PONE-D-20-36043

A qualitative exploration of young people’s experiences of attempted suicide in the context of alcohol and substance use.

PLOS ONE

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Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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Reviewer #1: No

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: Thank you for the opportunity to review this manuscript. This is an important topic for a vulnerable population that requires an in-depth analysis to inform appropriate, future interventions. My specific comments are appended below.

ABSTRACT

• It is somewhat difficult to follow the themes placed in quotations. I would suggest that the authors either find new ways to describe and/or organize their key themes

• This manuscript would be greatly improved if the authors detailed the percentage of participants who endorsed a given theme

• The abstract highlights barriers. Were facilitators also explored?

INTRODUCTION

• The authors highlight risk factors of suicide. Are these limited to completed suicide or also relevant for ideation? Can a sentence or two also highlight protective factors?

• It is not clear how the authors differentiate ‘alcohol’ and ‘substance use’

• Please add appropriate references for statistics: e.g., “Young people (over 18) who engage in binge drinking have been found to be 2.6 times more likely to attempt suicide”

METHODS

• Inclusion/exclusion criteria: need to be better justified.

o The authors list that having a ‘self-defined problematic use of alcohol (and substances’ was required as inclusion criteira; however, it is known that adolescents may not recognize that they have issues with substances, especially alcohol. Can the authors justify why this criteria was required?

o The authors exclude those who have made a suicide attempt in the past 6 months. Why was this the case when the authors previously argue that it is important to examine those with alcohol issues to inform suicide interventions?

• Can the authors justify why they used a sample size of 7 and not less or more? Was saturation of specific themes considered for the listed sample size?

• Interviews being conducted by the local mental health team may introduce bias. Independent and trained research personnel are typically the gold standard for qualitative research. A rationale for why this interviewee was selected for the current study should be detailed and potentially recognized as a limitation in the Discussion section.

• Who conducted the debrief session that followed the qualitative interview?

• It is not clear who conducted the analysis and whether inter-rater reliability was reached prior to completing all analyses

RESULTS

• Table 2 is informative however it is not clear what the third column (“Participants that contributed”). These results could be bolstered by highlighting the frequency and percentage of participants who endorsed a given theme

• The theme “Keeping safe from others’ does not seem to appropriately reflect the longer text. It sounds like all participants felt misunderstood by people around them

• It may worthwhile to organize the themes accordingly to barriers and facilitators. This organization is particularly informative to interventionists.

• It is not clear whether the data was analyzed for stratified groups e.g., younger vs. older youth; male vs. female

DISCUSSION

• Additional limitations including the small sample size should be noted. It is not clear whether these results are generalizable to contexts outside of the UK or to other, non-white groups

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Reviewer #1: No

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A qualitative exploration of young people’s experiences of attempted suicide in the context of alcohol and substance use.

PONE-D-20-36043R1

Dear Dr. Guest,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

José J. López-Goñi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: