A Clinician's Guide to Statistics in Mental Health PDF
Preview A Clinician's Guide to Statistics in Mental Health
A Clinician’s Guide to Statistics in Mental Health Second Edition Published online by Cambridge University Press Published online by Cambridge University Press ’ A Clinician s Guide to Statistics in Mental Health Second edition S. Nassir Ghaemi TuftsUniversity HarvardMedicalSchool Published online by Cambridge University Press ShaftesburyRoad,CambridgeCB28EA,UnitedKingdom OneLibertyPlaza,20thFloor,NewYork,NY10006,USA 477WilliamstownRoad,PortMelbourne,VIC3207,Australia 314–321,3rdFloor,Plot3,SplendorForum,JasolaDistrictCentre, NewDelhi–110025,India 103PenangRoad,#05–06/07,VisioncrestCommercial,Singapore238467 CambridgeUniversityPressispartofCambridgeUniversityPress&Assessment, adepartmentoftheUniversityofCambridge. WesharetheUniversity’smissiontocontributetosocietythroughthepursuitof education,learningandresearchatthehighestinternationallevelsofexcellence. www.cambridge.org Informationonthistitle:www.cambridge.org/9781108814966 DOI:10.1017/9781108887526 ©S.NassirGhaemi2009,2023 Thispublicationisincopyright.Subjecttostatutoryexceptionandtotheprovisions ofrelevantcollectivelicensingagreements,noreproductionofanypartmaytake placewithoutthewrittenpermissionofCambridgeUniversityPress&Assessment. Firstpublished2009 Secondedition2023 PrintedintheUnitedKingdombyTJBooksLimited,PadstowCornwall AcataloguerecordforthispublicationisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Names:Ghaemi,S.Nassir,author. Title:Aclinician’sguidetostatisticsinmentalhealth/S.NassirGhaemi. Othertitles:Aclinician’sguidetostatisticsandepidemiologyinmentalhealth|Statisticsinmentalhealth Description:Secondedition.|Cambridge,UnitedKingdom;NewYork,NY:CambridgeUniversityPress,2022.| PrecededbyAclinician'sguidetostatisticsandepidemiologyinmentalhealth/S.NassirGhaemi.2009.|Includes bibliographicalreferencesandindex. Identifiers:LCCN2022033989(print)|LCCN2022033990(ebook)|ISBN9781108814966(paperback)|ISBN 9781108887526(epub) Subjects:MESH:Psychiatry–methods|StatisticsasTopic|MentalDisorders–epidemiology Classification:LCCRC467.8(print)|LCCRC467.8(ebook)|NLMWM100| DDC616.890072–dc23/eng/20221026 LCrecordavailableathttps://lccn.loc.gov/2022033989 LCebookrecordavailableathttps://lccn.loc.gov/2022033990 ISBN978-1-108-81496-6Paperback CambridgeUniversityPress&Assessmenthasnoresponsibilityforthepersistence oraccuracyofURLsforexternalorthird-partyinternetwebsitesreferredtointhis publicationanddoesnotguaranteethatanycontentonsuchwebsitesis,orwill remain,accurateorappropriate. .................................................................................................... Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformation thatisinaccordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesare drawnfromactualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthattheinformationcontained hereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantly changingthroughresearchandregulation.Theauthors,editors,andpublishersthereforedisclaimallliability fordirectorconsequentialdamagesresultingfromtheuseofmaterialcontainedinthis book.Readersarestronglyadvisedtopaycarefulattentiontoinformationprovidedbythemanufacturerof anydrugsorequipmentthattheyplantouse. Published online by Cambridge University Press InmemoryofFrederickK.Goodwin,MD Published online by Cambridge University Press Theartofmedicineistheartofbalancingprobabilities. AdaptedfromWilliamOsler,1948,p.38 Published online by Cambridge University Press Contents Preface ix Acknowledgments xi 1 WhyDataNeverSpeak 14 Causation 97 forThemselves 1 15 APhilosophyofStatistics 107 2 WhyYouCannotBelieveYour 16 Evidence-BasedMedicine:Defense Eyes 5 andCriticism 113 3 LevelsofEvidence 10 17 SocialandEconomicFactors: 4 Bias 14 PeerReview,Funding, andtheConventional 5 Randomization 