In Reply We appreciate this opportunity to respond to the points raised by Zhou and Karina about our recent article.1 Zhou and Karina suggested that additional factors may have contributed to an imbalance between the Youth-Nominated Support Team Intervention for Suicidal Adolescents–Version II (YST) and treatment as usual groups, possibly giving an advantage to YST in terms of a lower predisposition to suicide or self-injury mortality. This is a valid consideration. We randomized 448 adolescents to YST (plus treatment as usual) or treatment as usual alone using stratification to ensure balance between groups with respect to sex, age, and multiple suicide attempt history.2 Although stratification guarantees balance on stratification factors and randomization yields balance between groups on average over other variables, the possibility remains that 1 or more important variables may be unbalanced.
King CA, Czyz E, Gillespie BW. Youth-Nominated Support Team Intervention For Suicidal Adolescents And Mortality Outcomes—Reply. JAMA Psychiatry. 2019;76(7):765–766. doi:10.1001/jamapsychiatry.2019.1062
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