Teleconference 7 Program Pra Doktor 16 Maret 2015 Jam 11:00 -13:00

Pokok Bahasan Teleconference 3 – Senin 2/3: Melacak makalah penelitian empirik (PE) pasca SR. 4.Kamis 5/3: Critical Appraisal (CA) makalah PE. 5.Senin 9/3: Masalah & Tujuan penelitian yg diperbaharui (+ Telaah Pustaka) 6.Kamis 12/3: Melengkapi Bab I 7.Senin 16/3: Melengkapi Bab I

TopikKata-kata KunciMakalah SR Masalah Penelitian (awal) Updating Telaah Pustaka Updating Masalah Penelitian Bagian-bagian lain Bab I Bab IIBab III Alir Menulis Pra-Proposal

Contoh: Topik: Pencegahan bunuh diri pada remaja  suicide prevention in adolescents. Google Scholar: suicide prevention in adolescents systematic review. Since: Ougrin, D., et al. (2015). Therapeutic interventions for suicide attempts and self- harm in adolescents: Systematic review and meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry Volume 54, Issue 2, Pages 97–107.e2

Objective:... progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years  Masalah praktis! Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta- analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents.

Method: Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and PubMed databases as of May RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through age 18 years) with self-harm were included.

Results: 19 RCTs including 2,176 youth were analyzed. TI = psychological and social interventions and no pharmacological interventions. Proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p =.02). TI with largest effect sizes were dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically significant.

Conclusion: TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a research priority.  Masalah Penelitian (awal): Apakah intervensi terapeutik (IT) efikasius utk mencegah cedera- diri? Tujuan Penelitian (awal): Melakukan ujicoba kendali acak (RCT) untuk melihat apakah ada perbedaan yg bermakna antara IT dan TAU dalam hal cedera-diri bunuhdiri dan non-bunuhdiri.

Catatan: IT yg diujicoba dapat DBT (dialectical behavior therapy), CBT (cognitive-behavioral therapy), atau/dan MBT (mentalization-based therapy). Pada meta-analysis yg dilakukan Ougrin dkk. : Secara terpisah DBT, CBT dan MBT tidak menunjukkan perbedaan yg bermakna secara statistik dibandingkan TAU. Kemaknaan statistik = ? Kemaknaan Praktis = ?

Dua pertanyaan penting yg akan dibahas Bu Ngesti Gandini: 1.Bagaimana mengakses full-text makalah SR ini? 2.Jika peneliti tertarik menguji coba CBT (Cognitive-Behavioral Therapy) bagaimana ia melacak makalah penelitian empirik ttg CBT yg terkini (sejak Mei 2014)?

Ngesti Gandini: Alamat No HP: No Telp Perpustakaan FK UGM:

Google Scholar: “cognitive behavioral therapy for suicide prevention in adolescents systematic review”: Mann, J.J., et al. (2005). Suicide Prevention Strategies: A Systematic Review. JAMA Oct 26, Vol 294, Nno. 16.

Hirarki Bukti Sumber:

15 Moderator Intervensi (Prediktor) Hasil (Kriterion) Mediator V2V2V1 Explanatory Theory Mengapa RCT memberikan “Quality of Evidence” yg lebih tinggi?” F1F3F2 F = Faktor = Dimensi V = variabel atau item Confounding = moderator non-spesifik Action (Predictive) Theory

Jenis VariabelPerlakuanTujuan Prediktor (X) & Kriterion (Y) DiamatiMeneliti korelasi X & Y V Bebas (X) & V Terikat (Y) V Bebas dimanipulasi (variasinya ditentu- kan), V Terikat diamati Meneliti korelasi X & Y ModeratorDikontrol, diamati atau dimanipulasi Meneliti pengaruh ciri atau keadaan unit analisis thd korelasi X & Y MediatorDiamatiMeneliti mekanisme korelasi X & Y Confounding (Moderator yg tidak spesifik) DikontrolMenghilangkan pengaruh V Confounding (perancu) thd korelasi X & Y

Validitas Penafsiran Data Pada RCT Validitas Dalam dan Validitas Luar ditingkatkan dengan mengendalikan moderator spesifik dan non-spesifik. Pada Non-RCT Validitas Dalam dapat ditingkatkan dengan: 1. mengamati moderator2 spesifik (analisis multivariat). 2. mengontrol moderator2 spesifik (kriteria inklusi, matching, stratifikasi). 3. memanipulasi moderator2 spesifik.

Variabel2 Perancu a)History – variabel2 lingkungan b)Maturasi – variabel2 intra subyek c)Testing – variabel2 pengukuran d)Instrumentasi – variabel2 alat ukur e)Seleksi diferensial – variabel2 inter-subyek f)Tendensi sentral – variabel2 subyek extrem g)Mortalitas – variabel2 subyek yang drop-out

Dengan penempatan acak unit2 analisis ke kelompok2 kontrol diharapkan data variabel2 perancu sama di kelompok2 tsb, kecuali Mortalitas Populasi Sampel X1X1 X0X0 R R R

Cara mengendalikan Mortalitas dengan Pre-test (untuk melihat siapa yang drop-out) Hipotesis penelitian didukung jika Selisih Mean O post kedua kelompok ≥ Selisih Mean Minimum (yang dipatok sebelum penelitian dimulai). O pre juga dapat digunakan untuk melihat apakah unit2 analisis kedua kelompok setara dalam hal variabel terikat sebelum V bebas dimanipulasi. R O X 1 O R O X 0 O

Validitas external menurun karena ada kemungkinan interaksi antara Pre-test dengan Intervensi Interaksi antara Seleksi dengan Intervensi Pengaturan2 khusus

Updating Telaah Pustaka 1. Melacak dan mengumpulkan makalah PE terkini  Kata kunci? self-harmself-harm, randomized controlled trials, meta- analysisrandomized controlled trialsmeta- analysis Mesin pencari? Kriteria inklusi? 2.Menyaring makalah PE (CA). 3.Sintesis  Kerangka konsep & hipotesis penelitian, (dan meta-analysis/meta-etnografi). 4.Melengkapi Bab I: Masalah/Tujuan Penelitian yg baru dan “Keaslian Penelitian” (mereplikasi PE yg mana? Dengan perbaikan apa dalam Kerangka Konsep, Rancangan Penelitian dan Pelaksanaan Penelitian.