is two or more, then their assessment is marked “invalid” (Lee-Riordan & Sweet, 1994).
It is of note that scales have considerable content overlap and may measure highly similar dimensions (Lee-Riordan & Sweet, 1994).

Floor/Ceiling Effects

Few patients have base rates over 75 (denotes presence of construct) on any of the MBHI scales. This could indicate a “floor effect” (Murphy, Sperr, & Sperr, 1986).

Test/Retest Reliability

Medical Patients and Non-Clinical Subjects: (Millon et al., 1982, n = 2,565 (2,113 patients with a variety of medical conditions and 452 subjects from non-clinical settings, MBHI)

Acceptable test-retest reliability for all MBHI subscales (ICCs ranged from 0.76 to 0.90), with the exception of the Emotional Vulnerability scale (ICC = 0.59).

Medical Patients: (Millon et al., 2006; n = 720, female = 52%, patient conditions included: heart problems, cancer, diabetes, gynecological, problems, chronic pain, accident/injury, back pain, headaches, neurological problems, gastrointestinal problems, organ transplants, and HIV/AIDS, MBMD)

Acceptable test-retest reliability for all MBMD subscales (ICCs ranged from 0.71 to 0.92)

Internal Consistency

Medical Patients and Non-Clinical Subjects: (Millon et al., 1982, n = 2,565 (2,113 patients with a variety of medical conditions and 452 subjects from non-clinical settings, MBHI)

Adequate to Excellent internal consistency for nearly all MBHI subscales (Kuder-Richardson-20 (KR-20) coefficients ranged from 0.72 to 0.90), with the exception of the Cooperative (KR-20 = 0.68) and Confident (KR-20 = 0.66) coping styles.

Medical Patients: (Millon et al., 2006; n = 720, MBMD)

Adequate to Excellent internal consistency for most MBMD subscales (Cronbach’s alpha ranged from 0.74 to 0.89).
Poor internal consistency for Coping Styles (Cronbach’s alpha):
- Cooperative (0.68)
- Sociable (0.54)
- Confident (0.61)
- Non-Conforming (0.67)
- Forceful (0.67)
- Respectful (0.62)
Poor internal consistency for Treatment Prognostics (Cronbach’s alpha):
- Medication Abuse (0.65)
- Information Discomfort (0.47)
- Problematic Compliance (0.62)

Bariatric Surgical Candidates: (Walfish, S. et al., 2008; examination of reliability data published in Miller Behavioral Medicine Diagnostic (MBMD) manual)

Poor: Cronbach’s alpha < 0.70 for 16 of the 32 scales: disclosure (0.54), desirability (0.47), debasement (0.69), introversive (0.65), cooperative (0.63), sociable (0.59), confident (0.61), nonconforming (0.58), forceful (0.58), respectful (0.56), medication abuse (0.59), information discomfort (0.22), utilization access (0.68), problematic compliance (0.55), adjustment difficulties (0.69), and psych referral (0.64)
- Recommended use of alternative measures to assess the 16 constructs with questionable reliability

Bariatric Surgical Patients: (Hoyt & Walter, 2022; n = 224, mean age = 40.8 (12.5), female = 198 (88.4%), BMI was retrospectively recorded from medical visits over a 60-month time period at ten different time points: pre-surgical baseline, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months.)

When all MBMD scales were included simultaneously, Significantly worse fit was observed for the model using MBMD scales (-2LL = 10176.14) than for the model based on demographic factors (-2LL = 9074.84) (Chi-square = 1101.3, p < 0.001)
With each MBMD scale entered separately, the Bayesian information criterion (BIC) values for each model showed that the addition of each individual MBMD scale resulted in significantly worse fit than the model based on demographic factors for all scales, with BIC values increasing by an average of 38.9 (SD = 2.2) across all models (range = 31.8-42.0)
Overall results indicated that pre-surgical MBMD scales do not predict BMI outcomes over a 5-year period in bariatric surgery candidates.

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Cardiac transplant candidates and recipients: (Brandwin, M. et al., 2000; 103 patients referred for heart transplant evaluation, mean age = 48.93, male = 84 (82%), 37 (36%) receiving transplant, all patients tested with MBHI as part of comprehensive initial work-up for transplant candidacy.

Main effect for cluster based on MBHI profiles in which all scales across the three domains in which higher scores indicate increased psychological stress/higher stress-related illness vulnerability were higher for one cluster (high distress) than the other cluster (low distress), p < 0.001.
- Significant differences in mortality by cluster membership at 1 and 5 year follow-up, Chi-square = 8.93, p < 0.005, and 8.16, p < 0.005, respectively, with high distress cluster patients having a greater proportion of deaths in each group.
- Cluster membership was a significant predictor of mortality at 5-year follow-up, Chi-square = 10.59, p < 0.002.

Cardiac transplant recipients: (Harper et al., 1998; n = 90, male = 86%, mean age = 53.16 (11.19), all received transplants with average waiting time = 147 (141) days, survival status following 56-month observation period: 61 patients still living and 29 deceased)

Survival curves for low and high risk groups defined by the median split of composite MBHI risk factor scores (Wald = 7.24, p = 0.07) showed the low risk leveled off at about 0.8 at 1000+ days, while the curve for the high risk group indicated the cumulative probability of survival to be slightly better than 0.5 for the same time period.
An analysis of the postsurgical care required as an index of the cost of the transplant associated with the low and high risk groups revealed that the two groups were significantly different (Levene’s t corrected for unequal variances = 2.09, p = 0.041), with the high risk group requiring more than twice the amount of care as the low risk group.
For the Care Rate variable, the MBHI scales Pain Threat Responsivity (β = 0.45, t = 4.420, p = 0.0000) and Cooperative coping style (β = 0.21, t = 2.11, p = 0.037) were the best predictors of post-transplant care required.
For the Infection Rate variable, the Future Despair (β = 0.65, t = 3.39, p = 0.001) and Life Threat Reactivity (β = -0.44, t = 12.32, p = 0.02) in combination were the best predictors of post-transplant care required.

Construct Validity

Discriminant validity:

Highly significant results of a discriminant function analysis of the 8 coping scales of the MBHI for the coping rating, Chi-square = 26.25, p = 0.0000
- The sensitive, sociable, inhibited, and respectful scales were significant contributors (p < 0.000) to this differentiation, with the more sensitive, more inhibited, less sociable, and less respectful patients classified as the poorer copers.
Significant results of a discriminant function analysis of the 8 coping scales of the MBHI for the support rating, which indicated the MBHI sensitive scale alone classified 71.11% pf cases (Chi-square = 12.33, p = 0.0004)

Cardiac transplant candidates: (Coffman, K. L. & Brandwin, M. B., 1999; n = 103, heart transplant candidates referred to University of Michigan Medical Center given the MBHI during their transplant evaluation, patients categorized into a high-risk (n = 43) or low-risk group (n =60) based on their score on the Life Threat Reactivity Scale (LRTS) with a cutoff score of 70.)

Significant difference in one-year mortality for patients on the waiting list between high-risk (42%) and low-risk (18%) groups, Chi-square = 35.17, p < 0.001.
No significant difference between the high-risk and low-risk groups in five-year mortality following transplantation.
The overall LTRS scores were significantly higher for the high-risk subjects (mean = 80.7) than for the low-risk subjects (mean = 41.7), p = 0.0001.
Deceased patients in the high-risk group had significantly higher scores than five-year survivors for the MBHI variables of inhibition (p = 0.02) and social alienation (p = 0.05) as well as significantly worse indices of heart function. For low-risk patients, there were also significantly higher scores for social alienation (p = 0.03) among the deceased, but their indices of heart function were nearly identical. Thus, it appears that even when heart function is the same, social alienation may play an important role in the survival of heart transplant patients.
High-risk transplant survivors rated themselves as significantly less cooperative before the transplant on the MBHI (survivors = 36.5 vs. deceased = 66.3, p = 0.02), while high-risk survivors were not transplanted scored significantly higher on cooperation (survivors = 65.6 vs. deceased = 46.4, p = 0.04).
The scores of deceased patients in the high-risk group were significantly higher on social alienation than the scores of the survivors (deceased = 57.7 vs. survivors = 38.1, p = 0.01).

Face Validity

The MBHI coping scales significantly discriminated between good and poor pre-transplant compliance as well as interview judgments of good and poor coping and support resources, with modest accuracy. The MBHI also was superior to interview judgments in predicting post-transplant survival time and medical care utilized by patients. Certain scales were also positively associated with physical parameters of pre-transplant and post-transplant status. (Harper et al., 1998, p. 563).

