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Adolescents Who Attempt Suicide-Reply

David Shaffer, FRCP(Lond), FRCPsych; Veronica Vieland, PhD; Ann Garland, MA; Mary Rojas, PhD; Maureen Underwood, MSW; Cary Busner, MPH
JAMA. 1991;265(21):2805-2806. doi:10.1001/jama.1991.03460210051010.
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In Reply.—  Drs Kaufman and Mann accurately restate the findings and reservations that appeared in our article. We would like to take issue with three points made in their letter.They correctly state that an unpleasant intervention is not necessarily a bad one, drawing what may be an inappropriate analogy to vaccination, where an unpleasant inflammatory reaction or mild infection is expected and required for the vaccination to be effective. In the instance of suicide prevention classes, a negative response to programs is neither expected nor planned, nor, as far as we can determine, is there any a priori theory that predicts that an unpleasant reaction should serve a positive outcome. It is precisely because we do not understand why a significantly greater number of high-risk teenagers indicate that they are upset by a program and that, in their view, programs could increase the risk of suicide that we cannot


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