The Impact of Attempted Suicide on Young Adults: Learning from the Lived Experiences of UK Students in Further and Higher Education
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors have done a valuable and sensitive qualitative study that amplifies the voices of young adults with lived experience of suicide attempts. It addresses an under-researched area and has strong ethical grounding. The paper is rich in participant narratives and offers important insights for higher education policy and practice. However, there are areas where the manuscript could be strengthened in terms of focus, methodological clarity, and integration with existing literature.
- Abstract: Please state explicit research questions or objectives.
- Introduction: Also explicitly state what exactly the RQs in this study are.
- The paper uses both “lived” and “living” experience, but does not define the distinction. More explanation is needed about both terms.
- Methodology: The authors should consider adding how saturation was determined, how many coders were involved, and how disagreements were resolved.
- Methodology: Arts-based responses are mentioned in the methods but not integrated into the findings. Please justify why mentioning this in that part if data were not analyzed in this paper.
- Methodology: The authors mentioned the diversity of the samples; however, there is no table showing how diverse the participants are and how they contextualise the findings.
- Results: Some quotations are overly long and overshadow the authors’ analytic voice. Several subthemes are descriptive rather than interpretive; the authors may consider re-grouping of the current findings.
- Discussion: As the authors mention some policy in the introduction, stronger connections to higher education policy frameworks (e.g., UUK guidance, Suicide-Safer Universities) would enhance the practical contribution in the discussion section. More linking with the theories is expected, apart from only providing echoes with previous studies.
Author Response
Reviewer 1
The authors have done a valuable and sensitive qualitative study that amplifies the voices of young adults with lived experience of suicide attempts. It addresses an under-researched area and has strong ethical grounding. The paper is rich in participant narratives and offers important insights for higher education policy and practice.
We are grateful to the reviewer for the positive feedback, and we would like to thank the reviewer for time taken to review the paper and for their helpful comments and suggestions. Please find our response to the suggestions below.
However, there are areas where the manuscript could be strengthened in terms of focus, methodological clarity, and integration with existing literature.
Thank you for noting this, we have revisited the entire manuscript and re-focused the structure of the discussion, clarified methodology and provided further integration with existing literature.
Abstract: Please state explicit research questions or objectives.
The research questions related to this study have been added: 1. What can we learn from the lived experiences of young adults who have attempted suicide and 2. How can these findings be applied to better meet the needs of young adults experiencing suicidal thoughts/behaviour in Further and Higher Education.
Introduction: Also explicitly state what exactly the RQs in this study are.
In addition to the above, an online appendix with the semi-structured interview questions and a COREQ have been provided for further clarification.
The paper uses both “lived” and “living” experience, but does not define the distinction. More explanation is needed about both terms.
Thank you for highlighting this, the distinction between ‘lived’ and ‘living’ experience has now been clarified on p.2 of the manuscript: “Both lived and living experience are referred to in this article to acknowledge that for some, the experiences reported are in the past and for others, living with suicidal thoughts, feelings and behaviours is ongoing.”
Methodology: The authors should consider adding how saturation was determined, how many coders were involved, and how disagreements were resolved.
Thank you, we have taken not of this comment and saturation, coders and review have now been clarified in the manuscript on p.5.
Methodology: Arts-based responses are mentioned in the methods but not integrated into the findings. Please justify why mentioning this in that part if data were not analyzed in this paper.
Thank you for raising this point, we have removed the mention of arts-based responses, as this was part of a longer study and as this component has already been written about and we have referenced it in the manuscript it is superfluous to this article.
Methodology: The authors mentioned the diversity of the samples; however, there is no table showing how diverse the participants are and how they contextualise the findings.
A table has now been included to contextualise the findings. Limitations related to non-homogeneity have also been included on p.20.
Results: Some quotations are overly long and overshadow the authors’ analytic voice. Several subthemes are descriptive rather than interpretive; the authors may consider re-grouping of the current findings.
This has been carefully revisited; the findings have been reorganised and restructured to make clearer the analysis and how this supports the key research questions and to provide greater clarity. Quotations have been reviewed to ensure they are clear and shortened where appropriate. Unnecessary filler words have been removed from quotations.
Discussion: As the authors mention some policy in the introduction, stronger connections to higher education policy frameworks (e.g., UUK guidance, Suicide-Safer Universities) would enhance the practical contribution in the discussion section. More linking with the theories is expected, apart from only providing echoes with previous studies.
Thank you for this suggestion, the findings and discussion have been revisited and reorganised to focus more on the study’s practical contribution and to build stronger connections with policy frameworks and theory, with the inclusion of the recent social determinist model of suicide published in the Lancet Psychiatry, clarified on p.20, 21 and 22.
