The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life

Round 1

Reviewer 1 Report

The submission requires a significant amount of copy-editing for English language and style. Some errors are typographical, such as "that was a in the" (line 273). Some errors leave gaps that inhibit understanding, such as "Came and complained about  very linear type of man" (lines 114-115) or "O yes.. S***!" (line 117). Some errors convey meaning that is likely unintended, such as "wide specter of patient needs" (line 282). These distract from the content of your submission.

With a sample size of 10, it is unclear age range of 29-64 years, it is unclear how many GPs are in the category of "more than 30 years' experience" noted on line 176. With an even number of men and women interviewed, an additional sampling question is what the gender split was for first five interviews compared to the second set of interviews (line 72-73). The manner of recruitment (convenience plus snowball sampling) needs to be included in the limitations as the respondents are less likely to be representative of GPs in general (i.e., they may be more informed or interested about suicide-related topics compared to the average). In the limitations section it also says "gender and the range of experience resembles the population" but no comparison data is provided for the reviewer to judge the accuracy of the statement.

Under data analysis methods, it says that the study used "established procedures of qualitative analysis" with a reference to a general qualitative analysis literature review. Because the reference is nonspecific it is not clear which procedures were actually used.

Overall, it is an interesting research question, and using a case series approach is a good start. Adding patient perspectives, as noted under "implications for future research" would strengthen the study results. It is useful for the field to have a better understanding of what GPs are comfortable and confident with, where they struggle, and where they experience meaningful outcomes. 

Author Response

Dear editor and reviewers, thanks for reviewing this paper, for the comments and suggestions. In the following we have responded to each response point by point, and we hope that you find the changes satisfactory improved and accomdated.

It was very nice to hear that you found the aim and results interesting.

Best regards,

M. Styrvold and TK. Grimholt

 

Responses

REVIEWER NUMBER 1

The submission requires a significant amount of copy-editing for English language and style.

 

Answer: Reviewer 2 think that the language and style are fine/minor spell check required and that the manuscript is generally fluently written. We want to underline that the quotes are referred identical to how they were expressed but understand that there might be some confusing phrases. In total we have gone thoroughly through the paper with help from a fluent English speaker and made several minor changes (n=56) that we hope is satisfactory.

Some errors are typographical, such as "that was a in the" (line 273).

Answer: This is now changed.(line 273)

Some errors leave gaps that inhibit understanding, such as "Came and complained about  very linear type of man" (lines 114-115)

Answer: That is exactly how the GP talked, and the quote is referred with his own words. We have added a pause of thinking in the sentence to enhance the readers understanding.

 or "O yes.. S***!" (line 117).

Answer: That was a cursing that we didn’t think was proper to refer in the manuscript, however it is now changed please see line 117.

Some errors convey meaning that is likely unintended, such as "wide specter of patient needs" (line 282). These distract from the content of your submission.

Answer:  Thank you for pointing out this error, we have now changed in into: Patients arrive their GPs office with different problems and needs. One quote was particularly interesting and described the essence of the study aim: (line 278)

With a sample size of 10, it is unclear age range of 29-64 years, it is unclear how many GPs are in the category of "more than 30 years' experience" noted on line 176.

Answer:  We agree, that is unclear and now changed into: “The GPs with long experience had followed some of the patients for several years and followed life events like marriage, pregnancy or divorce” (line 176-177)

With an even number of men and women interviewed, an additional sampling question is what the gender split was for first five interviews compared to the second set of interviews (line 72-73).

Answer: We have added information about this (line 71).

The manner of recruitment (convenience plus snowball sampling) needs to be included in the limitations as the respondents are less likely to be representative of GPs in general (i.e., they may be more informed or interested about suicide-related topics compared to the average).

Answer: Thanks, we have now added this limitation. (line 317-319).

In the limitations section it also says "gender and the range of experience resembles the population" but no comparison data is provided for the reviewer to judge the accuracy of the statement.

Answer: We agree, and this is now rephrased into: The first limitation was the sample size; however, saturation was achieved in the main findings. (line 320-322).

Under data analysis methods, it says that the study used "established procedures of qualitative analysis" with a reference to a general qualitative analysis literature review. Because the reference is nonspecific it is not clear which procedures were actually used.

Answer: We agree that this was unclear, and the reference was misplaced. We have changed and elaborated on this, please also see comment on this reviewer 2.

Overall, it is an interesting research question, and using a case series approach is a good start. Adding patient perspectives, as noted under "implications for future research" would strengthen the study results. It is useful for the field to have a better understanding of what GPs are comfortable and confident with, where they struggle, and where they experience meaningful outcomes. 

Answer: We have added this in the “implications for future research “ section (line 391-393)

 

REVIEWER NUMBER 2

In this manuscript, the authors interviewed ten GPs about how they dealt with patients with depression and potential suicidal ideation to indicate the role of GPs in suicide prevention. The manuscript is generally fluently written, except for two issues that can be enhanced.

1), in section 2.3, the authors may elaborate a bit more on "using established procedures of qualitative analysis" to let the readers know what has been done here.

Answer: We have now added this in the section 2.3 “All interviews were transcribed verbatim. They were analyzed with five stages of data analyses using the framework approach; familiarization, identifying a thematic framework, indexing, charting and finally mapping and interpretation [9].»

 

2), section 3.6 can be enhanced as this is an important part of the manuscript. The authors may elaborate more on how the GPs employed preventions measures or strategies when they have or have not identified suicide ideation in the patients, because there are perhaps always unidentified patients with suicide ideation and for all these cases, the GPs may have some preventive stategies.

