Multilevel modeling was a convenient alternative to common regression designs in longitudinal suicide research.


BACKGROUND AND OBJECTIVE:The prospective investigation of repetitive nonfatal suicidal behavior is associated with two methodological problems. Due to the commonly used definitions of nonfatal suicidal behavior, clinical samples usually consist of patients with a considerable between-person variability. Second, repeated nonfatal suicidal episodes of the same subjects are likely to be correlated. We examined three regression techniques to comparatively evaluate their efficiency in addressing the given methodological problems. STUDY DESIGN AND SETTING:Repeated episodes of nonfatal suicidal behavior were assessed in two independent patient samples during a 2-year follow-up period. The first regression design modeled repetitive nonfatal suicidal behavior as a summary measure. The second regression model treated repeated episodes of the same subject as independent events. The third regression model represented a hierarchical linear model. RESULTS:The estimated mean effects of the first model were likely to be nonrepresentative for a considerable part of the study subjects. The second regression design overemphasized the impact of the predictor variables. The hierarchical linear model most appropriately accounted for the heterogeneity of the samples and the correlated data structure. CONCLUSION:The nonhierarchical regression designs did not provide appropriate statistical models for the prospective investigation of repetitive nonfatal suicidal behavior. Multilevel modeling provides a convenient alternative.


J Clin Epidemiol


Antretter E,Dunkel D,Osvath P,Voros V,Fekete S,Haring C




Has Abstract


2006-06-01 00:00:00














  • Location bias in controlled clinical trials of complementary/alternative therapies.

    abstract:UNLABELLED:To systematically investigate location bias of controlled clinical trials in complementary/alternative medicine (CAM). METHODS:Literature searches were performed to identify systematic reviews and meta-analyses, which were used to retrieve controlled clinical trials. Trials were categorised by whether they ...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Pittler MH,Abbot NC,Harkness EF,Ernst E

    更新日期:2000-05-01 00:00:00

  • Proxy respondents reliably assessed the quality of life of elective cardiac surgery patients.

    abstract:BACKGROUND AND OBJECTIVE:The level of agreement between index and proxy respondents on assessment of health status of clinical cohorts is variable. There is limited information regarding agreement between cardiac surgery patients and their proxies, and levels of agreement examined across repeated measures. This study e...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Elliott D,Lazarus R,Leeder SR

    更新日期:2006-02-01 00:00:00

  • The statistical significance of meta-analyses is frequently fragile: definition of a fragility index for meta-analyses.

    abstract:OBJECTIVES:Meta-analyses inform clinical practice by summarizing treatment effect estimates based on results from several trials. However, the statistical significance of a meta-analysis (i.e., whether the pooled treatment effect is statistically significant or not) may rely on the outcome of only a few patients from s...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Atal I,Porcher R,Boutron I,Ravaud P

    更新日期:2019-07-01 00:00:00

  • Assessment of generalized lymphadenopathy in AIDS research: the degree of clinical agreement.

    abstract::The degree of clinical agreement amongst different physicians on the presence or absence of generalized lymphadenopathy was assessed in 32 randomly selected participants from a prospective study of male sexual contacts of men with AIDS or an AIDS-related condition (ARC). Three physicians completed the same standard ex...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Coates RA,Fanning MM,Johnson JK,Calzavara L

    更新日期:1988-01-01 00:00:00

  • Diagnostic interpretation of electrocardiograms in population-based research: computer program research physicians, or cardiologists?

    abstract::We assessed the performance of diagnostic electrocardiogram (ECG) interpretation by the computer program MEANS and by research physicians, compared to cardiologists, in a physician-based study. To establish a strategy for ECG interpretation in health surveys, we also studied the diagnostic capacity of three scenarios:...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: de Bruyne MC,Kors JA,Hoes AW,Kruijssen DA,Deckers JW,Grosfeld M,van Herpen G,Grobbee DE,van Bemmel JH

    更新日期:1997-08-01 00:00:00

  • Serum albumin and risk of stroke, coronary heart disease, and mortality: the role of cigarette smoking.

    abstract:OBJECTIVE:Lower levels of serum albumin are associated with increased risk of all-cause and cardiovascular mortality as well as with coronary heart disease and stroke incidence. These relationships have been examined with specific focus on the role of cigarette smoking. STUDY DESIGN AND SETTING:A prospective study of ...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Shaper AG,Wannamethee SG,Whincup PH

