Mental Health Research Methods Quiz

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Questions and Answers

What was the primary outcome measured in the study investigating the effectiveness of mirtazapine?

  • Beck Depression Inventory scores (correct)
  • Blood pressure
  • Body Mass Index (BMI)
  • Height

What statistical method was used to analyze the continuous outcome data in the study?

  • ANOVA
  • T-test
  • Linear regression (correct)
  • Chi-square test

What was the mean BDI-II score for the active treatment group at 12 weeks of follow-up?

  • 19.7
  • 18.0 (correct)
  • 20.5
  • 17.3

What was the mean difference in BDI-II scores between the active treatment group and the placebo group?

<p>-1.7 (A)</p> Signup and view all the answers

How many adults were recruited for the study on mirtazapine?

<p>480 (A)</p> Signup and view all the answers

What are the three most common types of outcome measurement seen in mental health research papers?

<p>Continuous outcomes, binary outcomes, time-to-event outcomes (B)</p> Signup and view all the answers

Which statistical concept is important for understanding the reliability of study conclusions?

<p>Confidence intervals (B)</p> Signup and view all the answers

In the PICO framework, which component refers to what researchers measure?

<p>Outcome (A)</p> Signup and view all the answers

Why is statistics particularly important in mental health research?

<p>To answer questions about mental health in the population (C)</p> Signup and view all the answers

Which of the following is NOT one of the steps in the four-step approach to research?

<p>Sample size (B)</p> Signup and view all the answers

What are binary outcomes in the context of mental health research?

<p>Outcomes that produce two distinct categories (C)</p> Signup and view all the answers

What is the goal of hypothesis testing in statistical analyses?

<p>To evaluate evidence against a null hypothesis (D)</p> Signup and view all the answers

What does a p-value indicate in statistical analysis?

<p>The likelihood of observing the data if the null hypothesis is true (C)</p> Signup and view all the answers

What is the risk of depression for children with adverse childhood experiences (ACEs)?

<p>10% (B)</p> Signup and view all the answers

Which of the following statements is true regarding the odds of depression in children without ACEs?

<p>Odds are calculated as 160/3,200. (A)</p> Signup and view all the answers

What does an odds ratio greater than 1 indicate?

<p>There is an increased risk in the exposed. (B)</p> Signup and view all the answers

Which variable serves as the exposure in the longitudinal study?

<p>Presence of adverse childhood experiences (ACEs). (B)</p> Signup and view all the answers

What does a risk ratio of 1 indicate about the comparison between two groups?

<p>No difference in risk between the groups. (D)</p> Signup and view all the answers

Why is odds more commonly used than risk in health research?

<p>Odds provide a clearer understanding of exposure effects. (B)</p> Signup and view all the answers

What outcome variable is measured at age 16 in the longitudinal study?

<p>Diagnosis of depression. (A)</p> Signup and view all the answers

What is the interpretation of an incidence rate ratio (IRR) greater than 1?

<p>The incidence rate is higher in the exposed group compared to the unexposed group. (C)</p> Signup and view all the answers

How can Poisson regression models be adjusted in analyzing incidence rates?

<p>By adjusting for multiple confounders or covariates. (C)</p> Signup and view all the answers

Which is the correct null hypothesis statement for comparing outcomes between groups?

<p>There is no difference in the outcome between the groups. (A)</p> Signup and view all the answers

In the context of depression rates among males and females, what were the rates for females aged 16-20?

<p>20.92 (A)</p> Signup and view all the answers

What does a confidence interval (CI) generated around the IRR represent?

<p>The range in which the true IRR is likely to fall. (B)</p> Signup and view all the answers

How can one disprove the hypothesis that depression always begins during adolescence?

<p>By finding just one individual who had their first episode as an adult. (B)</p> Signup and view all the answers

What determines the outcome variable when using Poisson regression in mental health research?

<p>It must be a count variable. (A)</p> Signup and view all the answers

Which rate indicates a higher level of depression between females and males in the provided data?

<p>Females with a rate of 20.92. (A)</p> Signup and view all the answers

What is the null value that would represent the null hypothesis when interpreting risk or odds ratios?

<p>1 (D)</p> Signup and view all the answers

Which statement best describes a p-value in the context of hypothesis testing?

<p>It reflects the strength of evidence against the null hypothesis. (B)</p> Signup and view all the answers

How should p-values be interpreted regarding their thresholds?

<p>Thresholds like 0.05 are arbitrary and can be misleading. (A)</p> Signup and view all the answers

What does a smaller p-value indicate about the null hypothesis?

<p>Stronger evidence against the null hypothesis. (B)</p> Signup and view all the answers

Why is it considered bad practice to interpret p-values based solely on a threshold?

