Volume 39 · Number 7
JULY 2009
Statistical Approaches to Modeling Multiple Outcomes in Psychiatric Studies
By Armando Teixeira-Pinto, PhD; Juned Siddique, DrPH; Robert D. Gibbons, PhD; Sharon-Lise T. Normand, PhD
Multiple outcomes are increasingly collected both in randomized clinical trials and observational studies in order to characterize treatment or intervention effectiveness, or to investigate the association of the outcomes with other variables of interest. The decision to include more than one outcome arises for several reasons, including a lack of consensus on the most important clinical outcomes or a desire to demonstrate effectiveness on more than one outcome. The inclusion of multiple outcomes is particularly common in psychiatric studies where disease complexity is often not adequately characterized by a single outcome measure. Depression, for example, is assessed by multiple instruments.
ABOUT THE AUTHORS
Armando Teixeira-Pinto, PhD, is with the Department of Biostatistics and Medical Informatics, Faculty of Medicine, CINTESIS, University of Porto, Portugal. Juned Siddique, DrPH, is with the Department of Preventive Medicine, Northwestern University, Chicago. Robert Gibbons, PhD, is with the Center for Health Statistics, University of Illinois at Chicago. Sharon-Lise Normand, PhD, is with the Department of Health Care Policy, Harvard Medical School; Department of Biostatistics, Harvard School of Public Health.
Address correspondence to: Armando Teixeira-Pinto, PhD, Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; fax: 351 22 551 3623; or e-mail tpinto@post.harvard.edu.
Dr. Teixeira-Pinto and Dr. Siddique have disclosed no relevant financial relationships. Dr. Normand disclosed the following relevant financial relationship: National Institute of Mental Health (MH54693): research grant recipient. Dr. Gibbons disclosed the following relevant financial relationships: National Institutes of Mental Health: research grant recipient (R56-MH078580 and R01-MH8012201)
The WeCare data were generously provided through the efforts of Dr. Jeanne Miranda. The authors are also grateful to Dr. Hendricks Brown and Dr. Elizabeth Stuart for their valuable comments and suggestions. Dr. Miranda has disclosed no relevant financial relationships. Dr. Stuart has disclosed the following relevant financial relationships: Center for Prevention and Early Intervention, jointly funded by the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (Grant MH066247; PI: N. Ialongo), and NIMH grant K25-MH083846: research grant recipient. Dr. Brown has disclosed the following relevant financial relationship: research grant recipient (NIMH Grant R01-MH040859).
doi: 10.3928/00485713-20090625-08
EDUCATIONAL OBJECTIVES
- Review the role of multiple outcomes in psychiatric trials.
- Review different analytic strategies for analysis of multiple outcome measures.
- Discuss the best approach(s) to the simultaneous analysis of multiple outcome measures.
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