Answer: Thank you for this important perspective. We have now added some information about this (line 298-303. Even out of the scope for this study, some necessary interventions outside the general practice should be mentioned. The GPs described measures where they referred to a specialist or higher levels of health care. One GP said that she knew the specialty of some of the psychologists e.g., in personality disorders or couples therapy, and then recommended a more customized treatment. The GPs also underlined that if they followed the patient over time or there was a more acute situation, they referred to specialist health care, like acute ambulant teams or psychiatric outpatient clinics. If there was an acute crisis, they had to leave all other patients wait and arrange for hospitalization.

 

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

In this manuscript, the authors interviewed ten GPs about how they dealt with patients with depression and potential suicidal ideation in order to indicate the role of GPs in suicide prevention. The manuscript is generally fluently written, except for two issues that can be enhanced.

1), in section 2.3, the authors may elaborate a bit more on "using established procedures of qualitative analysis" to let the readers know what has been done here.

2), section 3.6 can be enhanced as this is an important part of the manuscript. The authors may elaborate more on how the GPs employed preventions measures or strategies when they have or have not identified suicide ideation in the patients, because there are perhaps always unidentified patients with suicide ideation and for all these cases, the GPs may have some preventive stategies.

Author Response

Dear editor and reviewers, thanks for reviewing this paper, for the comments and suggestions. In the following we have responded to each response point by point, and we hope that you find the changes satisfactory improved and accomdated.

It was very nice to hear that you found the aim and results interesting.

Best regards,

M. Styrvold and TK. Grimholt

 

Responses

REVIEWER NUMBER 1

The submission requires a significant amount of copy-editing for English language and style.

 

Answer: Reviewer 2 think that the language and style are fine/minor spell check required and that the manuscript is generally fluently written. We want to underline that the quotes are referred identical to how they were expressed but understand that there might be some confusing phrases. In total we have gone thoroughly through the paper with help from a fluent English speaker and made several minor changes (n=56) that we hope is satisfactory.

Some errors are typographical, such as "that was a in the" (line 273).

Answer: This is now changed.(line 273)

Some errors leave gaps that inhibit understanding, such as "Came and complained about  very linear type of man" (lines 114-115)

Answer: That is exactly how the GP talked, and the quote is referred with his own words. We have added a pause of thinking in the sentence to enhance the readers understanding.

 or "O yes.. S***!" (line 117).

Answer: That was a cursing that we didn’t think was proper to refer in the manuscript, however it is now changed please see line 117.

Some errors convey meaning that is likely unintended, such as "wide specter of patient needs" (line 282). These distract from the content of your submission.

Answer:  Thank you for pointing out this error, we have now changed in into: Patients arrive their GPs office with different problems and needs. One quote was particularly interesting and described the essence of the study aim: (line 278)

With a sample size of 10, it is unclear age range of 29-64 years, it is unclear how many GPs are in the category of "more than 30 years' experience" noted on line 176.

Answer:  We agree, that is unclear and now changed into: “The GPs with long experience had followed some of the patients for several years and followed life events like marriage, pregnancy or divorce” (line 176-177)

With an even number of men and women interviewed, an additional sampling question is what the gender split was for first five interviews compared to the second set of interviews (line 72-73).

Answer: We have added information about this (line 71).

The manner of recruitment (convenience plus snowball sampling) needs to be included in the limitations as the respondents are less likely to be representative of GPs in general (i.e., they may be more informed or interested about suicide-related topics compared to the average).

Answer: Thanks, we have now added this limitation. (line 317-319).

In the limitations section it also says "gender and the range of experience resembles the population" but no comparison data is provided for the reviewer to judge the accuracy of the statement.

Answer: We agree, and this is now rephrased into: The first limitation was the sample size; however, saturation was achieved in the main findings. (line 320-322).

Under data analysis methods, it says that the study used "established procedures of qualitative analysis" with a reference to a general qualitative analysis literature review. Because the reference is nonspecific it is not clear which procedures were actually used.

Answer: We agree that this was unclear, and the reference was misplaced. We have changed and elaborated on this, please also see comment on this reviewer 2.

Overall, it is an interesting research question, and using a case series approach is a good start. Adding patient perspectives, as noted under "implications for future research" would strengthen the study results. It is useful for the field to have a better understanding of what GPs are comfortable and confident with, where they struggle, and where they experience meaningful outcomes. 

Answer: We have added this in the “implications for future research “ section (line 391-393)

 

REVIEWER NUMBER 2

In this manuscript, the authors interviewed ten GPs about how they dealt with patients with depression and potential suicidal ideation to indicate the role of GPs in suicide prevention. The manuscript is generally fluently written, except for two issues that can be enhanced.

1), in section 2.3, the authors may elaborate a bit more on "using established procedures of qualitative analysis" to let the readers know what has been done here.

Answer: We have now added this in the section 2.3 “All interviews were transcribed verbatim. They were analyzed with five stages of data analyses using the framework approach; familiarization, identifying a thematic framework, indexing, charting and finally mapping and interpretation [9].»

 

2), section 3.6 can be enhanced as this is an important part of the manuscript. The authors may elaborate more on how the GPs employed preventions measures or strategies when they have or have not identified suicide ideation in the patients, because there are perhaps always unidentified patients with suicide ideation and for all these cases, the GPs may have some preventive stategies.

Answer: Thank you for this important perspective. We have now added some information about this (line 298-303. Even out of the scope for this study, some necessary interventions outside the general practice should be mentioned. The GPs described measures where they referred to a specialist or higher levels of health care. One GP said that she knew the specialty of some of the psychologists e.g., in personality disorders or couples therapy, and then recommended a more customized treatment. The GPs also underlined that if they followed the patient over time or there was a more acute situation, they referred to specialist health care, like acute ambulant teams or psychiatric outpatient clinics. If there was an acute crisis, they had to leave all other patients wait and arrange for hospitalization.

 

 

 

Author Response File: Author Response.docx