21 Wisdom 121 6 ClinicalTrials:ImprovingonClinical 18 TheNewCanonof Experience 27 Psychopharmacology(STAR*D, 7 P-Values:UsesandMisuses 43 STEP-BD,CATIE):HowClinicalTrials AreMisinterpreted 131 8 ForgetP-Values:TheImportanceof EffectSizes 52 19 HowtoAnalyzeaStudy 139 9 UnderstandingPlaceboEffects 62 20 FalsePositiveMaintenanceClinical TrialsinPsychiatry 145 10 UnderstandingConfidence Intervals 71 11 ObservationalStudies 76 12 TheAlchemyofMeta-Analysis 79 Appendix:Understanding Regression 154 13 BayesianStatistics:WhyYour References 161 OpinionCounts 86 Index 169 vii Published online by Cambridge University Press Published online by Cambridge University Press Preface Oneofthemajorproblemsinthementalhealthprofessionsisthatthemajorityofclinical researchers in psychiatry are not formally trained in statistics and clinical epidemiology. Imagine if most professors of mathematics were self-educated and never took formal coursesinalgebraorgeometry?Statisticsisnotsomethingyoucanpickuponyourown, along the way of your busy career as an academic and clinician. It requires time in the classroom–yearsoftime,notmonths.Iknow.Ihadbeenpracticingasaclinicalresearcher for a decade before I got the opportunity for formal public health training in research methods.Aftertwoyearsofstudy,Irealizedhowmuchofmypriorresearchwasweakand faulty.That’swhyIwrotethisbook:toeducatemycolleagues,andtotrytoputintoashort workwhatIhadlearnedintwoyears.Thisdebatebringsouttheimportanceforeveryoneof bettertrainingandeducationinstatisticsandresearchmethods.Thisextratrainingshould berequiredofthosewhobecomeresearchersinparticular.Iknowthatinthe20yearssince Ihadmyformaltraining,manyofthechangesinmyviewsinpsychiatryhavehadtodowith realizingthefalsehoodofmanyoftheclaimsaboutresearchmethodswhichareusedtoprop up false clinical judgments, such as the long-term efficacy of antidepressants and anti- psychoticsorthedebatesaboutthevalidityofDSM. Insum,themostprominent“experts”inclinicalresearchmethodsinacademicpsych- iatry who publish and speak about clinical trial design have never been trained in those topics.Myviewisthatmuchofthecontroversytodayinpsychiatryaroundstatisticalissues hastodowiththelackofknowledgeoftheexperts.Theydon’tknowwhattheydon’tknow, andyetthefieldandthepharmaceuticalindustryreliesontheiropinions.Anewgeneration is tending to get a few years of post-residency training in schools of public health. That trainingisarequirement–anecessity,inmyopinion–forsomeonetobeaqualifiedclinical researcher in psychiatry. Meanwhile, the older generation is taking up space with their limitedknowledge. Researchersinpsychiatryareuninformedaboutstatistics. Cliniciansfearstatistics. Why? I’maclinician.I’vetreatedthousandsofpatients.Idonothaveamathematicsdegree. I do not have formal statistical training outside a Masters degree in public health. I have been teaching psychiatric residents and medical students about clinical psychiatry for almost three decades, including a course in statistics and evidence-based medicine. I’ve givenmanylecturestoclinicians.Inthesesettings,oneofthemostconsistentobservations I’vemadeisthatpsychiatricclinicians,whetherexperiencedorearlyintheirtraining,are afraidofstatistics. I wrote this book to ease their fears but, after a decade in publication, the problem remains.Ingeneral,themerementionof“statistics”inthetitleofatextbookisareasonfor acliniciantoavoidit.Thequestioniswhy. Onepossibilityisthatmanycliniciansarenothighlyscientificallyoriented.Medicineis a predominantly experiential education, and the science that is involved is mostly of the visual or qualitative kind, such as observing and memorizing the anatomy of the human body.Theuseofmathematicalequationsisquitelimited. ix https://doi.org/10.1017/9781108887526.001 Published online by Cambridge University Press
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