Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.

Name: Kaimen Rigor review — Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.
Item: Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.
Rating: 59
Author: Alpha1

Husain N, Tofique S, Kiran T, Pierce M, Chaudhry IB, Husain MO, Memon R, Waqas A, Gire N, Edwards S, Bassitt P, Shakoor S, Zaddeh ZF, Arshad U, Colucci E, Mughal F, Shahid S, Panagioti M, Nizami AT, Jafri F, Naeem F, Emsley R, Ansari MA, Sultan S, Aggarwal S, Williams C, Chaudhry N

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Kaimen Rigor review — 2★ (Weak), 0 critical, 5 high issues for “Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.”

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This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

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Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.

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DOI

10.1136/bmj-2024-083272

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Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.

Paper source

Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.

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Links back to this Kaimen Rigor review.

Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

Kaimen Rigor review

Kaimen Rigor reviewed

2 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×4−2★
StatisticsStatistic did not reproduce−0.5★
StatisticsPrinted percentage does not match its own count (capped)−0.25★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Biggest issues

01Printed percentage does not match its own count
highArithmeticrecomputedFull detail
1% does not match the reported count 48/342
“48 (1)”
Table 1
02Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
99% does not match the reported count 331/342
“331 (99%)”
Table 2

Findings by category

301ArithmeticNumerical inconsistencies 102OverreachOverstated conclusions 103AuthenticityData authenticity concerns 04DisclosureNone found 105AvailabilityBroken references and links 06Copyedit8 minor suggestions

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and transparently reported randomised controlled trial of a culturally adapted psychological intervention for adolescents who self-harm. The design, ethics, statistical methods, and data sharing are all exemplary, with only minor reporting inconsistencies and a few reproducibility gaps (e.g., unnamed statistical software).

Both reviewers independently scored all eight dimensions as pass with high confidence, and their evidence was consistent. The study type is interventional (RCT). Non-applicable sub-criteria (e.g., animal-related, cell line authentication) were excluded. The statistics verification covered only a subset of tests; the two inconsistent recomputations were not specified, so they are noted but not treated as confirmed errors.

Numerical inconsistencies

3 findings · worst high

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
Printed percentage does not match its own countRecomputed
Internal contradictions in the reported numbersAssessed

Recomputed 4 tests: 4 consistent, 0 inconsistent; 1 recomputed directly from the reported test statistics, 3 via agent-written checks. 1 reported summary statistic mathematically impossible for the stated N (PERCENT). 1 printed percentage that does not match its own count.

Overstated conclusions

1 finding · worst low

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Conclusions only partially backed by the presented evidenceAssessed

4 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

Efficacy claim is anchored to an adequate endpoint and a meaningful effect.

Data authenticity concerns

1 finding · worst low

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Data look implausibly cleanAssessed

4 integrity concerns flagged (0 high).

Reporting gaps

None found

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Checked — nothing surfaced.

Eight Dimensions8 pass

The introduction cites global and regional statistics on self-harm, prior meta-analyses, and the adult CMAP trial, acknowledging its limitations (e.g., non-significant reduction in self-harm repetition). The rationale for adapting CMAP for adolescents is clearly linked to the evidence gap. Limitations of prior research are addressed by the cultural adaptation and the trial design.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with extensive prior work cited, a logical rationale, and addresses limitations of prior research.

Evidence

“A meta-analysis on suicide prevention in young people highlighted that interventions delivered in educational and clinical settings are effective in reducing self-harm immediately after the intervention, but the effects diminish at follow-up.”

Introduction ¶1Find in source

“Therefore, we aimed to adapt the existing adult CMAP intervention to specifically target young people (YCMAP) and to assess the clinical effectiveness of this intervention in reducing repeat self-harm among adolescents with a recent history of self-harm.”

IntroductionFind in source

“Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant.”

Introduction ¶5Find in source

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise with extensive prior work cited, a logical rationale, and addresses limitations of prior research.

Evidence

Introduction ¶1Find in source

IntroductionFind in source

“Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant.”

Introduction ¶5Find in source

Randomization used stochastic minimization with method and unit described. Blinding of assessors and statistician is stated, with rationale for lack of therapist/participant masking. Power analysis is detailed with assumptions and adjustments for clustering and loss to follow-up. Inclusion/exclusion criteria are pre-specified. Outlier handling is addressed through sensitivity analyses for missing data. Controls are inherent in the enhanced treatment as usual arm. Independent replication is not applicable for a single pivotal trial.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous with adequate randomization, blinding of assessors, power analysis, and pre-specified inclusion/exclusion criteria.

Evidence

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

MethodsFind in source

“Researchers conducting follow-up assessments, as well as the trial statistician, remained masked to the treatment allocation.”

MethodsFind in source

“Under these assumptions, and with a 5% significance level and 90% power, a study with no clustering would require 158 patients per group.”

MethodsFind in source

PASSReviewer 2· 95% conf

The trial design is rigorous with adequate randomization, blinding of assessors, power analysis, and pre-specified inclusion/exclusion criteria.

Evidence

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

MethodsFind in source

“Researchers conducting follow-up assessments, as well as the trial statistician, remained masked to the treatment allocation. However, the trial therapist and participants were not masked to treatment allocation.”

MethodsFind in source

paraphrase[Methods, Participants]

“Under these assumptions, and with a 5% significance level and 90% power, a study with no clustering would require 158 patients per group. ... Assuming an intraclass correlation coefficient of 0.05 and a cluster size of 16 patients per therapist, we calculated a design effect of 1.75, increasing the numbers required to 277 participants per group.”

Sex is reported for all participants (53% female, 47% male). Age is reported with mean and SD. Demographics include marital status, education, employment, and income. Health status is indirectly captured via self-harm history and consultations. Species/strain and housing are not applicable for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Demographic and clinical characteristics are well reported, including sex, age, and other relevant variables.

Evidence

“Of the 684 participants, 365 (53%) were female and 319 (47%) were male, with a mean age of 16.1 years (standard deviation 1.7).”

Table 1Find in source

“Most participants came from families who owned their homes (64%); 401 (59%) had received more than eight years of schooling, and 591 (86%) were unemployed.”

Table 1Find in source

PASSReviewer 2· 90% conf

Sex, age, and other demographics are reported; sex is not single-sex so justification is not applicable.

Evidence

“Of the 684 participants, 365 (53%) were female and 319 (47%) were male, with a mean age of 16.1 years (standard deviation 1.7).”

Results ¶1Find in source

“Most participants came from families who owned their homes (64%); 401 (59%) had received more than eight years of schooling, and 591 (86%) were unemployed.”

Table 1Find in source

The paper reports approval from the National Bioethics Committee of Pakistan and the Research Ethics Committee of the University of Manchester, with reference numbers. Informed consent is described in detail, including adaptations for literacy and COVID-19. Regulatory compliance is implied through adherence to CONSORT and good clinical practice.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approval from named committees and informed consent procedures are clearly documented.

Evidence

“This trial involved human participants and received ethics approval from the National Bioethics Committee, Pakistan (reference 4-87/NBC-419/19/1213) and the Research Ethics Committee of the University of Manchester (reference 2019-5024-10755).”

EthicsFind in source

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian.”

MethodsFind in source

PASSReviewer 2· 95% conf

Ethical approval from named committees and informed consent procedures are clearly documented.

Evidence

EthicsFind in source

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian.”

MethodsFind in source

The YCMAP intervention is described with its components and session content. The manual is included as an online supplementary file. No drugs, biologics, or devices are used. Software tools are not specifically identified, but the statistical analysis software is implied. Since this is a psychological intervention trial, the key resource is the manual, which is adequately identified.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

The investigational intervention (YCMAP) is described in detail, and the therapy manual is provided as a supplementary file.

Evidence

“The intervention manual is included as an online supplementary file.”

MethodsFind in source

“Box 1 Description of YCMAP (youth culturally adapted manual assisted problem solving) intervention content”

MethodsFind in source

PASSReviewer 2· 85% conf

The investigational product (YCMAP intervention) is described in detail, and the therapy manual is provided as a supplementary file.

Evidence

“The intervention manual is included as an online supplementary file.”

MethodsFind in source

“Session 1: Getting started—helping participating adolescents to make sense of their self-harm attempt”

Box 1Find in source

The primary analysis used Fisher's exact test due to low event rates, with sensitivity analyses for missing data. Secondary outcomes were analyzed using linear mixed models. Tests are named, and effect sizes with 95% CIs are reported. Exact p-values are provided. Software is not explicitly named, but the statistical methods are described. Data presentation includes tables with means, SDs, and differences with CIs.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedINADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well described, with exact p-values and effect sizes with confidence intervals.

Evidence

“Consequently, Fisher’s exact test was used to estimate the P value and confidence interval of the odds ratio, instead of using a multivariable logistic regression model, as specified in the analysis plan.”

Statistical analysisFind in source

“0.20 (0.06 to 0.70) | 0.006”

Table 2Find in source

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well-described, with exact p-values and effect sizes with confidence intervals.

Evidence

Statistical analysisFind in source

“The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006).”

AbstractFind in source

The data availability statement names the Open Science Framework repository with a DOI and states that anonymised datasets, analysis scripts, and the therapy manual are available. This meets the criteria for a concrete access route. Repository deposit and accession numbers are satisfied by the OSF DOI. Code sharing is satisfied by the analysis scripts.

Sub-criteria

code sharingADEQUATE

accession numbersADEQUATE

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Data and code are publicly available on OSF with a DOI, and the data availability statement is concrete.

Evidence

“Anonymised datasets, data management and analysis scripts, and the therapy manual supporting the findings of this study are publicly available on the Open Science Framework at https://doi.org/10.17605/OSF.IO/6JQ8K .”

Data availabilityFind in source

PASSReviewer 2· 95% conf

Data and code are publicly available on OSF with a DOI, and the data availability statement is concrete.

Evidence

Data availabilityFind in source

Trial registration numbers are provided (ClinicalTrials.gov and ISRCTN). The paper states it is reported in accordance with CONSORT guidelines. All outcomes are reported, including non-significant ones. Limitations are discussed. Conclusions are proportional. Funding sources and competing interests are declared.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The trial is registered, reported per CONSORT, and includes funding and COI statements.

Evidence

“Trial registration ClinicalTrials.gov NCT04131179 (https://clinicaltrials.gov/ct2/show/NCT04131179) and ISRCTN registry ISRCTN57325925.”

AbstractFind in source

“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

MethodsFind in source

“Funding: This study was funded by the Joint Global Health Trials scheme; a partnership between the Foreign, Commonwealth and Development Office, the UK Medical Research Council, the National Institute for Health Research and the Wellcome Trust (MR/R022461/1).”

FundingFind in source

PASSReviewer 2· 90% conf

The trial is registered, reported per CONSORT, and includes limitations and funding/COI statements.

Evidence

“Trial registration ClinicalTrials.gov NCT04131179 (https://clinicaltrials.gov/ct2/show/NCT04131179) and ISRCTN registry ISRCTN57325925.”

AbstractFind in source

“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

MethodsFind in source

“This study has few limitations with implications for the generalisability of our findings because the results might not fully apply to populations with severe psychiatric conditions.”

LimitationsFind in source

Registered (2 IDs: ClinicalTrials.gov, ISRCTN). Reporting guideline cited: CONSORT.

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

Checked 46 references by DOI: 35 verified — 1 DOI unresolved, 10 no DOI (shown, not verified).

1 data/code link checked; 1 live.

Copyediting

8 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 8 minor suggestions below.

8 copyedit issues flagged: mostly consistency, typo, clarity.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is robust and trustworthy; an informed reader should weigh the minor internal inconsistencies (p-value discrepancy, Table 1 typo, lost-to-follow-up count) and the lack of named statistical software as minor limitations, none of which undermine the primary conclusions. No erratum is urgently required, but the authors should consider issuing a correction for the p-value and Table 1 typo.

1.
HIGHcopyedit
Reconcile the primary outcome p-value: the Abstract reports P=0.006 while the Discussion reports P=0.007; verify against the analysis output and correct one to match.
An internal inconsistency in the headline result undermines reader trust and could be flagged as an error.
2.
HIGHcopyedit
Correct the typo in Table 1, Education row: '48 (1)' should be '48 (14)' to match the percentage for 'No formal education' in the enhanced treatment as usual group.
A clearly impossible percentage (1%) is a data integrity red flag that reviewers and readers will notice.
3.
HIGHcopyedit
Verify the number of participants lost to follow-up (stated as 10) against the CONSORT flow diagram and correct any discrepancy.
Inconsistent participant flow numbers between text and diagram are a reporting error that could affect interpretation of attrition.
4.
HIGHreporting
Remove the extraneous DOI (10.7759/cureus.1665) from the Data Availability Statement, which appears to be a copy-paste error.
An unrelated DOI in the data availability statement is confusing and could be mistaken for the repository link.
5.
HIGHreporting
Verify or correct the reference 'GBD Results' (DOI 10.1016/s0140-6736(22) that could not be found in any registry; it may be fabricated or incomplete.
An unresolved reference is a potential fabrication signal and must be corrected or removed.
6.
MEDIUMreporting
Specify the statistical software and version (e.g., R, Stata) used for all analyses in the Methods section.
Naming the software is essential for reproducibility and is a standard reporting expectation.
7.
MEDIUMreporting
Clarify the phrase 'standard error was non-conservative' in the Statistical analysis section; rephrase to 'not conservative' or explain the intended meaning.
The current wording is ambiguous and could mislead readers about the statistical approach.
8.
MEDIUMreporting
Report the intraclass correlation coefficient (ICC) estimated from the trial data to validate the assumed value of 0.05 used in the sample size calculation.
Providing the observed ICC strengthens confidence in the power analysis and design effect.
9.
MEDIUMreporting
Add a CONSORT checklist as a supplementary file to explicitly document adherence to each CONSORT item.
A checklist makes compliance transparent and is often required by journals.
10.
MEDIUMreporting
Clarify the handling of the participant who died by suicide in the primary outcome analysis, as this was a deviation from the analysis plan.
Transparent handling of a serious adverse event in the primary analysis is critical for interpretability.
11.
MEDIUMreporting
Report the results of the sensitivity analysis assuming missing not at random in the main text or as a supplementary table with clear interpretation.
This sensitivity analysis addresses potential bias from missing data and should be accessible to readers.
12.
MEDIUMreporting
Include a statement on whether any adverse events were related to the intervention in the Results section.
Adverse event attribution is important for assessing the intervention's safety profile.
13.
MEDIUMdata code
Provide a data dictionary or codebook for the anonymised dataset to facilitate reuse.
A codebook enhances the usability of the publicly available data and supports reproducibility.
14.
MEDIUMreporting
Mention the version of the YCMAP manual used and any updates made during the trial.
Version control of the intervention manual is important for replication and fidelity assessment.
15.
MEDIUMreporting
Add a note on the generalizability of findings to other low and middle income countries in the Discussion.
Contextualizing the applicability of the intervention helps readers interpret its broader relevance.
16.
MEDIUMreporting
Include the number of participants who received each number of sessions (e.g., 8, 9, 10) to describe intervention dose.
Dose-response information is valuable for understanding the intervention's effectiveness and implementation.
17.
LOWreporting
Add a statement on the availability of the qualitative interview data, if applicable.
Clarifying the availability of all data types supports transparency and data sharing best practices.
18.
LOWreporting
Consider adding a table of baseline characteristics for those lost to follow-up vs. completers.
Comparing completers and dropouts can reveal potential attrition bias.
19.
LOWreporting
Clarify the definition of 'enhanced treatment as usual' and any standardization across sites.
A clear description of the control condition is essential for interpreting the intervention effect.
20.
LOWreporting
Clarify the role of the 'internal pilot' and any pre-specified stop/go criteria in the main analysis.
Transparency about pilot phases and decision rules strengthens the trial's methodological rigor.
21.
LOWreporting
Provide more detail on the handling of therapist effects in the sensitivity analyses.
Therapist effects are a potential source of clustering; detailing their handling improves confidence in the results.

Full text (63,123 chars)Analyzed: Aug 15, 2026

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Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.

Read full text (PMC)

DOI

10.1136/bmj-2024-083272

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Issued Aug 15, 2026Engine 7.39.0

Alpha1 assesses methodological rigor, not the importance of the findings. See how we calibrate →

Kaimen Rigor review

Kaimen Rigor reviewed

2 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×4−2★
StatisticsStatistic did not reproduce−0.5★
StatisticsPrinted percentage does not match its own count (capped)−0.25★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Biggest issues

01Printed percentage does not match its own count
highArithmeticrecomputedFull detail
1% does not match the reported count 48/342
“48 (1)”
Table 1
02Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
99% does not match the reported count 331/342
“331 (99%)”
Table 2

Findings by category

Numerical inconsistencies

3 findings · worst high

Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
Printed percentage does not match its own countRecomputed
Internal contradictions in the reported numbersAssessed

Overstated conclusions

1 finding · worst low

Conclusions only partially backed by the presented evidenceAssessed

4 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.

Efficacy claim is anchored to an adequate endpoint and a meaningful effect.

Data authenticity concerns

1 finding · worst low

Data look implausibly cleanAssessed

4 integrity concerns flagged (0 high).

Reporting gaps

None found

Checked — nothing surfaced.

Eight Dimensions8 pass

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise with extensive prior work cited, a logical rationale, and addresses limitations of prior research.

Evidence

Introduction ¶1Find in source

IntroductionFind in source

“Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant.”

Introduction ¶5Find in source

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise with extensive prior work cited, a logical rationale, and addresses limitations of prior research.

Evidence

Introduction ¶1Find in source

IntroductionFind in source

“Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant.”

Introduction ¶5Find in source

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous with adequate randomization, blinding of assessors, power analysis, and pre-specified inclusion/exclusion criteria.

Evidence

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

MethodsFind in source

“Researchers conducting follow-up assessments, as well as the trial statistician, remained masked to the treatment allocation.”

MethodsFind in source

“Under these assumptions, and with a 5% significance level and 90% power, a study with no clustering would require 158 patients per group.”

MethodsFind in source

PASSReviewer 2· 95% conf

The trial design is rigorous with adequate randomization, blinding of assessors, power analysis, and pre-specified inclusion/exclusion criteria.

Evidence

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

MethodsFind in source

paraphrase[Methods, Participants]

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Demographic and clinical characteristics are well reported, including sex, age, and other relevant variables.

Evidence

“Of the 684 participants, 365 (53%) were female and 319 (47%) were male, with a mean age of 16.1 years (standard deviation 1.7).”

Table 1Find in source

“Most participants came from families who owned their homes (64%); 401 (59%) had received more than eight years of schooling, and 591 (86%) were unemployed.”

Table 1Find in source

PASSReviewer 2· 90% conf

Sex, age, and other demographics are reported; sex is not single-sex so justification is not applicable.

Evidence

“Of the 684 participants, 365 (53%) were female and 319 (47%) were male, with a mean age of 16.1 years (standard deviation 1.7).”

Results ¶1Find in source

“Most participants came from families who owned their homes (64%); 401 (59%) had received more than eight years of schooling, and 591 (86%) were unemployed.”

Table 1Find in source

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approval from named committees and informed consent procedures are clearly documented.

Evidence

EthicsFind in source

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian.”

MethodsFind in source

PASSReviewer 2· 95% conf

Ethical approval from named committees and informed consent procedures are clearly documented.

Evidence

EthicsFind in source

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian.”

MethodsFind in source

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 85% conf

The investigational intervention (YCMAP) is described in detail, and the therapy manual is provided as a supplementary file.

Evidence

“The intervention manual is included as an online supplementary file.”

MethodsFind in source

“Box 1 Description of YCMAP (youth culturally adapted manual assisted problem solving) intervention content”

MethodsFind in source

PASSReviewer 2· 85% conf

The investigational product (YCMAP intervention) is described in detail, and the therapy manual is provided as a supplementary file.

Evidence

“The intervention manual is included as an online supplementary file.”

MethodsFind in source

“Session 1: Getting started—helping participating adolescents to make sense of their self-harm attempt”

Box 1Find in source

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedINADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well described, with exact p-values and effect sizes with confidence intervals.

Evidence

Statistical analysisFind in source

“0.20 (0.06 to 0.70) | 0.006”

Table 2Find in source

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well-described, with exact p-values and effect sizes with confidence intervals.

Evidence

Statistical analysisFind in source

AbstractFind in source

Sub-criteria

code sharingADEQUATE

accession numbersADEQUATE

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Data and code are publicly available on OSF with a DOI, and the data availability statement is concrete.

Evidence

Data availabilityFind in source

PASSReviewer 2· 95% conf

Data and code are publicly available on OSF with a DOI, and the data availability statement is concrete.

Evidence

Data availabilityFind in source

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The trial is registered, reported per CONSORT, and includes funding and COI statements.

Evidence

“Trial registration ClinicalTrials.gov NCT04131179 (https://clinicaltrials.gov/ct2/show/NCT04131179) and ISRCTN registry ISRCTN57325925.”

AbstractFind in source

“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

MethodsFind in source

FundingFind in source

PASSReviewer 2· 90% conf

The trial is registered, reported per CONSORT, and includes limitations and funding/COI statements.

Evidence

“Trial registration ClinicalTrials.gov NCT04131179 (https://clinicaltrials.gov/ct2/show/NCT04131179) and ISRCTN registry ISRCTN57325925.”

AbstractFind in source

“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

MethodsFind in source

“This study has few limitations with implications for the generalisability of our findings because the results might not fully apply to populations with severe psychiatric conditions.”

LimitationsFind in source

Registered (2 IDs: ClinicalTrials.gov, ISRCTN). Reporting guideline cited: CONSORT.

Broken references and links

1 finding · worst low

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

Checked 46 references by DOI: 35 verified — 1 DOI unresolved, 10 no DOI (shown, not verified).

1 data/code link checked; 1 live.

Copyediting

8 minor

Wording, consistency and formatting errors that need correcting before submission.

No major wording or formatting errors. 8 minor suggestions below.

8 copyedit issues flagged: mostly consistency, typo, clarity.

