Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.
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
- DOI
- 10.1136/bmj-2024-083272
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-20
Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/2847f976-1761-4bd1-9128-76737c573877 is authoritative.
How this rating was calculated
- 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★
- 01Printed percentage does not match its own count
1% does not match the reported count 48/342
“48 (1)”
Table 1 - 02Printed percentage does not match its own count
99% does not match the reported count 331/342
“331 (99%)”
Table 2
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 highValues 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.
- PERCENT99% does not match the reported count 331/342
“331 (99%)”
Table 2 - PERCENT1% does not match the reported count 48/342
“48 (1)”
Table 1
- CONSISTENTreported p = .006 · recomputed p = .010Recomputed odds ratio 0.20 (95% CI 0.06–0.70), reported p=0.006
“odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006”
Taken as given: 0.06–0.70 is a two-sided 95% confidence interval for the odds ratio of 0.20, not a range, an IQR, or a different interval level; the odds ratio is a RATIO measure, so the interval is symmetric on the log scale; p=0.006 is the p for THIS estimate, not for another comparison in the same sentenceMethod: back the two-tailed p out of the log-scale CI width and compare it against the printed pHow we recomputed it: pCI(0.2, 0.06, 0.7, 1) - CONSISTENTreported p = .006 · recomputed p = .007Reviewers 1, 2Primary outcome odds ratio p-value from Fisher's exact test
“YCMAP plus enhanced treatment as usual | 331 (99%) | 3 (1%)* | 0.20 (0.06 to 0.70) | 0.006”
Taken as given: The table is 2x2 with YCMAP group: 3 events, 339 non-events; control group: 15 events, 327 non-events.; The p-value is two-tailed from Fisher's exact test without mid-p correction.Method: Fisher's exact test on the 2x2 table using cell counts.How we recomputed it: pFisher2x2(3,339,15,327,0) - CONSISTENTreported p = .030 · recomputed p = .034Reviewer 1Secondary outcome: suicidal ideation at 3 months p-value
“3 months | 0.37 (2.25) | 1.69 (4.98) | −0.86 (−1.65 to −0.07) | 0.03”
Taken as given: The difference is from a linear mixed model with approximately 684 participants, so df ~ 682.; The reported p-value is two-tailed from a t-test on the difference.Method: Two-tailed t-test using the reported difference and CI to derive t-statistic.How we recomputed it: pT(2.13, 682) - CONSISTENTreported p < .001 · recomputed p = <.001Reviewer 2Secondary outcome: Kessler distress at 3 months p-value
“3 months | 15.28 (6.59) | 19.48 (7.37) | −3.83 (−5.10 to −2.56) | <0.001”
Taken as given: The difference is −3.83 with 95% CI (−5.10 to −2.56).; The standard error is (5.10-2.56)/(2*1.96) ≈ 0.648.; The p-value is two-tailed from a normal approximation.Method: Two-tailed z-test using the difference and its standard error derived from the CI.How we recomputed it: pZ(-3.83 / 0.648)
- lowinternal contradictionTable 1 shows 'No formal education' for the enhanced treatment as usual group as 48 (1), which appears to be a typo for 48 (14).
“No formal education | 44 (13) | 48 (1) | 92 (13)”
Table 1Find in source - lowinternal contradictionThe text states 10 patients were lost to follow-up, but the CONSORT diagram may show different numbers; ensure consistency.
“10 patients (1.5%) were lost to follow-up by 12 months (eight in the YCMAP group and two in the control group)”
Statistical analysisFind in source - lowinternal contradictionThe abstract reports P=0.006 for the primary outcome, while the Discussion reports P=0.007 for the same comparison.
Abstract: 'odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006' vs Discussion: '1% v 4%, P=0.007'
Discussionreviewer’s wording
Overstated conclusions
1 finding · worst lowConclusions 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.
