A narrower study by the G.A.O. in 2005 first drew public attention to the issue.
The mean proportion of criteria suggesting a narrower study population was 9% (5%to13%3%, range 0-50).
For each of the 52 trials the proportion of missing or modified criteria that would lead a reader to assume a broader or narrower study population was calculated.
Inversely, readers would assume a narrower study population if comorbidities were mentioned as exclusion criteria in the trial report but not in the protocol.
Most of the missing eligibility criteria (96%, 94% to 97%) and modified eligibility criteria (54%, 46%to62%2%) suggested broader study populations and most of the added eligibility criteria (86%, 74%to94%4%) suggested narrower study populations.
Specifically, either a narrower study should be undertaken on the side of negative health (i.e., more work-related) or a broader one on the side of positive health (i.e., less work-related).
Narrow studies, done on those with specific disorders, tend to be more reliable.
Narrow studies have identified many specific indications for antidepressants, such as depression in neurological disorders, including multiple sclerosis and epilepsy; depression caused by interferon, a medication used to treat hepatitis and melanoma; and anxiety disorders in children.
We need broader studies that examine all seven forms of DV, not narrow studies whose subsets may be constrained by biased selection practices, and whose reports may have been submitted to ideological guidelines of interpretation.
When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families.
