![]() The above comment specifically raises the question of uncontrolled confounding by mental health concerns that are not “reasonably well controlled”, which may be associated with both depression, anxiety, or suicidality (outcomes) as well as the receipt of PB/GAH (intervention). Confounding by indication occurs when a variable is both associated with the outcome as well as receipt of the intervention/treatment interest, without being on the causal pathway. The above comment raises another question related to confounding by indication. In our study, this approach allowed us to compare outcomes among youth who received PB/GAH to those who have not (yet) received PB/GAH at each timepoint. ![]() This statistical model estimates the average population-level effect of the exposure on the outcome and accounts for correlations between binary outcomes across time within the same individual. To do this, we employed generalized estimating equations, which is a common statistical approach for estimating the association between a time-varying exposure variable (in our study, PB/GAH) on a repeated outcome measure (in our study, mental health symptoms). Rather, we examined temporal trends within a single cohort of youth with a time-varying exposure variable. Therefore, these mental health conditions are used as criteria for selecting which cohort participants were moved to, likely confounding the results.īefore responding to the reviewer’s primary comment regarding confounding, we would like to clarify that our study design did not compare two cohorts, as suggested by the above comment. Additionally, patients with coexisting mental concerns may have been potentially discouraged from accepting the treatments until their coexisting conditions were addressed. If their care does follow WPATH guidelines, any patients with uncontrolled coexisting mental concerns should not receive PB and GAH treatments if they do receive mental health interventions, they are moved from one cohort to the other. The mental health outcomes evaluated by this model are depression, suicidality and generalized anxiety. anxiety, depression) must be "reasonably well controlled" as a prerequisite for hormone therapy.įor this study, two cohorts are compared: those who have been exposed to puberty blockers (PBs) and gender-affirming hormones (GAHs) (intervention group) and those who have not (control group). ![]() Shared Decision Making and CommunicationĬare for transgender youth should ostensibly follow the WPATH guidelines for initiating care, which state that coexisting mental health concerns (eg.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |