eLetters to:

ELECTRONIC ARTICLE: Gail Slap, Elizabeth Goodman, and Bin Huang Adoption as a Risk Factor for Attempted Suicide During Adolescence Pediatrics 2001; 108: e30 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

eLetters published:

Statistically Insignificant Finding??

Glenn Sugameli   (7 August 2001)

Response to "statistically insignificant?"

Gail Slap   (8 August 2001)

Re: Statistically Insignificant Finding??

Steve Gunnell   (11 August 2001)

Breastfeeding – A Possible Contributing Factor for Increased Suicide in Adopted Children

Cory Mermer   (26 August 2001)

Re: Response to "statistically insignificant?"

Cathy A Seltzer   (22 May 2002)

Statistically Insignificant Finding?? 7 August 2001
Glenn Sugameli, Attorney none Send letter to journal: Re: Statistically Insignificant Finding?? sugameli{at}starpower.net Glenn Sugameli	I am not an expert on statistics, but after reading a Reuters lay report and the abstract, this strikes me as inviting a follow-up article or a clarification/correction on how the reported conclusion is what seems like a statistically insignificant difference. The abstract indicates that overall "The receiver operating characteristic curve for the model had an area of 0.834, indicating performance significantly better than chance." But, only 214 (just over 3%) of the students in the study were living with adoptive mothers. With such a small number the margin of error must exceed the reported difference between the 7.6% of adopted adolescents who had attempted suicide in the past year, compared with 3.3% of their peers. 7.6% of 214 is about 15 adolescents, while 3% is about 6. So the whole "difference" is based on 9 people. National random polls with much greater numbers of respondents have overall margins of error of plus or minus 3%. The margin of error increases considerably with smaller subgroups. --Glenn Sugameli
Response to "statistically insignificant?" 8 August 2001
Gail Slap, Author of article Children's Hospital Cincinnati Send letter to journal: Re: Response to "statistically insignificant?" slap{at}chmcc.org Gail Slap	I am pleased to respond to Mr. Sugameli's letter regarding the statistical significance of our findings. The univariate analysis comparing the proportions of adopted and nonadopted adolescents who reported suicide attempt(s) in the past 12 months was significant at P<0.001. The confusion is in the size of the study sample. There were 6,577 adolescents in the study, not 214 as noted by Mr. Sugameli. Of the 6,577 study subjects,214 lived with adoptive mothers and, of these, 16 (7.6%) reported suicide attempt(s) in the past 12 months. Of the 6,303 non-adopted adolescents, 197 (3.1%) reported suicide attempt(s) in the past 12 months. The absolute difference therefore was 197 minus 16, or 181 adolescents, rather than 9 adolescents as suggested by Mr. Sugameli. In the multivariate analysis, adoption was one nine variables that independently differentiated 213 adolescents who attempted suicide from 6,304 adolescents who did not attempt suicide. A receiver operating characteristic curve was drawn to depict the overall performance of the multivariate model . A model that performs perfectly has an area under the curve of 1.0. A model that performs no better than chance has an area of 0.5. The area of 0.834 that we reported represents performance significantly better than chance.
Re: Statistically Insignificant Finding?? 11 August 2001
Steve Gunnell, Project Manager LDS Families Supporting Adoption Send letter to journal: Re: Re: Statistically Insignificant Finding?? sgunne{at}qwest.net Steve Gunnell	Allow me acknowledge at the outset that I'm an adoptive parent and am affiliated with LDS Families Supporting Adoption, a volunteer group which provides mentoring, education and advocacy of adoption in the US and other countries. You state in your study that the age at which the adoption was done was not controlled for. Studies have found differences between adoptees adopted as infants and those adopted later in life. This is important because children coming out of foster care situations, particularly at older ages, are going to have some attachment issues. Second, do you control for differences between children living with both parents vs living with a single parent, whether adopted or not? Third, the validity of the study's conclusions depends on assumptions of random sampling. I have the following questions in this regard: 1- How random was the initial sampling of 90,118 students? 2- What is the potential impact of non-reponse or self-selection bias, i.e., of 90,118 adolescents who completed the in-school survey (the original sample), only 17,125 (19%) completed the in-home survey, which was further reduced to 6,577 to control for various family factors. I'm not a statistician, but it would seem to me that an 80% non-response rate on the home survey could be a significant issue. How would your conclusions be impacted if various subgroups in the study, such as the wealthy, higher income or those with more troubled children respond at higher rates? If you could survey the non responders, controlling for the family profile factors, might you get a very different result? Finally, assuming these findings are valid, people need to be very careful about how they use the results. People could intepret this study as being negative about adoption. However, consider the alternatives in many cases: a) staying in the foster care system as a ward of the state (or in the case of other countries, remaining in an orphanage), b) being raised by a single parent (children raised by a single mother generally have lower grades, are much more likely to live in poverty, drop out of school, etc.). Other studies have shown that children placed with adoptive couples are better off economically and are less depressed, have higher self esteem, a higher sense of security and less involvement with alcohol other problems compared with other teens. Adoptive parents are also less likely to divorce.
