Randomized Control Trials ( Rcts ) Are Considered The Golden Standard

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Randomized control trials (RCTs) are considered the golden standard when assessing the effect of a variable of interest which refers to a specific treatment. Observational studies are another way to estimate treatment effects and in specific, they allow casual relationships to be explored between a given intervention and an outcome variable, the main problem in such studies however, is that bias might be introduced in the estimates. Instrumental variables (IV), provide a useful tool to overcome this problem by adjusting for all confounders, observed or not (Martens et al., 2006). The rationale behind the construction of instrumental variables is explicitly described in a study by Ludwig et al. published in 2009, who aim to provide an estimate on the casual relationship between suicide mortality and a specific category of antidepressant drugs, the SSRIs (selective serotonin reuptake inhibitors) by using data from 26 countries for up to 25 years. Researchers in past studies attempted to link suicide mortality and anti-depressant therapies, the main concerns raised however, were around endogeneity issues and the bias generated with regards to SSRI utilization rates and suicide mortality. Ludwig et al. provide a solution to overcome the above limitations. In specific, they assume that institutional differences across countries have no relation with trends in mental disease treatments and suggest that the variation in SSRIs sales can be predicted by changes in the rate
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