    更新日期:2004-02-01 00:00:00

  • Evidence-Based Research Series-Paper 3: Using an Evidence-Based Research approach to place your results into context after the study is performed to ensure usefulness of the conclusion.

    abstract:BACKGROUND AND OBJECTIVE:There is considerable actual and potential waste in research. Using evidence-based research (EBR) can ensure the value of a new study. The aim of this article, the third in a series, is to describe an EBR approach to putting research results into context. STUDY DESIGN AND SETTING:EBR is the us...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Lund H,Juhl CB,Nørgaard B,Draborg E,Henriksen M,Andreasen J,Christensen R,Nasser M,Ciliska D,Tugwell P,Clarke M,Blaine C,Martin J,Ban JW,Brunnhuber K,Robinson KA,Evidence-Based Research Network.

    更新日期:2021-01-01 00:00:00

  • Pseudo cluster randomization dealt with selection bias and contamination in clinical trials.

    abstract:BACKGROUND AND OBJECTIVES:When contamination is present, randomization on a patient level leads to dilution of the treatment effect. The usual solution is to randomize on a cluster level, but at the cost of efficiency and more importantly, this may introduce selection bias. Furthermore, it may slow down recruitment in ...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,评审


    authors: Teerenstra S,Melis RJ,Peer PG,Borm GF

    更新日期:2006-04-01 00:00:00

  • Deficiencies in addressing effect modification in network meta-analyses: a meta-epidemiological survey.

    abstract:OBJECTIVE:The objectives of this study were to evaluate the current state of reporting and handling of effect modification in network meta-analyses (NMAs) and perform exploratory analyses to identify variables that are potentially associated with incomplete reporting of effect modifiers in NMAs. STUDY DESIGN AND SETTI...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,meta分析


    authors: Kovic B,Zoratti MJ,Michalopoulos S,Silvestre C,Thorlund K,Thabane L

    更新日期:2017-08-01 00:00:00

  • An e-mail survey identified unpublished studies for systematic reviews.

    abstract:BACKGROUND AND OBJECTIVE:A large number of trials remain difficult to locate or unpublished for systematic reviews. The objective of this article was to determine the usefulness of making e-mail contact with authors of clinical trials and literature reviews found in MEDLINE to identify unpublished or difficult to locat...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Reveiz L,Cardona AF,Ospina EG,de Agular S

    更新日期:2006-07-01 00:00:00

  • AHRQ series on complex intervention systematic reviews-paper 3: adapting frameworks to develop protocols.

    abstract:BACKGROUND:Once a proposed topic has been identified for a systematic review and has undergone a question formulation stage, a protocol must be developed that specifies the scope and research questions in detail and outlines the methodology for conducting the systematic review. RATIONALE:Framework modifications are of...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Butler M,Epstein RA,Totten A,Whitlock EP,Ansari MT,Damschroder LJ,Balk E,Bass EB,Berkman ND,Hempel S,Iyer S,Schoelles K,Guise JM

    更新日期:2017-10-01 00:00:00

  • Procedures that assess inconsistency in meta-analyses can assess the likelihood of response bias in multiwave surveys.

    abstract:BACKGROUND AND OBJECTIVE:Response bias may affect the result of surveys with <100% response rate. We applied methods commonly used in meta-analysis to ascertain the extent to which response bias affects multiwave survey results. METHODS:To test hypotheses of between-wave similarity, we used the Cochran-Armitage test f...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Montori VM,Leung TW,Walter SD,Guyatt GH

    更新日期:2005-08-01 00:00:00

  • Rapid reviews may produce different results to systematic reviews: a meta-epidemiological study.

    abstract:OBJECTIVE:To simulate possible changes in systematic review results if rapid review methods were used. STUDY DESIGN AND SETTING:We recalculated meta-analyses for binary primary outcomes in Cochrane systematic reviews, simulating rapid review methods. We simulated searching only PubMed, excluding older articles (5, 7, ...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,meta分析


    authors: Marshall IJ,Marshall R,Wallace BC,Brassey J,Thomas J

    更新日期:2019-05-01 00:00:00

  • Comparing clinical information with claims data: some similarities and differences.