Reviewer 2 Report
Comments and Suggestions for Authors
Dear Authors,
The research is good and interesting.
- The introduction was appropriate and included citations from recent studies.
Methods: Unclear.
- The authors did not mention the sample selection method.
- There is no homogeneity in the sample, and the authors did not mention its specific characteristics.
Suicidal ideation and an individual's perception of suicide differ greatly and cannot be compared between someone with a depressive disorder, bipolar disorder, psychotic disorder, or personality disorder. Therefore, patients' perceptions of suicide are very different, making generalization of the results impossible.
- How were the axes divided? Based on which school of psychology, and how were these four dimensions established?
The study would have been more scientifically sound if the question axes had been pre-defined in psychological sessions rather than a structured interview.
- The study sample is relatively small.
- The results are appropriate and consistent with the majority of international studies.
- The discussion is good and supported by successful citations.
- The references are appropriate.
- The research adds something scientific to the medical literature.
Comments on the Quality of English Language
no
Author Response
Reviewer 2
The research is good and interesting.
We are grateful to the reviewer for the positive feedback.
The introduction was appropriate and included citations from recent studies.
The authors would like to thank the reviewer for time taken to review the paper and for their helpful comments and suggestions. Please find our response below.
The English could be improved to more clearly express the research.
The revised manuscript has been carefully proofread for clarity and any inconsistencies.
Methods: Unclear.
- The authors did not mention the sample selection method.
- There is no homogeneity in the sample, and the authors did not mention its specific characteristics.
The methods section has been clarified. An online appendix with the semi-structured interview questions and a COREQ have been provided for clarity and transparency. Review of the codes and themes has been clarified in the manuscript. A table has now been included on p.3 to contextualise the findings.
Suicidal ideation and an individual's perception of suicide differ greatly and cannot be compared between someone with a depressive disorder, bipolar disorder, psychotic disorder, or personality disorder. Therefore, patients' perceptions of suicide are very different, making generalization of the results impossible.
This is an interesting point, thank you for raising it. Although the study was not a quantitative medical study and therefore diagnoses were not part of the analysis per se, the authors agree that aspects of lived and living experiences of suicidality cannot be generalised and are deeply personal. The limitations related to non-homogeneity have now been explicitly acknowledged on p.20, clarified and included in the manuscript.
How were the axes divided? Based on which school of psychology, and how were these four dimensions established?
In response and to add clarity, we have now included the epistemological underpinnings to add clarity to methodology have been added on p.4.
The study would have been more scientifically sound if the question axes had been pre-defined in psychological sessions rather than a structured interview.
The authors take note of this and thank the reviewer for their comment; however, this was outside the scope of the study but may be considered for future research.
The study sample is relatively small.
The authors acknowledge the size of the study sample and have added to the limitations on p.20, explicitly stating that although recruitment reached far and wide across the 4 nations of the UK, the authors acknowledge the limitations of the non-homogenous nature of the study and that we only heard the voices of people who came forward. Consequently, the findings presented are therefore not necessarily representative of all people experiencing attempted suicide in Further and Higher Education.
The results are appropriate and consistent with the majority of international studies.
- The discussion is good and supported by successful citations.
- The references are appropriate.
- The research adds something scientific to the medical literature.
Thank you, we are most grateful for the reviewer’s positive acknowledgements.
Reviewer 3 Report
Comments and Suggestions for AuthorsFirst of all, I would like to congratulate the authors on the work carried out and thank them for the opportunity to review this manuscript. Below, I outline several suggestions for improvement:
- Abstract: The abstract should be revised, particularly the conclusions, once these have been improved in the main text.
- Introduction: The introduction is well structured, addresses the main topics of the study, and is coherent with the research objectives.
- Methodology: The study design needs to be explicitly stated, including its methodological foundation and the period during which the study was conducted. The authors should indicate the use of the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The sample selection criteria should be clearly described, avoiding the inclusion of data extracted from the interviews in this section. This information should instead appear in the population description. Additionally, the interview guide should be included either as a table or as supplementary material.
- Results: The results are well developed; however, they may be overly extensive. It might be advisable to focus them more specifically on aspects related to the postgraduate or doctoral student population, rather than on general issues concerning suicide that have already been widely discussed in previous studies.
- Conclusions: The research objective could be restated at the beginning of the discussion section, rather than in the conclusions. The conclusions should be limited to summarizing the main findings of the study, avoiding the inclusion of verbatim quotes. The current conclusions could be improved and should be rewritten more clearly and precisely, ensuring that they respond directly to the study objectives without restating them verbatim.
