A p-value represents the probability of observing the study results, or more extreme results, assuming the null hypothesis is true. However, p-values do not provide evidence in support of the null hypothesis, irrespective of their value or the significance threshold. Consequently, statements suggesting that a non-significant p-value indicates ‘no difference’ or ‘no effect’ are inaccurate. ^{Reference Ferr1} Bayesian statistics and Bayes factors ^{Reference Goligher, Heath and Harhay2,Reference Schmalz, Biurrun Manresa and Zhang3} offer more appropriate approaches for quantifying evidence in favor of the null hypothesis, as they can directly measure support for ‘no difference’ versus ‘a difference’, unlike p-values that cannot support ‘no difference’ claims. On the other hand, significant p-values do not necessarily indicate the presence of a true effect, nor do small p-values represent large effect sizes. ^{Reference van Zwet, Gelman, Greenland, Imbens, Schwab and Goodman4}

Furthermore, the interpretation of decision p-values is binary, and findings are either statistically significant (rejecting the null hypothesis) or not (failing to reject the null hypothesis). ^{Reference Greenland5} Qualifying terms such as ‘highly significant’, ‘trend toward significant’, ‘borderline significance’, or ‘near-significant’ are discouraged, as statistical significance is not a spectrum. This concept is important in RCTs, where the p-value is often compared to a predefined threshold to assess an intervention’s efficacy or safety.

Yet the reporting and interpretation of randomized controlled trial (RCT) findings, which are central to advancing and shaping evidence-based psychiatric care, often follow a frequentist approach that misinterprets these statistical principles. This approach tends to prioritize statistical significance, commonly defined by an alpha threshold of 0.05, over clinical relevance. ^{Reference Thirthalli and Rajkumar6} This practice risks conflating statistical significance with clinical relevance, potentially misleading clinicians, researchers, and policymakers about the clinical importance or magnitude of effect of interventions. ^{Reference Citrome7} Misinterpretation of non-significant results, such as incorrectly accepting the null hypothesis by stating ‘there was no difference between groups’ or describing findings as ‘trending toward significance’, can distort perceptions of findings and influence decision makers.

When examining recent publications in leading psychiatry journals, the extent of this problem became evident. A review of RCTs using hypothesis testing published between January 2024 and May 2025 in six major psychiatry journals (American Journal of Psychiatry, Biological Psychiatry, BMJ Mental Health, JAMA Psychiatry, Molecular Psychiatry, and The Lancet Psychiatry) revealed widespread statistical misinterpretation.

Of 259 records, 70 were eligible for inclusion. Among the 189 excluded records, 149 (79%) were conference abstracts, and 3 (2%) had used Bayesian statistics. Of 70 included publications, 45 (64%; 95% CI, 53–75) contained null acceptance terminology, 13 (19%; 95% CI, 11–29) included trend terminology, and 6 (9%; 95% CI, 4–18) contained both types of terminology. Additionally, 3 (4%; 95% CI, 2–12) did not report effect sizes, and 13 (19%; 95% CI, 11–29) did not include confidence intervals for effect estimates. Table 1 contains the characteristics of publications with inaccurate statistical phrases.

Table 1 The characteristics of randomized controlled trials in six major psychiatry journals with null acceptance and/or trend phrases published between 2024 and 2025

CI, Confidence interval; n, Number of eligible entities; N, Total number.

a Total exceeds the number of publications due to several sources per publication.

Null acceptance terminology had a median p-value of 0.52 (IQR, 0.30–0.74), with the most common examples being ‘two groups did not differ’, ‘there were no differences between the groups’, and ‘there was no evidence of difference’. This terminology appeared in 12 abstracts (27%; 95% CI, 16–41) and 42 full texts (93%; 95% CI, 82–98).

Trend terminology had a median p-value of 0.0595 (IQR, 0.051–0.0805), with examples such as ‘near-significant (p = 0.06),’ ‘marginally significant (p = 0.067),’ and ‘borderline significant (p = 0.055).’ One exception involved a p-value less than 0.00001 interpreted as ‘highly significant.’ This terminology appeared in two abstracts (15%; 95% CI, 4–42) and 12 full texts (92%; 95% CI, 67–99).

The evidence based on this subset of the literature was striking: nearly two-thirds of publications contained inappropriate null acceptance claims, while almost one in five used misleading trend terminology. Nevertheless, the absence of assessing the presence of spin, a form of selective reporting, and the limitation to six journals may restrict their generalizability. Despite most publications reporting effect sizes and confidence intervals, problematic interpretive language remained common, indicating that the issue lies in how researchers interpret rather than report their findings, underscoring the need for greater clarity in statistical communication.

To summarize, the p-value alone provides limited information about the clinical relevance of a finding. As recommended by the American Psychological Association, researchers should accompany hypothesis testing results with effect estimates and measures of statistical precision, such as confidence intervals, to provide a more comprehensive interpretation rather than relying solely on statistical significance. This approach is important in psychiatry research, where small sample sizes are common due to recruitment challenges in populations with psychiatric disorders such as schizophrenia. In these contexts, hypothesis testing may be less informative, and alternative methods such as Bayesian statistics may provide more intuitive interpretations by incorporating evidence-based prior knowledge and directly quantifying the likelihood that treatments differ, rather than relying solely on p-values. Researchers are also encouraged to predefine evidence-based significance thresholds that best fit their investigation and hypothesis, rather than focusing exclusively on an alpha level of 0.05. Additionally, researchers should determine and incorporate the minimal clinically important difference a priori to contextualize the clinical relevance of their findings. Collectively, these practices help avoid dichotomizing results solely based on statistical significance.