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Iatrogenic Risk of Screening for Youth Suicide—Reply
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In Reply: In designing our analytic strategy, we had considered accounting for the clustering associated with group randomization by employing mixed effects linear models.1 As also noted by Dr Schlenger and colleagues, we had recognized that the traditional multivariable regression models that we used might inflate type I error rates.2 However, in light of this yielding a conservative test of the safety of youth suicide screening programs (maximizing the statistical power to detect a difference between the experimental and control groups), we considered it prudent to use this analytic strategy.
We nevertheless appreciate these concerns, particularly in light of the significant interactions that we reported for depression-by-randomization group, and for suicide attempt history-by-randomization group. As a result, we have reanalyzed our data employing mixed effects linear models, which take our nested design into account. Random effects were estimated for classroom-to-classroom variation, school-to-school variation, and individual (or error) variation. A fixed . . . [Full Text of this Article]
Madelyn S. Gould, PhD, MPH
gouldm@childpsych.columbia.edu
Marjorie Kleinman, MS;
Mark Davies, MPH;
Frank A. Marrocco, PhD
New York State Psychiatric Institute
Columbia University
New York, NY
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