PONE-D-21-39300Submission of a manuscript entitled “Depression, suicidal ideation and suicide risk in German veterinary medical students compared to the German general population”PLOS ONE

Dear Dr. Schunter,

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==============================Reviewers have highlighted that your paper is an interesting work and I agree with them. However, reviewers have pointed out some issues that should be resolved prior to publication acceptance. Please, consider their comments.

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PLOS ONE

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Additional Editor Comments (if provided):

Reviewers have highlighted that your paper is an interesting work and I agree with them. However, reviewers have pointed out some issues that should be resolved prior to publication acceptance. Please, consider their comments.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The present study aims to evaluate the presence of depression, suicidal ideation and suicide risk in veterinary medical students in Germany, since there is evidence that veterinarians have a significantly higher risk of suffering from these problems. The authors concluded that German veterinary medical students have a higher risk to be screened positive for depression, to report current suicidal ideation and to have an increased suicide risk compared with the general population in Germany of the same age range (18-46 years).

This kind of research is very useful and necessary. Therefore, the proposed work can be very interesting. I wish to compliment the authors on their thoughtful work and worthwhile goal.

Overall, the article is well written, and the logic of the study is according to the goal. The paper provides useful data, and the main findings are consistent. In addition, it is a novel study since it focuses on a specific population, making the particular situation of German veterinary medical students visible. Even so, some considerations and suggestions are provided below.

MAJOR CONCERNS

Method

For the evaluation of suicidal ideation, a single item of the PHQ-9 questionnaire is used. Authors are suggested to be careful in assessing this problem. Making use of a self-report can be dangerous and falsify the data due to the component of subjectivity. In addition, using an online questionnaire limits the information obtained. For future research, it could be solved with the use of an interview to collect information on suicidal ideation and risk.

MINOR CONCERNS

Introduction

A good review of the topic is presented and well structured.

Results

Authors are suggested to indicate percentages and n in the same way (page 14, paragraph 2).

It is not necessary to mention table 1 at the end of each paragraph of the results. Mentioning table 1 in the first paragraph of the results is sufficient.

Discussion

The discussion section is well presented. A good comparison is made with studies carried out in other countries, highlighting the novelty of the current study.

With these changes, readers will be able to fully appreciate the potential clinical significance of the findings and future directions for research. I hope these proposed modifications will serve to improve the manuscript.

Reviewer #2: State gen pop source more clearly in abstract

122 define council initiative

Make more clear the purpose of the gen pop sample. It does not seem to be for the purpose of the comparison in this paper, but is a dataset these authors accessed after the fact. <ore about="" and="" between="" collection="" data="" for="" gen="" in="" information="" initial="" is="" needed.="" of="" owners="" paper="" pop="" purpose="" relationship="" researchers="" set="" the="" this="">

Find a way to merge paragraphs about german gen pop sample 1 and 2 since much of the methodology was the same

194 “the online questionnaire used with the veterinary student population for this research…..”

218 remove economically… it is confusing… to reliably and validly assess would serve more merit on the reasoning for using this tool more over, the tool was used on the gen pop which sample so I imagine is the reason this tool was used with students?

224 remove “patients” as this tool is not being used in a mental health clinical population with either the DVM or gen pop samples for this research. If this tool is only used for mental health patients there should be some discussion of the validity of the tool for use with gen pop and veterinary populations.

244 If there is a statistical difference between the sample and the population of veterinary students regarding proportion of females, state it. The research is still valuable even with this caveat. The way this reads does not provide a clear description of the limitations of your sample. You can cite research which suggests females tend to report distress more readily than males as a possible reason for this discrepancy between your sample and the larger dvm sample…

357 when stating that attempts are lower in veterinary population it is important to acknowledge that may be due to the fact that the survey is collecting information from living people and that DVM’s are more successful at completing suicide than the gen pop. Attempts look as if they are less simply because of the sampling of living individuals instead of death records… see Tomasi, S. E., Fechter-Leggett, E. D., Edwards, N. T., Reddish, A. D., Crosby, A. E., & Nett, R. J. (2019). Suicide among veterinarians in the United States from 1979 through 2015. Journal of the American Veterinary Medical Association, 254(1), 104–112.

413 Limitations… consider discussing more fully in this and other sections… this topic Koopmans, G. T., & Lamers, L. M. (2007). Gender and health care utilization: the role of mental distress and help-seeking propensity. Social Science & Medicine, 64(6), 1216–1230.

Moreover, just because males may under report they more successfully complete suicide, so efforts to decrease stigma for help seeking is key for men… could be added to recommendations section…

Good job team!</ore>

Reviewer #3: 58 Keywords

I suggest: Occupational risk factors, psychological wellbeing

70: This and other potential risk factors were described by a recent paper where a wide set of extracted literature was submitted to text mining and topic modelling

76: veterinary students= veterinary medicine students; here and elsewhere I suggest you talk about veterinary students to shorten the sentence specifying the first time that for veterinary students you mean those enrolled in the veterinary program and not nurses and similar courses

110: Mention the large amount of studies on students in literature about here

145: “One participant indicated diverse gender”

? How did you control that? That should not be included

339: Please include a statement and consider compassion fatigue among the following

392: See paper by Brscic, M., Contiero, B., Schianchi, A., & Marogna, C. (2021). Challenging suicide, burnout, and depression among veterinary practitioners and students: text mining and topics modelling analysis of the scientific literature. BMC veterinary research, 17(1), 1-10.

423: Consider the different years and methods/instruments as well

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Depression, suicidal ideation and suicide risk in German veterinary medical students compared to the German general population

PONE-D-21-39300R1

Dear Dr. Schunter,

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.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

José J. López-Goñi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: After a second revision, the authors have fully implemented the proposed changes.

I congratulate the authors for their work and trust that the recommendations and proposed changes have been helpful.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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