    abstract::How well can hospital discharge abstracts be used to estimate patient health status? This paper compares information on comorbidity obtained from hospital discharge abstracts for patients undergoing prostatectomy or cholecystectomy at a Winnipeg teaching hospital with clinical data on preoperative medical conditions p...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Roos LL,Sharp SM,Cohen MM

    更新日期:1991-01-01 00:00:00

  • Age at natural menopause and total mortality and mortality from ischemic heart disease: the Adventist Health Study.

    abstract::We studied the relationship between age at natural menopause and total mortality as well as mortality from ischemic heart disease in a cohort of 6182 California Seventh-Day Adventist women who reported a natural menopause. During follow-up from 1976 through 1988, there were 1831 deaths. A total of 308 deaths due to is...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Jacobsen BK,Knutsen SF,Fraser GE

    更新日期:1999-04-01 00:00:00

  • Female specialists were more likely to respond to a postal questionnaire about drug treatments for Alzheimer disease.

    abstract:OBJECTIVE:To assess demographic predictors of response for specialists who were mailed a postal questionnaire on drug treatments for Alzheimer disease. STUDY DESIGN AND SETTING:The questionnaire was sent to 317 specialists in Quebec, Canada. Demographic variables included specialty, urban/rural practice, language, sex...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Oremus M,Wolfson C

    更新日期:2004-06-01 00:00:00

  • Phone respondents reported less mental health problems whereas mail interviewee gave higher physical health ratings.

    abstract:OBJECTIVE:This study examines the effects of telephone and mail interview methods on the measurement of health-related quality of life. STUDY DESIGN AND SETTING:One thousand six hundred ninety individuals aged 25-66 were interviewed randomly either by telephone or by mail. Health-related quality of life was assessed w...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,随机对照试验


    authors: Ravens-Sieberer U,Erhart M,Wetzel R,Krügel A,Brambosch A

    更新日期:2008-10-01 00:00:00

  • Likelihood and clinical trials.

    abstract::The history of the application of statistical theory to the analysis of clinical trials is reviewed. The current orthodoxy is a somewhat illogical hybrid of the original theory of significance tests of Edgeworth, Karl Pearson, and Fisher, and the subsequent decision theory approach of Neyman, Egon Pearson, and Wald. T...

    journal_title:Journal of clinical epidemiology

    pub_type: 历史文章,杂志文章


    authors: Hill G,Forbes W,Kozak J,MacNeill I

    更新日期:2000-03-01 00:00:00

  • Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis.

    abstract:OBJECTIVE:To determine which simple index of overweight and obesity is the best discriminator of cardiovascular risk factors. STUDY DESIGN AND SETTING:This is a meta-analysis of published literature. MEDLINE was searched. Studies that used receiver-operating characteristics (ROC) curve analysis and published area unde...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,meta分析,评审


    authors: Lee CM,Huxley RR,Wildman RP,Woodward M

    更新日期:2008-07-01 00:00:00

  • The epidemiological relationship of hypercholesterolemia, hypertension, diabetes mellitus and obesity to coronary heart disease and atherogenesis.

    abstract::Coronary heart disease (CHD) is an imprecise, inappropriate monitor of atherosclerosis severity and by inapplicable extrapolation CHD risk factors are incorrectly assumed to be causes of atherosclerosis. Taking into account (1) the misuse and substantial diagnostic error of CHD, (2) errors in determining the prevalenc...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,评审


    authors: Stehbens WE

    更新日期:1990-01-01 00:00:00

  • P. C. A. Louis and the birth of clinical epidemiology.

    abstract::Pierre Charles Alexandre Louis (1787-1872) has been the direct or indirect mentor of influential U.S. and English scientists in public health, epidemiology, medicine, and biostatistics during the 19th and 20th century. Louis was primarily a clinician, but his name has been more closely associated with the history of e...

    journal_title:Journal of clinical epidemiology

    pub_type: 传,历史文章,杂志文章


    authors: Morabia A

    更新日期:1996-12-01 00:00:00

  • The impact of changes in coffee consumption on serum cholesterol.

