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December 14, 2005

Cognitive Therapy and Preventing Suicide Attempts—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(22):2847-2848. doi:10.1001/jama.294.22.2848

In Reply: Drs Tepper and Whitehead and Messrs Filion and Delaney express concern about several variables that may account for our study results. They suggest that confounding related to either baseline marital and employment status or lack of any treatment during follow-up could be the underlying explanation for the observed difference in repeat suicide attempt rates between the 2 groups.

We created Cox regression models adjusting for these factors. They did not explain the intervention effect when controlling for marital and employment status (hazard ratio [HR], 0.51 [95% confidence interval {CI}, 0.25-1.01]; Wald χ21 = 3.72; P = .054). After controlling for lack of treatment during the 18-month follow-up period, we found a HR of 0.41 (95% CI, 0.20-0.80; Wald χ21 = 6.42; P = .01). The increased significance of the cognitive therapy effect after controlling for lack of treatment is explained by an association between no treatment and a reduced suicide reattempt rate relative to those patients who received some treatment (HR, 0.38 [95% CI, 0.19-0.74]; Wald χ21 = 7.91; P = .005). In contrast, neither marital status (P = .23) or employment status (P = .89) were significantly related to suicide reattempt status, with the differences in statistical significance after adjustment likely due to random variation.

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