- partialReviewers 1, 2YCMAP participants reported significantly better quality of life and satisfaction with services at three months, with effects sustained at all follow-up points.Quality of life (EQ-5D) and VAS showed significant improvements at 3 months, but the EQ-5D index was not significantly different at 6, 9, or 12 months; only the VAS remained significant at all time points. Satisfaction data are not presented in the main text.Evidence: Table 3: EQ-5D index significant at 3 months only; VAS significant at all time points. Satisfaction not reported in tables.
“YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points.”
AbstractFind in source - supportedReviewers 1, 2The YCMAP intervention significantly reduced the repetition of self-harm compared with enhanced treatment as usual at 12 months.The primary outcome analysis shows a statistically significant reduction with OR 0.20 (95% CI 0.06 to 0.70, P=0.006).Evidence: Table 2: 3/334 (1%) vs 15/342 (4%) repetitions, OR 0.20 (0.06-0.70), P=0.006.
“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 - supportedReviewers 1, 2YCMAP participants showed statistically significant reductions in distress, hopelessness, and suicidal ideation at three months.Secondary outcome analyses show significant differences at 3 months for all three measures.Evidence: Table 3: Suicidal ideation difference -0.86 (95% CI -1.65 to -0.07, P=0.03); hopelessness -1.21 (-2.09 to -0.33, P=0.007); distress -3.83 (-5.10 to -2.56, P<0.001).
“YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months.”
AbstractFind in source - supportedReviewers 1, 2The YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents.The primary outcome supports this claim, though the low event rate and sensitivity analysis under missing not at random suggest caution.Evidence: Primary outcome significant; sensitivity analysis under MAR supports, but MNAR analysis not significant.
“The YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents.”
ConclusionFind in source
Efficacy claim is anchored to an adequate endpoint and a meaningful effect.
- ADEQUATESurrogate endpointThe primary outcome is repetition of self-harm at 12 months, which is a hard clinical outcome (a clinical event). Secondary outcomes include distress, hopelessness, suicidal ideation, and quality of life, but the primary efficacy claim is based on the hard outcome. Therefore, the surrogate criterion is not applicable.
“The primary outcome was the repetition of self-harm at 12 months after randomisation.”
- ADEQUATEEffect sizeThe primary outcome shows a reduction in self-harm repetition from 4% in the control group to 1% in the intervention group, with an odds ratio of 0.20 (95% CI 0.06 to 0.70, P=0.006). This is a large relative reduction and is anchored to clinical meaningfulness as the sample size was based on a reduction from 20% to 7.5% considered clinically meaningful. Although the absolute event rate is low, the effect is statistically significant and clinically material.
“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).”
Data authenticity concerns
1 finding · worst lowAn 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).
- lowdata too cleanBaseline characteristics are very similar between groups, which is expected with randomization, but the near-identical means and SDs for age and income might be unusually balanced.
“Age, mean (SD) | 16.1 (1.7) | 16.2 (1.6) | 16.1 (1.7)”
Table 1Find in source
Reporting gaps
None foundRequired 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.
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.
“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.”
“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.”
“Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant.”
“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.”
“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.”
“Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant.”
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.
“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”
“Researchers conducting follow-up assessments, as well as the trial statistician, remained masked to the treatment allocation.”
“Under these assumptions, and with a 5% significance level and 90% power, a study with no clustering would require 158 patients per group.”
“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”
“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.”
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.
“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).”
“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.”
“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).”
“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.”
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.
“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).”
“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.”
“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).”
“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.”
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.
“The intervention manual is included as an online supplementary file.”
“Box 1 Description of YCMAP (youth culturally adapted manual assisted problem solving) intervention content”
“The intervention manual is included as an online supplementary file.”
“Session 1: Getting started—helping participating adolescents to make sense of their self-harm attempt”
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.
“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.”
“0.20 (0.06 to 0.70) | 0.006”
“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.”
“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).”
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.
“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 .”
“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 .”
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.
“Trial registration ClinicalTrials.gov NCT04131179 (https://clinicaltrials.gov/ct2/show/NCT04131179) and ISRCTN registry ISRCTN57325925.”
“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”
“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).”
“Trial registration ClinicalTrials.gov NCT04131179 (https://clinicaltrials.gov/ct2/show/NCT04131179) and ISRCTN registry ISRCTN57325925.”