- References: The reference list lacks consistency in citation style. The DOIs are cited inconsistently (e.g., DOI, Doi, https://doi…). There is no need to include other identifiers (e.g., PMID, PMCID) if a DOI is provided. Please review citation formatting for specific references (e.g., ref. 6, 11, 15) and ensure full consistency throughout.
Author Response
Reviewer 3
First of all, I would like to congratulate the authors on the work carried out and thank them for the opportunity to review this manuscript. Below, I outline several suggestions for improvement:
The authors would like to thank the reviewer for time taken to review the paper and for their helpful comments and suggestions. Please find our response below.
Abstract: The abstract should be revised, particularly the conclusions, once these have been improved in the main text.
The abstract has been revised to specifically conclude with a link to policy.
Introduction: The introduction is well structured, addresses the main topics of the study, and is coherent with the research objectives.
We are grateful for your positive feedback.
Methodology: The study design needs to be explicitly stated, including its methodological foundation and the period during which the study was conducted.
The methods section has been clarified and the period during which the study was conducted has been included. An online appendix with the semi-structured interview questions
The authors should indicate the use of the Consolidated Criteria for Reporting Qualitative Research (COREQ)guidelines.
An online appendix COREQ have now been provided.
The sample selection criteria should be clearly described, avoiding the inclusion of data extracted from the interviews in this section. This information should instead appear in the population description. Additionally, the interview guide should be included either as a table or as supplementary material.
A table showing the population description of participants has now been included to contextualise the findings. An online appendix with the interview questions has now been provided. Thank you for highlighting the need to avoid data extracted in this section, this has been addressed and the content relocated to the appropriate place in the findings.
Results: The results are well developed; however, they may be overly extensive.
Thank you, we are glad the results feel well-developed. The results section has been carefully reviewed with the reviewer’s comments in mind and these have been reorganised and restructured to make clearer the analysis and how this supports the key research questions, with an enhanced focus on how and what it identifies that adds to current literature and policy.
It might be advisable to focus them more specifically on aspects related to the postgraduate or doctoral student population, rather than on general issues concerning suicide that have already been widely discussed in previous studies.
The authors take note of this and thank the reviewer for their comment; however, this was outside the scope of the study but may be considered for future research.
Conclusions: The research objective could be restated at the beginning of the discussion section, rather than in the conclusions.
The research objective has been restated at the beginning of the discussion rather than conclusion.
The conclusions should be limited to summarizing the main findings of the study, avoiding the inclusion of verbatim quotes.
Thank you for highlighting this point, we agree that it is more helpful to provide a rationale for inclusion of a verbatim quotation in the conclusion. This has now been explicitly stated, to honour the voices presented in the article, in keeping with the integrity of the work’s aim to honour the voices presented in the article.
The current conclusions could be improved and should be rewritten more clearly and precisely, ensuring that they respond directly to the study objectives without restating them verbatim.
The conclusions have been revised according to the reviewer’s feedback.
References: The reference list lacks consistency in citation style. The DOIs are cited inconsistently (e.g., DOI, Doi, https://doi…). There is no need to include other identifiers (e.g., PMID, PMCID) if a DOI is provided. Please review citation formatting for specific references (e.g., ref. 6, 11, 15) and ensure full consistency throughout.
Thank you for bringing this to our attention, the revised manuscript has been carefully proofread for clarity and any inconsistencies, including revisiting the reference list for consistency in citation style.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThanks for the authors' hard work.
Most comments are well-addressed.
Only one minor point about the distinction between ‘lived’ and ‘living’ experience. The present form "oth lived and living experience are referred to in this article to acknowledge that for some, the experiences reported are in the past and for others, living with suicidal thoughts, feelings and behaviours is ongoing." may still be hard to understand. I suggest the authors could re-write this for easier reading.
Author Response
Please find our response to the second review below.
Comment: Most comments are well-addressed.
Response: We would like to thank the reviewer for taking the time to review the manuscript again and for the opportunity to address the remaining point.
Comment: Only one minor point about the distinction between ‘lived’ and ‘living’ experience. The present form "Both lived and living experience are referred to in this article to acknowledge that for some, the experiences reported are in the past and for others, living with suicidal thoughts, feelings and behaviours is ongoing." may still be hard to understand. I suggest the authors could re-write this for easier reading.
Response: Thank you for highlighting this. We have reflected together and re-written it, hopefully it is now clearer. The revised version can be found on p.2 of the manuscript, highlighted in yellow: “Both lived and living experience are referred to in this article: the former refers to those for whom the experiences reported are in the past and the latter those living with suicidal thoughts, feelings and behaviours in their present.”