Normative Data

HIV-Positive Men and Women: (Cruess et al., 2007; n = 117, mean age = 42.75 (8.27), male = 63%; inclusion criteria: a) HIV-positive diagnosis, b) age 18 to 65, c) currently on stable highly active antiretroviral therapy (HAART) medication for at least one month; exclusion criteria: a) currently prescribed other medication affecting the immune system, b) history of chemotherapy or whole body irradiation, and c) history of chronic illness (other than HIV) associated with persistent generalized lymphadenopathy or permanent changes in the immune system.)

Baseline Characteristics on the Millon Behavioral Medicine Diagnostic Among HIV-Positive Men and Women

Scale	Raw Score M (SD)	Prevalence Score M (SD)	% Prevalence Score >= 75
Psychiatric Indications
Anxiety- Tension	7.24 (6.97)	51.50 (25.06)	21.4%
Depression	9.31 (8.58)	57.62 (27.50)	34.2%
Cognitive Dysfunction	6.75 (6.43)	39.98 (21.87)	3.4%
Emotional Lability	9.59 (6.48)	55.02 (19.42)	11.1%
Guardedness	13.55 (6.40)	59.92 (15.66)	16.2%
Coping Styles
Introversive	9.54 (6.61)	59.93 (26.03)	28.2%
Inhibited	8.50 (7.24)	58.01 (26.20)	23.1%
Dejected	4.53 (4.91)	42.86 (34.16)	25.6%
Cooperative	9.34 (5.35)	55.62 (22.17)	22.2%
Sociable	11.19 (4.99)	50.23 (21.33)	13.7%
Confident	12.08 (4.91)	52.85 (19.26)	11.1%
Non-conforming	11.15 (5.46)	49.93 (16.92)	2.6%
Forceful	11.46 (5.43)	45.89 (17.57)	1.7%
Respectful	22.77 (4.95)	64.53 (20.74)	42.7%
Oppositional	13.86 (8.20)	62.90 (17.28)	12.0%
Denigrated	8.89 (6.21)	59.55 (21.97)	15.4%
Stress Moderators
Illness apprehension	11.80 (9.07)	58.48 (21.33)	23.1%
Functional deficits	9.68 (7.89)	55.68 (25.19)	21.4%
Pain sensitivity	12.59 (9.86)	60.50 (23.63)	28.2%
Social isolation	9.93 (8.13)	65.21 (22.31)	42.7%
Future pessimism	8.21 (6.93)	55.56 (20.46)	14.5%
Spiritual absence	4.77 (6.23)	33.89 (28.54)	10.3%
Treatment Prognostics
Intervention fragility	7.01 (6.45)	45.67 (20.98)	6.8%
Medication abuse	3.43 (3.60)	45.66 (23.03)	10.3%
Information discomfort	1.62 (2.29)	30.52 (30.49)	8.5%
Utilization excess	9.44 (5.64)	67.05 (16.75)	32.5%
Problematic compliance	6.41 (5.27)	44.26 (24.72)	12.8%
Management Guides
Adjustment difficulties	6.21 (4.42)	71.23 (17.75)	45.3%
Psych referral	4.74 (3.96)	56.13 (23.03)	22.2%

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Human Immunodeficiency Virus (HIV): (Pereira et al., 2004; n = 28, female = 100%, African American = 87%, HIV+ women at risk for cervical cancer)

Greater inhibited coping style on the MBHI was determined by regression analysis to be a significant predictor of greater non-adherence to clinic visits during both 1- (β = 0.45, p = 0.05) and 2-year (β = 0.54, p = 0.02) follow-up, even after controlling for depressed mood.

Human Immunodeficiency Virus (HIV): (Goodkin et al., 1992; n = 62, male = 100%, mean age = 33.8 (7.7); 66.1% exclusively homosexual, asymptomatic HIV-1 seropositive at CDC stages II and III)

Significant positive association of MBHI active coping style with natural killer cell cytotoxicity (NKCC) that was independent of all other variables, t = 2.48, p = 0.02.

HIV-Positive Men and Women: (Cruess et al., 2007; n = 117)

The MBMD Depression*, Cognitive Dysfunction*, Emotional Lability*, Dejected**, Denigrated**, and Medication Abuse** were all significantly associated with the categorical variable of adherence (>=95%) vs. non-adherence (<95%) on the Medical Adherence Training Interview (MATI) at baseline (*p < 0.05, **p < 0.01)
- An overall logistic regression model incorporating these significant scales and controlling for alcohol use and substance use accounted for 26.9% of the variance and correctly assigned 76.9% of participants as either adherent or non-adherent on the MATI at baseline, Chi-square ( 6, n = 117) = 14.193, p = 0.030.
- Scores on the Medication Abuse scale alone were uniquely associated with the categorization of adherence or non-adherence and increased the odds of correct categorization by 1.26 times in the overall model.
Higher scores on the Anxiety-Tension**, Cognitive Dysfunction***, Inhibited*, Dejected**, Cooperative**, Functional Deficits*, Pain Sensitivity**, Interventional Fragility**, and Medication Abuse** scales were significantly associated with taking more drugs than prescribed over the past month at baseline (*p < 0.05, **p < 0.01, ***p <0.001)
- Inclusion of these scales in an overall linear regression model controlling for education level was significant (R² = 0.17, F(10,114) = 2.19, p = 0.024)
The MBMD Medication Abuse scale was significantly associated with the categorical variable of adherence (>=95%) vs. non-adherence (<95%) on the MATI at 3-month follow-up (following medical adherence training) (p < 0.01)
Higher scores on the Medication Abuse Scale were significantly associated with higher mean percentage of weekdays in which medications were skipped over the past month.
- An overall logistic regression model incorporating the Medication Abuse scale and controlling for age and baseline MATI scores was significant at T2 (R² = 0.34, F(3, 79) = 13.04, p < 0.001).
- Higher scores on the Medication Abuse scale alone were uniquely associated with higher percentage of weekdays in which medications were skipped (p = 0.006)

Construct Validity

Convergent validity:

Personality Disorders: (Wise, 1994; n = 100; mean age = 47.0 years, age range = 18 to 83, elevated MBHI scale = Base Rate (BR) > 74; BR > 84 = dominant feature; 93% of sample with comorbid medical and psychiatric diagnoses)

Adequate to Excellent correlations (p < 0.01) between six of the eight complementary scales on the MBHI and Minnesota Multiphasic Personality Inventory (MMPI) were significantly related (r = .22-.61; Mx = 0.37).
The remaining two complementary scales (Introversive x Schizoid and Forceful x Antisocial) approached significance.

Discriminant validity:

Personality Disorders: (Wise, 1994; n = 100)

Significant differences in the classification rates between the MBHI and the MMPI: 93% of the sample was classified as “personality disordered” by the MBHI vs. 17% by the MMPI (Fisher’s exact probability < 0.01)
According to DSM-IV personality clusters, MBHI tended to describe the sample as fitting within the Anxious cluster of personality disorders, while MMPI categorized them within the Dramatic cluster (Chi-square = 25.40, p < 0.0001).
Significantly greater correlations between non-complimentary MBHI and MMPI scales than for complimentary MMPI scales: comparing the correlation between the MBHI Introversive scale and the complementary MMPI SCZ scale indicates that the MBHI Introversive scale correlates significantly better with the MMPI AVD scale [Hotelling’s t(69) = 2.48, p < 0.05], even though its compliment is the SCZ scale.
Interpretation: The MBHI and MMPI do not appear to be measuring the same personality constructs. In addition, they demonstrate poor convergent and discriminant validity.

Normative Data

Heart Failure: (Farrell et al., 2011; n = 105, mean age = 57.38 (10.75), male = 62%, volunteer sample from larger parent study (n = 177) recruited from outpatient clinics at private and county hospitals, inclusion criteria = primary diagnosis of heart failure and Spanish or English fluency, exclusion criteria = current drug or alcohol abuse, current diagnosis of HIV or other immune disorder, current treatment for cancer, or any psychiatric or cognitive disorder that would impede ability to complete questionnaires)

Mean MBMD medication abuse scale score = 11.54 (1.65)
Mean MBMD problematic compliance score = 28.72 (3.65)

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Heart Failure: (Farrell et al., 2011; n = 105)

Adequate correlation between MDMB medication abuse scores and medication adherence (r = 0.308, p <0.001)
Significant predictive ability of the medication abuse scale to predict medication adherence (with depression and medical abuse scores included in the model), β = 0.236, t[102] = 2.113, p = 0.037
Significant predictive ability of the medication abuse scale to predict medication adherence (with hostility and medical abuse scores included in the model), β = 0.244, t[102] = 2.506, p = 0.014
The Sobel test statistic for each of the mediation models mirrored the regression results by confirming that Medication Abuse partially mediates the relationship between adherence and hostility (Sobel z-score = 1.97, p = 0.061) and completely mediates the relationship between adherence and depression (Sobel z-score = 1.88, p = 0.049)

Normative Data

Localized Prostate Cancer: (Cruess et al., 2013; n = 66, males aged >= 45, mean age = 68.18 (7.07), cancer stage T1a-T2b, mean time since prostate cancer diagnosis = 18.03 (6.49) months, undergone radical prostatectomy or radiotherapy within past 18 months; mean time since treatment = 12.18 (4.11) months; participants reassessed at 3-, 6-, and 12-month follow-ups)

Baseline Characteristics on the Millon Behavioral Medicine Diagnostic (MBMD) Among Male Patients Diagnosed With Localized Prostate Cancer

MBMD Scale	Raw Score M (SD)	Prevalence Score M (SD)	% Prevalence Score >= 75
Psychiatric Indications
Anxiety-Tension	5.47 (7.18)	45.92 (26.86)	15.15%
Depression	5.92 (7.01)	46.70 (28.91)	22.72%
Cognitive Dysfunction	4.38 (4.98)	34.48 (19.79)	1.51%
Emotional Lability	6.41 (5.81)	46.45 (20.37)	6.06%
Guardedness	10.24 (6.01)	54.70 (19.12)	13.63%
Coping Styles
Introversive	6.74 (5.67)	52.29 (26.70)	21.21%
Inhibited	4.18 (5.64)	48.11 (26.34)	7.57%
Dejected	2.33 (4.33)	27.80 (31.14)	9.09%
Cooperative	7.24 (5.10)	51.18 (21.71)	13.63%
Sociable	11.45 (4.28)	57.17 (16.22)	13.63%
Confident	11.98 (4.37)	59.05 (16.93)	13.63%
Non-conforming	9.23 (5.39)	48.11 (17.74)	4.54%
Forceful	8.98 (5.59)	41.53 (19.51)	3.03%
Respectful	20.71 (6.17)	60.00 (23.57)	36.36%
Oppositional	8.67 (7.02)	52.53 (21.77)	4.54%
Denigrated	4.68 (5.26)	47.17 (24.80)	7.57%
Stress Moderators
Illness apprehension	8.67 (8.73)	49.50 (25.37)	19.69%
Functional deficits	8.98 (7.47)	59.09 (24.26)	22.72%
Pain sensitivity	9.83 (9.27)	53.86 (26.53)	24.24%
Social isolation	5.09 (6.01)	49.35 (26.12)	12.12%
Future pessimism	7.08 (6.62)	53.53 (22.80)	19.69%
Spiritual absence	7.45 (8.54)	46.98 (37.10)	30.30%
Treatment Prognostics
Interventional fragility	4.73 (6.07)	38.42 (23.85)	6.06%
Medication abuse	2.35 (2.87)	41.39 (23.81)	6.06%
Information discomfort	1.47 (2.00)	32.29 (29.06)	12.12%
Utilization excess	6.39 (5.26)	55.26 (21.36)	13.63%
Problematic compliance	7.86 (6.27)	54.24 (27.52)	25.75%
Management Guides
Adjustment difficulties	4.67 (4.01)	66.89 (19.96)	28.78%
Psych referral	3.12 (3.17)	44.03 (21.79)	15.15%

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Localized Prostate Cancer: (Cruess et al., 2013; n = 66, Millon Behavioral Medicine Diagnostic (MBMD))

Significant negative associations between MBMD scales at baseline and health-related quality of life outcomes averaged at 12-month follow-up, with higher scores on MBMD scales predicting lower FACT and SF-36 scores

Associations between MBMD raw scores at baseline and Functional Assessment of Cancer Therapy (FACT-P) Total score and Physical Well-Being and Emotional Well-Being sub-scores averaged at 12 months