“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”
“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.”
Registered (2 IDs: ClinicalTrials.gov, ISRCTN). Reporting guideline cited: CONSORT.
Broken references and links
1 finding · worst lowReferences 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).
- UNRESOLVED10.1016/s0140-6736(22GBD ResultsCited DOI does not resolve to any Crossref record.
- NO DOISuicide worldwide in 2019: global health estimatesNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIPsychosocial interventions for self‐harm in adultsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIA variational approach to stochastic minimization of convex functionalsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOICutting down: A CBT workbook for treating young people who self-harmNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOICosting psychiatric interventionsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIHandbook for good clinical research practice (GCP): guidance for implementationNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIBHS, Beck Hopelessness Scale: manualNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIManual for the Beck Scale for Suicide IdeationNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOITranslation and cultural adaptation of health questionnairesNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIInterventions for self‐harm in children and adolescentsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
1 data/code link checked; 1 live.
- dataOSFLIVEHTTP 200https://doi.org/10.17605/OSF.IO/6JQ8KResolves to OSF (data repository).
Copyediting
8 minorWording, 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.
- MINORtypoTable 1, Education row“48 (1)”→ 48 (14)Percentage for 'No formal education' in enhanced treatment as usual group appears to be a typo; should be 14% to match 48/342.
- MINORconsistencyAbstract vs Results“P=0.006”→ P=0.007Abstract reports P=0.006 for primary outcome, while Discussion reports P=0.007; should be consistent.
- MINORclarityMethods, Statistical analysis“standard error was non-conservative”→ standard error was not conservativePhrase 'non-conservative' is ambiguous; clarify meaning.
- MINORotherData Availability Statement“(10.7759/cureus.1665)”→ Remove extraneous DOIAn unrelated DOI appears in the data availability statement; likely a copy-paste error.
- MINORconsistencyAbstract, Results“P=0.006”→ Ensure p-values are consistently reported to two or three decimal places.The abstract reports P=0.006 while the discussion reports P=0.007 for the same outcome.
- MINORtypoTable 1, Education row“48 (1)”→ Correct to '48 (14)' to match the percentage.The percentage for 'No formal education' in the enhanced treatment as usual group appears to be a typo.
- MINORconsistencyMethods, Statistical analysis“10 patients (1.5%) were lost to follow-up by 12 months (eight in the YCMAP group and two in the control group)”→ Verify the numbers against the CONSORT flow diagram.The text states 10 lost, but the CONSORT diagram may show different numbers; ensure consistency.
- MINORclarityMethods, Statistical analysis“Because Fisher's exact test cannot accommodate weights, odds ratios were calculated using weighted logistic regression models, and therefore the standard error was non-conservative.”→ Clarify what 'non-conservative' means in this context.The phrase 'non-conservative' is ambiguous; consider rephrasing.
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.HIGHcopyeditReconcile 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.HIGHcopyeditCorrect 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.HIGHcopyeditVerify 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.HIGHreportingRemove 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.HIGHreportingVerify 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.MEDIUMreportingSpecify 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.MEDIUMreportingClarify 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.MEDIUMreportingReport 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.MEDIUMreportingAdd 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.MEDIUMreportingClarify 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.MEDIUMreportingReport 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.MEDIUMreportingInclude 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 codeProvide 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.MEDIUMreportingMention 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.MEDIUMreportingAdd 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.MEDIUMreportingInclude 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.LOWreportingAdd 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.LOWreportingConsider adding a table of baseline characteristics for those lost to follow-up vs. completers.Comparing completers and dropouts can reveal potential attrition bias.
- 19.LOWreportingClarify 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.LOWreportingClarify 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.LOWreportingProvide 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.
The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”
- Reporting — 8 dimensionseach dimension that fully fails−½★
- each dimension partially met−¼★
- Statistics · Integrity · Claimseach serious problem−1★
- each medium problem−½★
- Citationseach retracted or unverifiable reference−¼★
- Copyeditonly when the manuscript needs a full edit−½★
The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.
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Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.
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