Breastfeeding – A Possible Contributing Factor for Increased Suicide in Adopted Children 26 August 2001
Cory Mermer, Medical researcher/writer Send letter to journal: Re: Breastfeeding – A Possible Contributing Factor for Increased Suicide in Adopted Children camermer{at}yahoo.com Cory Mermer	While adopted children undoubtably face increased emotional stresses over their non-adopted counterparts, there is one factor that nobody mentions. Namely, that breastfeeding rates for adopted children are almost certainly almost zero. There will most definitely be some exceptions to this broad statement, such as some children raised by birth parents who become adopted at some later point. But statistically, I think that adopted children are unique in that they are one group where rates of breastfeeding are almost nil. Since human milk contains many substances crucial for brain development, and lacking in human milk substitutes, and breastfeeding has also be found to benefit neurodevelopment (1, 2) there is a biologically plausible basis for some association here. While none of this proves that an association exists, it might be worth examining further. Competing Interests: None. References 1. Vestergaard M, Obel C, Henriksen TB, Sorensen HT, Skajaa E, Ostergaard J. Duration of breastfeeding and developmental milestones during the latter half of infancy. Acta Paediatr 1999 Dec;88:1327-32. 2. Agostoni C, Marangoni F, Lammardo AM, Giovannini M, Riva E, Galli C. Breastfeeding duration, milk fat composition and developmental indices at 1 year of life among breastfed infants. Prostaglandins Leukot Essent Fatty Acids 2001 Feb;64(2):105-9
Re: Response to "statistically insignificant?" 22 May 2002
Cathy A Seltzer, Independent Distributer /AMS Sylvia's NY ADOPTION Send letter to journal: Re: Re: Response to "statistically insignificant?" Tolpaint23{at}aol.com Cathy A Seltzer	The one very important fact that is being over looked in these studies is blatently clear to those involved in adoption. You can not take away someone's identity and expect them to be left with no ill effects. The concept of adoption was meant to be a family a child could grow up with if their birth parents were not able to care for them for what ever reasons.It evolved into the children used as workers on family farms, babies for childless couples,disreputable Lawyers and Doctors over time took advantage of the money that could be made. These adoptees had no rights as infants or young children, they were placed by adults with adults. Even as adults now, themselves they are controlled by a system that never looks at them as adults.They are and always will be that being who has no rights to their past. The need to know can haunt them, but the laws in many states in this country can not see this simple fact. They over look their feelings because they were lucky enough to be given a home..."How could they not be grateful for what was done for them". The fact is the states went too far. They should have left records open for an adoptee to get their information upon becoming an adult. also they should have made it so the adoptive parents could get info on them for medical reasons. THIS IS CRIMINAL!!! The state knows info that can save the lives of so many adoptees and chooses to hang on to these antiquated laws. Is it any wonder there is suicide. What are they telling adoptees about their self worth?? Who is important here? Until we wake up as a country and realize what is happening in our adoptive community, this will continue. It is easy to watch the talk shows and be moved by the reunions that are made by some of them, but as soon as that TV is turned off people are thinking of their own lives again.But many adoptive children have heard it all and can not go on with their lives as normal.They are exploited again for entertainment. And finally, in their own adoptive families, there are always those well meaning aunts, uncles,friends that just seem to think they have to be the ones to tell the adoptee what is fact, and that usually is disasterous.Again another in control of their lives. I see so many statistics, but they are words on paper and do nothing to help the real problems. No one wants to jump in there and be the champion for open records. Until we all wake up and realize we have to fix the problem in the very beginning instead of waiting until the problems become so bad a childs life is snuffed out forever, things will never get any better. Sincerely Cathy A. Seltzer