Compliance with the Zero Suicide Initiative by Mental Health Clinicians at a Regional Mental Health Service: Development and Testing of a Clinical Audit Tool
Round 1
Reviewer 1 Report
The manuscript deals with a topic oft clinical interest,methodology is appropriate.
My only suggestion is to shorten results section with a more extensive use of tables.
Author Response
Please see the attachment
Author Response File: 
Author Response.docx
Reviewer 2 Report
Review report
This is an interesting study that addresses an important issue, that is suicidality assessment in mental health services. Most importantly, it involves regional mental health services. The findings are informative for a wide readership.
Some points require clarification, see my comments below.
I have some questions about the sample of patients that were assessed. It appears that across ages 18-35 schizophrenia is under-represented among the diagnoses associated with suicidality. It is known however, that most cases begin in younger life and first episode schizophrenia patients are at risk for suicide. The authors should comment their results in relation to this evidence. See the recommended references below:
Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY, Carvalho AF, Seeman MV, Correll CU, Fusar-Poli P. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 2022; 27:281-295.
Sher L, Kahn R. Suicide in Schizophrenia: An Educational Overview. Medicina 2019; 55: 361.
Popovic D, Benabarre A, Crespo JM, Goikolea JM, González-Pinto A, Gutiérrez-Rojas L et al. Risk factors for suicide in schizophrenia: systematic review and clinical recommendations. Acta Psychiatr Scand 2014; 130: 418-426.
In the ages 76-85 group 33% of patients were diagnosed with dementia. There is some evidence that the highest risk for suicide in dementia sufferers is observed among adults aged 65 to 74 years, whereas other recent evidence found that suicide risk was significantly increased in patients diagnosed with dementia before age 65 years. See the recommended references below. The authors should comment and interpret their findings in this regard.
Schmutte T, Olfson M, Maust DT, Xie M, Marcus SC. Suicide risk in first year after dementia diagnosis in older adults. Alzheimers Dement. 2022 Feb;18(2):262-271.
Alothman D, Card T, Lewis S, Tyrrell E, Fogarty AW, Marshall CR. Risk of Suicide After Dementia Diagnosis. JAMA Neurol. 2022 Oct 3;79(11):1148-54.
It would be interesting for an international readership to comment on assessment procedures in the Australian community mental health context. Who performs the assessments? A psychiatrist? A clinical psychologist? Do the authors believe that the zero suicide audit is that relevant for psychiatrists?
The authors found that only the HOPE team conducted thorough assessments. They have previously stated that this team is specialized in suicide risk assessment. Could this mean that high-risk cases are referred to this team, and accordingly the less severe cases that are referred to other teams may not require comprehensive assessment? This could explain, at least in part, the differences. Please comment and clarify.
The authors should elaborate on the potential implications of their study. Do they believe that this audit should be included in national guidelines? It is certainly a detailed way for recording, but what is its relevance for treating psychiatrists?
Author Response
Please see the attachment
Author Response File: 
Author Response.pdf
Reviewer 3 Report
Dear Author,
you would need to complete the information on page 11 from lines 390 to 412.
Author Response
Please see the attachment
Author Response File: Author Response.docx
Reviewer 4 Report
Overall:
- The manuscript presents an interesting study about compliance of the Zero Suicide initiative by mental health clinicians
- The references are not formatted appropriately (in the text: must be in square brackets as shown in the template; in the References section: format as shown in the template & in the order of appearance)
- Information about Supplementary materials, Funding, Institutional review board statement, Informed consent statement, Data availability statement, Acknowledgments, and Conflicts of interest is missing
Results:
- Please use the appropriate title of the chapter (“Results”)
- Table 1 is quite wide with large gaps; could you edit it a bit?
- Lines 156-164: it is not suitable to repeat the numbers (percentages) from the table
Author Response
Please see the attachment
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
My comments have been addressed in the revised manuscript.
