title: Coming Up Short: Risks of Bias in Assessing Psychological Outcomes in Growth Hormone Therapy for Short Stature.
abstract: BACKGROUND
  Two often cited assumptions for treating children with GH are that short stature (SS), as an isolated physical characteristic, is associated with psychosocial morbidity and that GH treatment may increase height and improve psychological adjustment. Findings across studies regarding the psychological consequences associated with GH management of children with SS are variable and frequently contradictory. The purpose of this systematic review is to evaluate the degree to which any conclusions about the relative risks or benefits of GH treatment on psychological outcomes can be made based on the published literature.
  
  
  METHODS
  Electronic databases were searched for randomized clinical trials and nonrandomized studies, published between 1958-2014, in which GH was administered for management of children with SS and psychosocial, cognitive, academic, or health-related quality of life outcomes were assessed. Methodological quality of each study was assessed using the Cochrane Collaboration's tool for assessing risk of bias.
  
  
  RESULTS
  Eighty studies were evaluated. No studies were rated as having a low risk of bias, the risk of bias was unclear in seven study outcome areas, and the remaining studies were judged as having a high risk of bias.
  
  
  CONCLUSIONS
  The high risk of bias present in the majority of the literature on GH treatment effects on psychological outcomes (in particular, lack of blinding) substantially weakens confidence in their results. This may serve to explain the variability of findings for these outcomes across studies.
authors.affiliation: Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405.
authors.forename: M
authors.initials: M
authors.lastname: Gardner
authors.affiliation: Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405.
authors.forename: M L
authors.initials: ML
authors.lastname: Boshart
authors.affiliation: Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405.
authors.forename: C E
authors.initials: CE
authors.lastname: Yeguez
authors.affiliation: Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405.
authors.forename: K M
authors.initials: KM
authors.lastname: Desai
authors.affiliation: Department of Pediatrics and Communicable Diseases and Child Health Evaluation & Research Unit (M.G., C.E.Y., D.E.S.), University of Michigan, Ann Arbor, Michigan 48109; Department of Psychiatry (M.L.B.), Geisel School of Medicine, Hanover, New Hampshire 03755; and Department of Pain Medicine, Palliative Care, and Integrative Medicine (K.M.D.), Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55405.
authors.forename: D E
authors.initials: DE
authors.lastname: Sandberg
mesh_terms: D001827:Body Height / Q000187:drug effects; D020249:Hormone Replacement Therapy / Q000523:psychology*; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone