Senior Mental Health Scenarios in Thai Buddhist Contexts: A Qualitative Study

Round 1

Reviewer 1 Report

This is a very good report of a qualitative research into Thai Buddhist elders and monks regarding perspectives of mental health issues and interventions. The paper, however, needs to be reorganized to present the research process and results. Below, I list suggestions to guide the authors in reorganizing their paper and also to address a few other area to address to strengthen the paper: 

-- Present a clear Purpose statement early on, identifying the specific research questions asked and to identify which group of participants (monks or elders) addressed each type of questions.

Organize the paper in this order : 

--Brief introduction with statement of purpose, and significance.

-- Review of any research findings regarding Buddhist elders' views about mental health and religion.

--Method used for the research (methods, materials, data analysis approach)

--Report of results.  But remove the interpretative, inferences types of statement from the Results section.  Instead, include these in the Discussion Section.  Also, in the report of Results, clarify which group (monks or elders) reported the particular themes. 

--Discussion.  (Also, see the suggestion for the Results section, to pull statements made in the Results, and incorporate into the Discussion section.)

--Conclusion.  Also, please elaborate to support and clarify what is 'profound' in this sentence: "profound insights into the intricate role of monastics in fostering senior mental 435 health within..."

Author Response

Reviewer1

Reviewer1 In response to the reviewer's feedback, I have diligently incorporated revisions throughout the document, clearly denoted by the use of red font for amended statements.

 Present a clear Purpose statement early on, identifying the specific research questions asked and to identify which group of participants (monks or elders) addressed each type of questions.

 Revised: Line 71-81.

2. Organize the paper in this order : I have sequenced the section by order requirement. I've incorporated a brief review of research findings regarding Buddhist elders' perspectives on mental health and religion in the introduction. Here's the revised structure for each section:

We changed the sequences in the suggested order.

2.1 Brief introduction with statement of purpose, and significance.

Revised: Lines 52-54.

2.2 Review of any research findings regarding Buddhist elders' views about mental health and religion.

Revised: Lines 40-45 (integrated into the introduction)

2.3 Method used for the research (methods, materials, data analysis approach)

We changed the sequences in the suggested order.

2.4 Report of results.  But remove the interpretative, inferences types of statement from the Results section.  Instead, include these in the Discussion Section.  Also, in the report of Results, clarify which group (monks or elders) reported the particular themes. 

We moved the statements from the results into the discussion.

2.5 Discussion.  (Also, see the suggestion for the Results section, to pull statements made in the Results, and incorporate into the Discussion section.)

We moved the statements from the results into the discussion.

2.6 Conclusion.  Also, please elaborate to support and clarify what is 'profound' in this sentence: "profound insights into the intricate role of monastics in fostering senior mental 435 health within..."

Revise: Line 484-486

Author Response File: Author Response.pdf

Reviewer 2 Report

Section 1 provides a thoughtful and well-documented discussion of the problem faced by the elderly, with Thailand and Buddhism serving as a representative example of larger global trends. 

Line 92: There's some idiomatic and phrasing issues in English after section 1, but the term "guy" serves as the kind of error benefitting from attention. Sections 2.1.1 and 2.1.2, stress/anxiety seem very similar. A more clear articulation of difference would be useful. 

Section 2.2-2.5 are clearly outlined, although it would benefit from edits to make the language more consistently idiomatic.

Section 3 repeats and enhances the themes with research. 

Section 4 provides the demographic data

Section 5 concludes by effectively repeating the findings.

Idiomatic English needs to be improved throughout. 

Author Response

Reviewer2 In response to the reviewer's feedback, I have diligently incorporated revisions throughout the document, clearly denoted by the use of blue font for amended statements.

 Section 1 provides a thoughtful and well-documented discussion of the problem faced by the elderly, with Thailand and Buddhism serving as a representative example of larger global trends. 

Revised: Lines 70-76

Line 92: There's some idiomatic and phrasing issues in English after section 1, but the term "guy" serves as the kind of error benefitting from attention.

We made revisions to ensure gender neutrality, respect to gender language, replacing 'guy' with 'seniors' based on feedback from another reviewer emphasizing gender equality. Additionally, we relocated statements from the results section to the discussion section, as suggested by the reviewer's feedback.

Revised: Lines 281,284,287,290, 310,316, 318, 341, 344,348

Sections 2.1.1 and 2.1.2, stress/anxiety seem very similar. A more clear articulation of difference would be useful. 

Revised: Lines 211,213.

Section (Results)  2.2-2.5 are clearly outlined, although it would benefit from edits to make the language more consistently idiomatic.

Revised: Lines 220-272

Section 3 (Discussion) repeats and enhances the themes with research. 

Revised: Lines 279, 291,304, 335, 372, 419

Section 4 (Materials and Methods) provides the demographic data

Revised: Lines 98, 102, 109-110

Section 5 concludes by effectively repeating the findings.

Revised: Lines 475-481

Author Response File: Author Response.pdf

Reviewer 3 Report

1. It would be useful to add the name of the country in the title ["(...) in Buddhist Contexts in Thailand"].
2. the abstract is correctly worded, includes all key information
3. the Introduction is correctly structured, the information is coherent and outlines well the theoretical context of the analyses.
4. In the section: Demographic characters/The Monk participants it is worth emphasizing more strongly that their monk participation in the study is related to their role in supporting seniors with coping with mental health difficulties.
5.The results are well organized, although it would be useful to expand and broaden them, such as quoting more statements, showing their context.
6. The discussion is very well developed. Materials and Methods are properly prepared.
7. Having corrected the minor deficiencies pointed out in the review, I recommend the article for publication.

Author Response

Reviewer3 In response to the reviewer's feedback, I have diligently incorporated revisions throughout the document, clearly denoted by the use of the green font for amended statements.

 It would be useful to add the name of the country in the title ["(...) in Buddhist Contexts in Thailand"].

Revised: Line 2

2. the abstract is correctly worded, includes all key information
3. the Introduction is correctly structured, the information is coherent and outlines well the theoretical context of the analyses.
4. In the section: Demographic characters/The Monk participants it is worth emphasizing more strongly that their monk participation in the study is related to their role in supporting seniors with coping with mental health difficulties.

Revised: Lines 110-112

5.The results are well organized, although it would be useful to expand and broaden them, such as quoting more statements, showing their context.

we relocated statements from the results section to the discussion section, as suggested by the reviewer's feedback

Revised: Lines 475-481, 310-321, 342-352, 381-393, 429-448

6. The discussion is very well developed. Materials and Methods are properly prepared.
7. Having corrected the minor deficiencies pointed out in the review, I recommend the article for publication.

Author Response File: Author Response.pdf

Reviewer 4 Report

I experience this as a fascinating article that is clearly organized and written - and has great potential to be a source of goodness in the world: helpful to academics and practitioners. It does need significant work before publishing, however, I think.

Below I labor to help grow the good of this article, always imperfectly and from my own limited vantage point. I hope the authors and editors find these remarks helpful. Since much of this literature is new to me, I cannot really comment on the research the authors are creating with and building upon.

1. What is your guiding research question(s)- or, put differently, what's the puzzle you are solving? Can you state it clearly at the onset?

2. Is there something new that your research brings to the field? If so, can you state that? If not, can you also state the difference your particular article is making to the conversation about, for example, spirituality, care for seniors, and public policy?

3. Would you like to be more inclusive with respect to gender language? Is there a guide within your field(s) that might help here? One source I find helpful: https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines. I draw attention to language 2.2.4 and 2.3 as an example - and the fact that only a gender binary is presented without comment.

4. How is your definition of stress experienced by seniors comparable to other definitions? See 2.1. I find it fascinating here that loneliness has to do with, in part, perception: https://www.uchicagomedicine.org/forefront/neurosciences-articles/research-shows-loneliness-poses-health-risk.

5. What is meant on 239 by "terrible state of health"?

6. Can you render your results in a clearer, more grounded in the research process, and more nuanced way, perhaps?  I think this section needs the most work.

7. How might you make this research more alive - more present and compelling to readers? Perhaps by telling a story?

8. 425: specifically how and in what context(s) might policy be influenced with the results of your research?

9. Can you also state clearly the benefits, potential pitfalls, and further questions that your study brings to the fore around spirituality and elder care?

Copy editing needed.

Author Response

Reviewer4 In response to the reviewer's feedback, I have diligently incorporated revisions throughout the document, clearly denoted by the use of the purple font for amended statements.

 What is your guiding research question(s)- or, put differently, what's the puzzle you are solving? Can you state it clearly at the onset?

Revised: Lines 71-81.

1. Is there something new that your research brings to the field? If so, can you state that? If not, can you also state the difference your particular article is making to the conversation about, for example, spirituality, care for seniors, and public policy?

Revised: Lines 481-484.

2. Would you like to be more inclusive with respect to gender language? Is there a guide within your field(s) that might help here? One source I find helpful: https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines. I draw attention to language 2.2.4 and 2.3 as an example - and the fact that only a gender binary is presented without comment.

Revised: Lines 281,284,287,290, 310,316, 318, 341, 344,348

3. How is your definition of stress experienced by seniors comparable to other definitions? See 2.1. I find it fascinating here that loneliness has to do with, in part, perception: https://www.uchicagomedicine.org/forefront/neurosciences-articles/research-shows-loneliness-poses-health-risk.

The stress experienced by seniors, defined as their inability to cope with stressful events, aligns with broader definitions of stress that emphasize the individual's response to external pressures. In both contexts, stress is characterized by the challenges individuals face in managing and adapting to various life stressors. This alignment highlights the universality of stress experiences across different age groups and underscores the importance of addressing stress management strategies tailored to seniors' needs.

By understanding loneliness as the perception that social interactions are less than desired, we acknowledge the subjective nature of this experience. It highlights how individuals' perceptions of their social connections influence their sense of loneliness, independent of the actual quantity of social interactions. This insight underscores the importance of addressing not only objective social isolation but also the subjective experience of loneliness in comprehensive approaches to promoting mental well-being among older adults.

4. What is meant on 239 by "terrible state of health"?

the seniors in the study had significant health problems or were in poor health overall. It implies that they may have had chronic illnesses, physical disabilities, or other health issues that impacted their daily lives and well-being. I remove it and instead of Poor health condition

Revised: Line 323

5. Can you render your results in a clearer, more grounded in the research process, and more nuanced way, perhaps?  I think this section needs the most work.

Revised: Lines 191-203

6. How might you make this research more alive - more present and compelling to readers? Perhaps by telling a story?

Revised: Line 204, Figure

7. 425: specifically how and in what context(s) might policy be influenced with the results of your research?

Revised: Lines 486-489

9. Can you also state clearly the benefits, potential pitfalls, and further questions that your study brings to the fore around spirituality and elder care?

Revised: Lines 489-491

Author Response File: Author Response.pdf

Round 2

Reviewer 4 Report

The authors addressed my concerns well. I trust their readers will learn about the important, complex relationship between spirituality and senior care in Thailand and around the world. Before publication, however, I suggest responding to the questions below clearly and more specifically in the conclusion.

What are the limitations of this study? Looking back over your research, what were you unable to understand? For example, I imagine that some seniors experience betrayal by monks, and that monks can, however well intentional and revered, undermine a senior’s health from time to time. Do you think this is true?

What might future researchers explore? What new questions, based on your research and findings, do you encourage others to pick up?

Can you name and describe at least one specific policy and/or initiative regarding elder care (a) in Thailand and (b) around the world that your research findings can help advance? You might consider, for example: https://sdgs.un.org/goals and https://innerdevelopmentgoals.org/

I note that the final sections “Materials and Methods” and “Conclusion” are not properly formatted in my copy and that a final, close copy edit would be helpful.