Kaimen Rigor Action ItemsFinal pass before journal submission

1.
HIGHcopyedit
Reconcile the primary outcome p-value: the Abstract reports P=0.006 while the Discussion reports P=0.007; verify against the analysis output and correct one to match.
An internal inconsistency in the headline result undermines reader trust and could be flagged as an error.
2.
HIGHcopyedit
Correct the typo in Table 1, Education row: '48 (1)' should be '48 (14)' to match the percentage for 'No formal education' in the enhanced treatment as usual group.
A clearly impossible percentage (1%) is a data integrity red flag that reviewers and readers will notice.
3.
HIGHcopyedit
Verify the number of participants lost to follow-up (stated as 10) against the CONSORT flow diagram and correct any discrepancy.
Inconsistent participant flow numbers between text and diagram are a reporting error that could affect interpretation of attrition.
4.
HIGHreporting
Remove the extraneous DOI (10.7759/cureus.1665) from the Data Availability Statement, which appears to be a copy-paste error.
An unrelated DOI in the data availability statement is confusing and could be mistaken for the repository link.
5.
HIGHreporting
Verify or correct the reference 'GBD Results' (DOI 10.1016/s0140-6736(22) that could not be found in any registry; it may be fabricated or incomplete.
An unresolved reference is a potential fabrication signal and must be corrected or removed.
6.
MEDIUMreporting
Specify the statistical software and version (e.g., R, Stata) used for all analyses in the Methods section.
Naming the software is essential for reproducibility and is a standard reporting expectation.
7.
MEDIUMreporting
Clarify the phrase 'standard error was non-conservative' in the Statistical analysis section; rephrase to 'not conservative' or explain the intended meaning.
The current wording is ambiguous and could mislead readers about the statistical approach.
8.
MEDIUMreporting
Report the intraclass correlation coefficient (ICC) estimated from the trial data to validate the assumed value of 0.05 used in the sample size calculation.
Providing the observed ICC strengthens confidence in the power analysis and design effect.
9.
MEDIUMreporting
Add a CONSORT checklist as a supplementary file to explicitly document adherence to each CONSORT item.
A checklist makes compliance transparent and is often required by journals.
10.
MEDIUMreporting
Clarify the handling of the participant who died by suicide in the primary outcome analysis, as this was a deviation from the analysis plan.
Transparent handling of a serious adverse event in the primary analysis is critical for interpretability.
11.
MEDIUMreporting
Report the results of the sensitivity analysis assuming missing not at random in the main text or as a supplementary table with clear interpretation.
This sensitivity analysis addresses potential bias from missing data and should be accessible to readers.
12.
MEDIUMreporting
Include a statement on whether any adverse events were related to the intervention in the Results section.
Adverse event attribution is important for assessing the intervention's safety profile.
13.
MEDIUMdata code
Provide a data dictionary or codebook for the anonymised dataset to facilitate reuse.
A codebook enhances the usability of the publicly available data and supports reproducibility.
14.
MEDIUMreporting
Mention the version of the YCMAP manual used and any updates made during the trial.
Version control of the intervention manual is important for replication and fidelity assessment.
15.
MEDIUMreporting
Add a note on the generalizability of findings to other low and middle income countries in the Discussion.
Contextualizing the applicability of the intervention helps readers interpret its broader relevance.
16.
MEDIUMreporting
Include the number of participants who received each number of sessions (e.g., 8, 9, 10) to describe intervention dose.
Dose-response information is valuable for understanding the intervention's effectiveness and implementation.
17.
LOWreporting
Add a statement on the availability of the qualitative interview data, if applicable.
Clarifying the availability of all data types supports transparency and data sharing best practices.
18.
LOWreporting
Consider adding a table of baseline characteristics for those lost to follow-up vs. completers.
Comparing completers and dropouts can reveal potential attrition bias.
19.
LOWreporting
Clarify the definition of 'enhanced treatment as usual' and any standardization across sites.
A clear description of the control condition is essential for interpreting the intervention effect.
20.
LOWreporting
Clarify the role of the 'internal pilot' and any pre-specified stop/go criteria in the main analysis.
Transparency about pilot phases and decision rules strengthens the trial's methodological rigor.
21.
LOWreporting
Provide more detail on the handling of therapist effects in the sensitivity analyses.
Therapist effects are a potential source of clustering; detailing their handling improves confidence in the results.

Full text (63,123 chars)Analyzed: Aug 15, 2026