    abstract::To investigate the possible association between changes in coffee consumption and serum cholesterol levels, information was obtained from 2109 healthy nonsmokers aged 25-65 years at two clinic visits to a preventive medical center between 1987 and 1991 (mean interval between visits: 16.7 months). After adjusting for a...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Wei M,Macera CA,Hornung CA,Blair SN

    更新日期:1995-10-01 00:00:00

  • Noncompliance in lifestyle intervention studies: the instrumental variable method provides insight into the bias.

    abstract:OBJECTIVE:In lifestyle intervention trials, participants of the control group often change their behavior despite the request to maintain their usual lifestyle pattern. These changes in the control group and changes in addition to the intended in the intervention group can lead to undesirable confounding effects. STUD...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Hertogh EM,Schuit AJ,Peeters PH,Monninkhof EM

    更新日期:2010-08-01 00:00:00

  • Trade-off between benefit and harm is crucial in health screening recommendations. Part I: general principles.

    abstract::Health screening is defined as the use of a test or a series of tests to detect unrecognized health risks or preclinical disease in apparently healthy populations to permit prevention and timely intervention. A health screening strategy consists of the sequence of a screening test, confirmatory test(s), and finally, t...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Dans LF,Silvestre MA,Dans AL

    更新日期:2011-03-01 00:00:00

  • Unpublished data can be of value in systematic reviews of adverse effects: methodological overview.

    abstract:OBJECTIVE:To assess the impact of including unpublished data on adverse effects in systematic reviews. STUDY DESIGN AND SETTING:We carried out a systematic review of methodological evaluations that compared the quantitative reporting of adverse effects data between published and unpublished sources, in particular, the...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,评审


    authors: Golder S,Loke YK,Bland M

    更新日期:2010-10-01 00:00:00

  • "Precision" and "accuracy": two terms that are neither.

    abstract:OBJECTIVE:In some publications, the terms "precision" and "accuracy" are used as if they were synonyms for "reliability" and "validity." METHODS AND RESULTS:This article shows that these terms are neither precise nor accurate when used in this way. Scales can demonstrate high test-retest or interrater reliability (i.e...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,评审


    authors: Streiner DL,Norman GR

    更新日期:2006-04-01 00:00:00

  • Characteristics of nonparticipants differed based on reason for nonparticipation: a study involving the chronically ill.

    abstract:BACKGROUND:Individuals who do and do not participate in studies often have different characteristics. The profile of nonparticipants may vary by type of nonparticipation. Few cross-sectional or longitudinal studies of chronically ill individuals identify these differences at baseline and of those that do; many do not h...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Holden L,Ware RS,Passey M

    更新日期:2008-07-01 00:00:00

  • Population surveys using validated questionnaires provided useful information on the prevalence of maternal morbidities.

    abstract:OBJECTIVES:To evaluate the ability of population surveys to estimate the occurrence of maternal morbidities. STUDY DESIGN AND SETTING:A literature search was conducted using MEDLINE, EMBASE, POPLINE references from relevant papers and proceedings of scientific meetings. No restrictions were made regarding language, da...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章,评审


    authors: Souza JP,Parpinelli MA,Amaral E,Cecatti JG

    更新日期:2008-02-01 00:00:00

  • International classification of diseases and current procedural terminology codes underestimated thrombolytic use for ischemic stroke.

    abstract:BACKGROUND AND OBJECTIVE:To determine the accuracy of recently introduced International Classification of Diseases Ninth Revision (ICD-9) procedure and Current Procedural Terminology (CPT) codes designed for injection or infusion of thrombolytic agents. MATERIALS AND METHODS:We determined the accuracy of ICD-9 procedu...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: Qureshi AI,Harris-Lane P,Siddiqi F,Kirmani JF

    更新日期:2006-08-01 00:00:00

  • Administrative database code accuracy did not vary notably with changes in disease prevalence.

    abstract:OBJECTIVES:Previous mathematical analyses of diagnostic tests based on the categorization of a continuous measure have found that test sensitivity and specificity varies significantly by disease prevalence. This study determined if the accuracy of diagnostic codes varied by disease prevalence. STUDY DESIGN AND SETTING...

    journal_title:Journal of clinical epidemiology

    pub_type: 杂志文章


    authors: van Walraven C,English S,Austin PC

    更新日期:2016-11-01 00:00:00