<p>It can overlook the actual evidence provided by the p-value. (D)</p> Signup and view all the answers

What does a p-value of 0.035 suggest in comparison to a p-value of 0.051?

<p>0.035 implies a greater significance than 0.051. (A)</p> Signup and view all the answers

What does it mean when the p-value approaches 1?

<p>There is little evidence against the null hypothesis. (A)</p> Signup and view all the answers

What aspect of p-values is emphasized regarding their reporting?

<p>Precise values should be reported for clarity. (A)</p> Signup and view all the answers

What is the primary effect estimate produced by logistic regression?

<p>Odds Ratio (C)</p> Signup and view all the answers

Which statistical method is primarily used to compare two rates?

<p>Poisson Regression (A)</p> Signup and view all the answers

How does risk differ from rate in a study context?

<p>Risk measures outcomes relative to the initial population at risk. (C)</p> Signup and view all the answers

What is a crucial component to include in the denominator to reduce bias?

<p>Person years at risk (C)</p> Signup and view all the answers

Which of the following can logistic regression accommodate in its analysis?

<p>Multiple binary, categorical, or continuous exposures (A)</p> Signup and view all the answers

In a cohort study, what is a primary characteristic of how participants are followed?

<p>They are grouped by a common exposure characteristic. (C)</p> Signup and view all the answers

What occurs when participants are in a study for longer observation periods?

<p>The risk of outcome events generally increases. (D)</p> Signup and view all the answers

What does the term 'immortal time bias' refer to in pharmacoepidemiology?

<p>Time during which participants cannot develop outcomes due to study rules. (C)</p> Signup and view all the answers

Flashcards

Continuous Outcome

A variable that can take on any value within a range, usually measured on a scale.

Linear Regression (with binary exposure)

A statistical method used to investigate the relationship between a continuous outcome variable and a binary exposure variable. It helps to understand how much the exposure group's average outcome score differs from the unexposed group.

Group Mean

A measure of the average score of a group. For example, the average BDI-II score of participants in the mirtazapine group.

Standard Deviation (SD)

A score that represents the spread of scores around the average. A larger standard deviation indicates a greater spread.

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Mean Difference

A measure of the difference between two groups' means. It represents how much the mean score of the exposed group differs from the mean score of the unexposed group.

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Why use statistics in mental health?

Mental health research often analyzes data to understand how common problems are, who is more likely to experience them, and what causes and outcomes are associated with them.

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Binary Outcomes

Binary outcomes have only two possible values, like yes or no, or present or absent, such as whether someone has a diagnosis.

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Count Outcomes

Count outcomes are measured by counting the number of times something occurs within a certain period, such as the number of panic attacks a person has in a week.

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PICO Framework

The PICO framework helps define the core elements of a research question: the Patient/problem, Intervention, Comparison, and Outcome.

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Hypothesis Testing

Hypothesis testing is a statistical process to evaluate if there's enough evidence to reject a null hypothesis, which is the default assumption. For example, does a new treatment significantly improve symptoms compared to standard care?

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P-value

A p-value tells the probability of observing the results if the null hypothesis were true. A low p-value, like less than 0.05, suggests strong evidence to reject the null hypothesis.

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Confidence Interval

A confidence interval is a range of plausible values for a parameter, like the true effect of a treatment. A narrow confidence interval indicates a more precise estimate.

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Risk

The chance or likelihood of an event occurring.

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Odds

The ratio of the probability of an event occurring to the probability of it not occurring.

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Odds Ratio (OR)

The ratio of the odds of an outcome in the exposed group to the odds of the outcome in the unexposed group.

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Risk Ratio (RR)

The risk of an outcome in the exposed group divided by the risk of the outcome in the unexposed group.

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Increased Risk or Odds

An OR or RR greater than 1 indicates an increased risk or odds of an outcome in the exposed group.

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Decreased Risk or Odds

An OR or RR less than 1 indicates a decreased risk or odds of an outcome in the exposed group.

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No Difference in Risk or Odds

An OR or RR of 1 indicates no difference in risk or odds between the exposed and unexposed groups.

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Null Value (for OR/RR)

A value representing the null hypothesis in OR or RR analysis, where there is no difference in risk or odds between groups.

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Odds Ratio (OR) in Logistic Regression

Odds ratios are the effect estimates produced from logistic regression, a statistical technique used to predict the probability of a binary outcome (e.g., presence or absence of a condition) based on one or more predictor variables. These odds ratios represent the multiplicative change in the odds of the outcome for a one-unit increase in the predictor variable.

