Psych MEQs / SAQs · Foundations — biostatistics for psychiatry exams
Biostatistics calculations from a psychiatry abstract (MEQ)
FRANZCP/MRCPsych-style MEQ on ARR/NNT, RR vs OR, p-value definition, CI reading, and base-rate dependence of PPV.
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Model answer
Reveal model answer
(i) Rates and NNT. CER (placebo response) = 34/100 = 0.34. EER = 52/100 = 0.52. Absolute benefit = 0.52 − 0.34 = 0.18. RR = 0.52/0.34 ≈ 1.53. RRR for non-response framing is less natural here; for response, relative increase = 0.18/0.34 ≈ 53% of the control response rate — note this is not "53% of patients improved." NNT = 1/0.18 ≈ 5.6 → about 6 patients treated for 8 weeks for one extra responder.[1][6]
(ii) Odds vs risk. Odds drug = 52/48; odds placebo = 34/66; OR = (52/48)/(34/66) ≈ 2.1, which can be spun as roughly a doubling of odds — different from RR ≈ 1.53 and from a 53% relative risk increase. OR ≈ RR only when the outcome is uncommon; at 34–52% response, OR is not a safe substitute for RR.[2]
(iii) p-value. p = 0.01 means that if H0 of no difference in response proportions (and model assumptions) were true, data this extreme or more would occur about 1% of the time. It is not the probability Drug X does not work, nor proof of clinical importance.[3]
(iv) Mean difference CI. −2.8 points (95% CI −4.9 to −0.7) excludes zero → statistically significant mean benefit; magnitude is modest and may or may not exceed an MCID depending on scale and context — separate statistical from clinical importance; continuous outcomes do not give NNT without dichotomisation.[4]
(v) Base rates. PPV depends on prevalence. A sample of trial enrolees with known MDD is not a screening population; exporting clinic PPV to 3% prevalence primary care without Bayes/recalculation is base-rate neglect and will overstate the chance a positive screen is true disease.[5]
Common errors
Using RRR headline without ARR; treating OR as RR; defining p as P(H0|data); equating any significant continuous difference with large NNT benefit; exporting PPV across prevalences; omitting time horizon on NNT.[1][2][3][5]
References
- [1]Cook RJ, Sackett DL The number needed to treat: a clinically useful measure of treatment effect BMJ, 1995.PMID 7873954
- [2]Bland JM, Altman DG Statistics notes. The odds ratio BMJ, 2000.PMID 10827061
- [3]Greenland S, Senn SJ, Rothman KJ, et al. Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations Eur J Epidemiol, 2016.PMID 27209009
- [4]Gardner MJ, Altman DG Confidence intervals rather than P values: estimation rather than hypothesis testing Br Med J (Clin Res Ed), 1986.PMID 3082422
- [5]Altman DG, Bland JM Diagnostic tests 2: Predictive values BMJ, 1994.PMID 8038641
- [6]Laupacis A, Sackett DL, Roberts RS An assessment of clinically useful measures of the consequences of treatment N Engl J Med, 1988.PMID 3374545