MBMD Sub-Scale	FACT-P Total Score (β, p)*	FACT-P Physical Well-Being (β, p)*	FACT-P Emotional Well-Being (β, p)*
Psychiatric Indications
Tension-Anxiety	-0.294, 0.029	-0.273, 0.055	-0.393, 0.010
Depression	-0.327, 0.075	-0.232, 0.182	-0.420, 0.013
Coping Styles
Introversive	-0.230, 0.067	-0.175, 0.211	-0.279, 0.048
Inhibited	-0.268, 0.062	-0.205, 0.163	0.414, 0.005
Dejected	-0.153, 0.287	-0.228, 0.116	-0.371, 0.016
Cooperative	-0.363, 0.002	-0.333, 0.012	-0.503, 0.000
Sociable	-0.025, 0.818	0.000, 0.998	-0.111, 0.931
Confident	-0.079, 0.460	-0.141, 0.268	-0.028, 0.826
Non-conforming	-0.112, 0.335	-0.125, 0.344	-0.090, 0.502
Forceful	-0.094, 0.410	-0.084, 0.516	-0.121, 0.352
Respectful	-0.141, 0.182	-0.092, 0.468	-0.244, 0.047
Oppositional	-0.219, 0.151	-0.173, 0.291	-0.363, 0.018
Denigrated	-0.327, 0.018	-0.338, 0.029	-0.350, 0.029
Stress Moderators
Pessimism	-0.259, 0.086	-0.208, 0.205	-0.266, 0.077
Treatment Prognostics
Interventional fragility	-0.380, 0.003	-0.415, 0.002	-0.526, 0.000
Utilization excess	-0.337, 0.008	-0.242, 0.102	-0.440, 0.002
Management Guides
Adjustment difficulties	-0.426, 0.002	-0.373, 0.022	-0.442, 0.002
Psych referral	-0.475, 0.001	-0.309, 0.055	-0.472, 0.001

*Values in bold are significant at p < 0.05.

Associations between MBMD raw scores at baseline and SF-36 Role Limitations-Emotional and SF-36 Role Limitations-Physical scores averaged at 12 months

MBMD Sub-Scale	SF-36 Role Emotional (β, p)*	SF-36 Role Physical (β, p)*
Psychiatric Indications
Tension-Anxiety	-0.395, 0.006	-0.091, 0.484
Depression	-0.384, 0.011	-0.162, 0.257
Coping Styles
Introversive	-0.339, 0.018	0.025, 0.861
Inhibited	-0.380, 0.012	-0.090, 0.541
Dejected	-0.287, 0.053	-0.073, 0.599
Cooperative	-0.503, 0.000	-0.116, 0.384
Sociable	0.038, 0.787	0.009, 0.944
Confident	0.027, 0.848	-0.020, 0.878
Non-conforming	-0.234, 0.111	0.105, 0.433
Forceful	-0.076, 0.589	0.032, 0.805
Respectful	-0.176, 0.207	0.021, 0.869
Oppositional	-0.347, 0.020	-0.109, 0.451
Denigrated	-0.502, 0.002	-0.094, 0.526
Stress Moderators
Pessimism	-0.300, 0.044	-0.288, 0.029
Treatment Prognostics
Interventional fragility	-0.384, 0.007	-0.112, 0.401
Utilization excess	-0.450, 0.001	-0.162, 0.257
Management Guides
Adjustment difficulties	-0.440, 0.002	-0.424, 0.001
Psych referral	-0.415, 0.005	-0.374, 0.003

*Values in bold are significant at p < 0.05.

Bibliography

Brandwin, M., Trask, P., Schwartz, S., & Clifford, M. (2000). Personality predictors of mortality in cardiac transplant candidates and recipients. Journal of Psychosomatic Research, 49, 141–147.

Coffman, K., & Brandwin, M. (1999). The Millon Behavioral Health Inventory Life Threat Reactivity Scale as a predictor of mortality in patients awaiting heart transplantation. Psychosomatics, 40, 44–49.

Cruess, D. G., Benedict, C., Lattie, E. G., Molton, I., Kinsinger, D., Kava, B., Manoharan, M., Soloway, M., & Penedo, F. J. (2013). Million Behavioral Diagnostic (MBMD) predicts Health-Related Quality of Life (HrQoL) over time among men treated for localized prostate cancer. Journal of Personality Assessment, 95(1), 54-61.

Cruess, D. G., Minor, S., Antoni, M. H., & Millon, T. (2007). Utility of the Millon Behavioral Diagnostic (MBMD) to predict adherence to Highly Active Antiretroviral Therapy (HAART) medication regimens among HIV-positive men and women. Journal of Personality Assessment, 89(3), 277-290.

