To the Editor: The study by Dr Gould and colleagues1 addressed whether asking high school students about suicidal ideation or behaviors was harmful. We are concerned about aspects of the study methods. The study describes a group-randomized trial design in which 181 classrooms, containing 2342 students enrolled at 6 purposively selected New York State high schools, were randomized to 1 of the 2 study conditions. Rather than using data analytic techniques developed for group-randomized designs2 that we believe are the current standard, the authors concluded, based on their observation that the within-school intraclass correlation coefficients (ICCs) were all close to 0, that traditional multivariable regression models would be appropriate.
Iatrogenic Risk of Screening for Youth Suicide. JAMA. 2005;294(20):2578-2580. doi:10.1001/jama.294.20.2578-c