Spirito 2002.
Study characteristics | ||
Methods |
Allocation: randomisation using a random numbers table. Follow‐up period: 3 months. N lost to follow up: 13/76 (17%) for repetition of SH data. |
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Participants |
Inclusion criteria: i) aged 12‐18 years; ii) receiving medical care in either the emergency department or paediatric ward of a children's hospital following a suicide attempt. Exclusion criteria: none stated. Numbers: Of the 76 participants, 36 were allocated to the experimental arm and 40 to the control arm. Profile: 63 (90%) were female. Source of participants: patients presenting to hospital following a suicide attempt. Location: Northeast USA, possibly Providence, RI. |
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Interventions |
Experimental: compliance enhancement intervention plus standard disposition planning involving a single, one‐hour session that reviewed expectations for outpatient treatment as well as addressing the factors likely to impede attendance and treatment misconceptions, and encouraged both the adolescent and parent to make a verbal contract to attend all treatment sessions. Participants were also contacted by telephone at 1, 2, 4, and 8 weeks post‐discharge to review their compliance with treatment. Control: standard disposition planning involving treatment based on judgment of psychiatric clinician who conducted the evaluation. Some participants in both the experimental and control arms had a brief inpatient psychiatric stay prior to receiving outpatient care. The remainder received outpatient care at local mental health centre. Therapist: 3 post‐doctoral fellows in psychology. Type of therapy offered: compliance enhancement. Length of treatment: 8 weeks. |
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Outcomes |
Included: i) repetition of SH according to self‐ and parent‐report, however, only data from self‐report was used; ii) suicide; iii) compliance. Excluded: i) problems concerning therapy sessions. |
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Notes |
Source of funding: "This investigation was supported by NIMH grant MH52411 and by a grant from the van Amerigen Foundation" (p.435). Declaration of author interests: not stated. Other: In two cases a parent reported repetition of SH but the adolescent denied this. |
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Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk |
Quote: “Randomly assigned” (p.436) Comment: Correspondence with study authors clarified that the method used was a "random numbers table." Use of a random numbers table is likely to have minimised the role of bias in the generation of the randomisation sequence. |
Allocation concealment (selection bias) | Unclear risk | Comment: no details on allocation concealment were provided. |
Blinding (performance bias and detection bias) Of participants | High risk | Comment: The nature of this study means that participants could have known to which group they had been allocated. |
Blinding (performance bias and detection bias) Of personnel | High risk | Comment: The nature of the study means personnel are likely to have known which participant was receiving which treatment. |
Blinding (performance bias and detection bias) Of outcome assessors | Unclear risk | Comment: No details on outcome assessor blinding were provided. |
Incomplete outcome data (attrition bias) All outcomes | Unclear risk |
Quote: “Adolescents who refused to participate in the project (n = 6) were compared on age and gender to those who were enrolled. No significant differences were found. In addition, adolescents who were lost to follow‐up (n = 13) were compared to those who remained in the project. There were no significant differences noted on age, gender, race, [socioeconomic status], or any of the baseline psychological measures” (p.437) Comment: Although there was no indication that intention‐to‐treat analyses had been conducted, efforts were clearly made to establish whether results could be affected by attrition bias. |
Selective reporting (reporting bias) | Unclear risk | Comment: Data on suicides had to be requested from study authors, suggesting that selective reporting bias may have been present. |
Other bias | Low risk | Comment: No apparent other sources of bias. |