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Poisson Regression: Comparing Rates

Used to estimate the incidence rate ratio (IRR), which compares the rate of new events in two groups (e.g., exposed vs unexposed) over a period of time. Poisson regression is applied when the outcome is a count variable, such as the number of events occurring within a specified period.

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Controlling for Confounders

A statistical technique used to estimate the association between an exposure and an outcome, while controlling for potential confounding variables that might influence the relationship.

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Person-Years at Risk (PYAR)

The total amount of time individuals contribute to a study. It is calculated by summing the time each participant is at risk for the outcome. For example, if 10 participants are followed for 5 years each, the total PYAR would be 50 person-years.

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Rate (Incidence Rate)

The probability of an event occurring during a specific time period, calculated by dividing the number of new events by the total observation time. For example, the heart attack rate per 1000 person-years.

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Risk (Cumulative Incidence)

A measure of the proportion of individuals who experience an event during a specified time period, calculated by dividing the number of new events by the number at risk at the start of the observation period.

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Immortal Time Bias

A bias that occurs when time spent in the study without the outcome (immortal time) is incorrectly included in the analysis. This can inflate the apparent effect of the exposure and lead to misleading results.

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What is a P-value?

A statistical value representing the odds of observing the results you got if there were NO real effect or difference. It helps determine if your findings are due to chance or a genuine effect.

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What represents the null hypothesis in odds ratios?

The null hypothesis in odds or risk ratios is represented by 1, indicating no difference or association between the groups.

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How does a p-value relate to evidence against the null?

A smaller p-value indicates stronger evidence against the null hypothesis, meaning it's less likely the results are due to chance.

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What does a larger p-value mean?

A larger p-value indicates weaker evidence against the null hypothesis, suggesting the observed differences could be due to random chance.

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Why is it wrong to use a threshold (like 0.05) to interpret p-values?

While it's tempting to interpret a p-value by comparing it to a threshold like 0.05, a p-value should be considered as a continuous measure of evidence, not just significant or not.

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Why are p-values not the only important factor?

While p-values can be helpful, they don't tell the whole story. It's crucial to look at the effect size and confidence interval alongside the p-value to get a fuller picture.

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How should you report p-values in research?

You should always report the p-value precisely rather than stating 'p<0.05' to ensure more precise and transparent presentation of your findings.

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What is the role of frequentist statistics?

Frequentist statistics is a framework that focuses on testing the strength of evidence against the null hypothesis. It uses p-values to determine if the null is likely true or not.

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What is the Incidence Rate Ratio (IRR)?

The incidence rate ratio (IRR) is a statistical measure used to compare the incidence rates of an outcome (like depression) between two groups (e.g., females and males). It tells us how many times higher the incidence rate is in the exposed group (females) compared to the unexposed group (males)

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What is Poisson Regression?

Poisson regression is a statistical model commonly used in mental health research to analyze count data (like the number of depressive episodes) and estimate the association between an exposure (e.g., being female) and an outcome (depression). It helps determine if there's a significant relationship, and measures the impact of the exposure (IRR) on the outcome.

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What is the Null Hypothesis in Hypothesis Testing?

The null hypothesis is the starting assumption in hypothesis testing, stating that there is no difference or association between the groups being compared. The goal is to find evidence to disprove the null hypothesis and support an alternative hypothesis that suggests there is a difference or association.

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What does a Confidence Interval (CI) tell us?

A confidence interval (CI) is a range of plausible values for an effect estimate (like the IRR) that provides an idea of the precision of the estimate. A narrower CI indicates a more precise estimate, while a wider CI suggests more uncertainty.

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What does the p-value tell us in Hypothesis Testing?

The p-value tells us the probability of obtaining the observed results if the null hypothesis were true. A low p-value (typically less than 0.05) indicates that the observed results are unlikely if the null hypothesis is true, providing evidence to reject the null.

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What is the goal of Hypothesis Testing?

When conducting hypothesis testing, our goal is to gather enough evidence to confidently reject the null hypothesis. This means demonstrating that the observed results are unlikely to have occurred by chance alone, indicating a real difference or association between the groups.

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What does the Mean Difference tell us?

The mean difference is a measure of how much the average outcome score of the exposed group differs from the average outcome score of the unexposed group. A larger mean difference indicates a greater difference in outcomes between the groups.

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What are Covariates?

A covariate is a variable that is not the primary focus of the study, but may potentially influence the relationship between the exposure and outcome. Controlling for covariates helps adjust for potential confounding factors and provide a more accurate assessment of the association between the exposure and outcome.

