Leon Andrew C
Weill Cornell Medical College, Department of Psychiatry, Box 140, 525 East 68th Street, New York, NY 10065, USA.
Dialogues Clin Neurosci. 2011;13(2):191-8. doi: 10.31887/DCNS.2011.13.2/aleon.
Characteristics of randomized controlled clinical trials (RCTs) and observational studies of psychiatric intervention effectiveness are contrasted. Randomization drives treatment assignment in an RCT, whereas clinician and patient selection determine treatment in an observational study. Strengths and weaknesses of randomized and observational designs are considered. The propensity adjustment, a statistical approach that allows for intervention evaluation in a nonrandomized observational study, is described here. The plausibility of propensity adjustment assumptions must be carefully evaluated. This data analytic strategy is illustrated with the longitudinal observational data from the National Institute of Mental Health Collaborative Depression Study. Evaluations presented here examine acute and maintenance antidepressant effectiveness and demonstrate effectiveness of the higher categorical doses.
对比了随机对照临床试验(RCT)的特征与精神科干预效果的观察性研究。在RCT中,随机化决定治疗分配,而在观察性研究中,治疗由临床医生和患者的选择决定。考虑了随机设计和观察性设计的优缺点。这里描述了倾向调整,这是一种允许在非随机观察性研究中进行干预评估的统计方法。必须仔细评估倾向调整假设的合理性。用美国国立精神卫生研究所协作抑郁研究的纵向观察数据说明了这种数据分析策略。这里呈现的评估考察了急性和维持性抗抑郁药的疗效,并证明了较高分类剂量的有效性。