Farrell, K., Biing-Jiun, S., Mallon, S., Penedo, F. J., Antoni, M. H. (2011). Utility of thje Millon Behavioral Medicine Diagnostic to predict medication adherence in patients diagnosed with heart failure. Journal of Clinical Psychology in Medical Settings, 18, 1-12.

Fishbain, D. A., Turner, D., Rosomoff, H. L., & Rosomoff, R. S. (2001). Millon Behavioral Health Inventory scores of patients with chronic pain associated with myofascial pain syndrome. Pain Medicine, 2(4), 328-335. https://doi.org/10.1046/j.1526-4637.2001.01040.x

Gatchel, R. J., Deckel, A. W., Weinberg, N., & Smith, J. E. (1985). The utility of the Millon Behavioral Health Inventory in the study of chronic headaches. Headache: The Journal of Head and Face Pain, 25, 49-54.

Goodkin, K., Blaney, N.T., Feaster, D., Fletcher, M.A., Baum, M.K., Mantero-Atienza, E., et al. (1992). Active coping style is associated with natural killer cell cytotoxicity in asymptomatic HIV-1 seropositive homosexual men. Journal of Psychosomatic Research, 36, 635–650.

Harper, R., Chacko, R., Kotik-Harper, D., Young, J., & Gotto, J. (1998). Self-report evaluation of health behavior, stress vulnerability, and medical outcome of heart transplant recipients. Psychosomatic Medicine, 60, 563–569.

Hoyt, T. & Walter, F. A. (2022). Millon Behavioral Medicine Diagnostic Scales do not predict long-term weight loss outcomes in bariatric surgery patients. Obesity Surgery, 32, 1796-1803.

Labbé, E. E., Goldberg, M., Fishbain, D., Rosomoff, H., & Steele‐Rosomoff, R. (1989). Millon Behavioral Health Inventory norms for chronic pain patients. Journal of Clinical Psychology, 45(3), 383–390. https://doi.org/10.1002/1097-4679(198905)45:3<383::AID-JCLP2270450306>3.0.CO;2-N

Lee-Riordan, D., & Sweet, J. J. (1994). Relationship between the Millon Behavioral Health Inventory and the Minnesota Multiphasic Personality Inventory (MMPI) in low-back pain patients. Journal of Clinical Psychology in Medical Settings, 1, 387–398.

Millon, T. (2006). The Institute for Advanced Studies in Personology and Psychopathology. Retrieved March 3, 2010, from http://www.millon.net/instruments/MBHI.htm

Millon, T., Green, C., & Meagher, R. (1982). Millon Behavioral Health Inventory manual (3rd ed.). Minneapolis, MN: National Computer Systems.

Murphy, J. K., Sperr, E. V., & Sperr, S. J. (1986). Chronic pain: An investigation of assessment instruments. Journal of Psychosomatic Research, 30, 289-296.

Pereira, D., Antoni, M., Danielson, A., Simon, T., Efantis-Potter, J., & O’Sullivan, M. (2004). Inhibited interpersonal coping style predicts poorer adherence to scheduled clinic visits in human immunodeficiency virus infected women at risk for cervical cancer. Annals of Behavioral Medicine, 28, 195–202.

Rustad, L. C. (1985). A review of the Millon Behavioral Health Inventory. Journal of Counseling & Development, 64, 280-282.

Sweet, J. J., Breuer, S. R., Hazlewood, L. A. Toye, R., & Pawl, R. P. (1985). The Millon Behavioral Health Inventory: Concurrent and predictive validity in a pain treatment center. Journal of Behavioral Medicine 8, 215–226 https://doi.org/10.1007/BF00870309

Walfish, S., Wise, E. A., & Streiner, D. L. (2008). Limitations of the Millon Behavioral Medicine Diagnostic (MBMD) with bariatric surgical candidates. Obesity Surgery, 18, 1318-1322.

Wise, E. A. (1994). Personality disorder correspondence between the Million Behavioral Health Inventory (MBHI) and the Minnesota Multiphasic Personality Inventory (MMPI). Journal of Clinical Psychology in Medical Settings, 1, 167–181. https://doi.org/10.1007/BF01999745

Wise, E. A. & Streiner, D. L. (2010). A comparison of the Millon Behavioral Medical Diagnostic and the Millon Behavioral Health Inventory with medical populations. Journal of Clinical Psychology, 66, 1281–1291. https://www.mhrmemphis.com/wp-content/uploads/2017/08/Wise-2010-JCP-MBMD-x-MBHI.pdf

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