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Study Notes

Session 4: 4th Oct - pt2

  • Introduction to Applied Statistics:
    • Covered three common outcome variables in mental health research: continuous, binary, and rates.
    • Used practical examples to determine appropriate statistical methods.
    • Provided how to interpret results from research papers.
    • Reading material available from PSBS0002: Core Principles of Mental Health Research | University College London (talis.com)
    • Class preparation included webpages on calculating the mean value, standard deviation, and variance.
  • Objectives:
    • Describe the aims of statistical analyses and investigations.
    • Comment on three primary outcome measurements in mental health research papers:
      • Continuous outcomes
      • Binary outcomes
      • Count outcomes
      • Time-to-event outcomes
  • Why use statistics in mental health?:
    • Answer questions about mental health within the population.
    • Example questions include:
      • How common are mental health problems?
      • Who is more likely to develop mental health problems?
      • Causes of mental health problems?
      • Outcomes of mental health problems?
      • Which treatments are effective?
  • PICO Framework:
    • Four-step approach to research:
      • Patient/problem
      • Intervention
      • Comparison
      • Outcome
    • Simple framework for understanding research.
    • Example research question: Are adverse childhood experiences (ACEs) associated with psychotic symptoms in adolescence?
  • Step 2: Define the Comparison:
    • Comparing two or more groups using examples like: Those exposed to risk factors versus those not exposed.
    • Example: Comparing treatment effectiveness (e.g., mirtazapine + sertraline vs. sertraline alone).
  • Step 3: Collect & Summarise Data:
    • Gathering mental health data on psychotic, depressive symptoms, and other relevant variables.
    • Collection often takes place at multiple time points.
  • Step 4: Test for Differences Between Groups:
    • Determining the magnitude of differences using effect size or association measures (e.g., mean difference, odds ratio, risk ratio).
    • Estimating the results' precision using 95% confidence intervals (CI).
    • Testing statistical significance using p-values.

Continuous Outcomes

  • Comparing Two Means:
    • Linear Regression
    • What does continuous outcome mean? (quantitative trait, e.g., depression, psychotic, eating disorder symptom score, BMI, height, age, blood pressure)
    • Example: Research into the efficacy of combining mirtazapine with another antidepressant for resistant depression. Randomizing participants to active treatment (mirtazapine + usual antidepressant) or placebo (placebo + usual antidepressant), and monitoring depressive symptoms over 12, 24, and 52 weeks using the Beck Depression Inventory(BDI-II).

Binary Outcomes

  • Comparing Two Proportions:
    • Probability, risks, and odds. Logistic regression.
  • Frequentist Definition: Probability = proportion of times that event would occur across numerous trials.
  • Example: Exploring the link between adverse childhood experiences (ACEs) and depression in adolescence.
    • Longitudinal study (4000 children aged 8-16) tracking ACEs exposure against depression diagnosis at age 16 using binary variables (exposed/unexposed, depression/no depression).
    • Calculate risks, odds, and odds ratios for these groups.
    • Calculation of risk and odds ratios, relating the probability to the observed values.
  • Risks:
    • Risk of outcome in the exposed = a / (a + b)
    • Risk of outcome in the unexposed = c / (c + d)
  • Odds:
    • Odds of outcome in exposed = a/b
    • Odds of outcome in unexposed = c/d
    • Odds ratios = (odds in exposed)/(odds in unexposed)
  • Key summary of risk and odds: Ratios close to 1 (or 0) would indicate no difference, ratios greater than 1 could indicate high risk.

Count Outcomes/Rates

  • Comparing Two Rates:
    • Incidence rate ratios, Poisson regression.
    • Mostly used in cohort studies.
    • People with and without known exposures followed over time
  • Information Collection: Exposure and outcomes tracked over the observation period. Calculating incidence rates and ratios.
  • Example: Investigating the link between family socioeconomic position in childhood and the development of depressive symptoms.
    • Observing a population (e.g., specific birth cohort) to measure socioeconomic status and tracking how many develop depressive symptoms over a period of time. Calculated incidence rates for those with certain exposures against those with no exposures.

Hypothesis Testing and P-values

  • Null-hypothesis:
    • There's no difference between groups.
  • P-Values:
    • Probability of obtaining results at least as extreme as the observed ones if the null hypothesis were true.
    • Low p-value indicates strong evidence against the null hypothesis.
  • Interpretation: Smaller p-values indicate stronger evidence against the null hypothesis. Larger p-values indicate weaker evidence against the null hypothesis and may need further investigation.
  • Confidence Intervals:
    • Range of likely values for an unknown population parameter (e.g., mean).
    • 95% CI range means there's a 95% confidence that the range will include the true value.

Cox Regression Model

  • This model explores the relationship between a time-to-event outcome.
  • Example: How long until an event occurs (e.g. first episode of depression)?
  • Examining how well an external factor predicts how long a person might take to experience that outcome.

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