In Reply We thank Gordon for his interest in our research. While we fail to appreciate how our article1 is a “demonstration of the major clinical problems created by the inadequacies of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) paradigm for the classification of mental disease,” it is well understood that childhood trauma and maltreatment have been strongly associated with suicide, depression, and other phenomenological psychiatric diagnoses.2,3 The limitations associated with health claims data–related research, and particularly with regard to coded mental health–related diagnoses, are well understood. We agree with Gordon that clinicians may undercode or fail to properly consider diagnostic codes related to child abuse and trauma in filing health claims. Given this reality and the lack of validation for child abuse and trauma-related codes in health claims research,4,5 they were not included in study analyses. This was related to the nature of the available data used to perform study analyses rather than being “restricted by the DSM-5.” We defer any dialogue regarding the nosological issues raised by Dr Gordon to others, acknowledging that they are beyond the scope of our study and that the relationship between childhood maltreatment and descriptive psychopathology in childhood and adolescence is complex.6
Fontanella CA, Campo JV. Child Abuse and Neglect Contributing to Youth Suicide—Reply. JAMA Pediatr. 2020;174(12):1214–1215. doi:10.1001/jamapediatrics.2020.2576
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