To the Editor: Dr Brown and colleagues1 studied the effectiveness of cognitive therapy for the prevention of suicide attempts. This randomized controlled trial appears to show a benefit to introducing cognitive therapy in these patients. Randomization will on average create comparable groups at baseline, but it is possible that bias could have occurred at a later point in the intervention because the study was not blinded.2
One area of concern is the number of participants who received no treatment in the usual care group, which is significantly higher than the number who did not receive treatment in the cognitive therapy group throughout the first 6 months. Lack of any treatment could be the underlying explanation for the observed difference between the 2 groups. Most of the divergence in the survival curves occurs in the first 6 months of treatment when the proportional difference in absence of treatment between the groups is statistically significant. Considering this possibility is important given the marginal statistical significance of the primary study outcome (P = .049), which becomes only a trend when adjusted for residual confounding.
It is possible that we are actually seeing the difference between any treatment and no treatment, which would not argue for the specific effectiveness of cognitive therapy. Instead, the study results suggest that some treatment, possibly including that of cognitive therapy, is better than no treatment. This phenomenon has been seen in various forms as the placebo effect.3
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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