PONE-D-24-08405Suicide Methods Among Brazilian Women from 1980 to 2019: Influence of Age, Period, and Cohort

PLOS ONE

Dear Dr. Meira,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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ACADEMIC EDITOR:

I regret to inform you that we are unable to accept your manuscript for publication in its current form. The reviewers have provided valuable feedback on your manuscript, with two out of three reviews being positive. 

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Therefore, we recommend that you thoroughly address all the comments provided by the reviewers and revise your manuscript accordingly.

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Claudio Alberto Dávila-Cervantes, Ph.D.

Academic Editor

PLOS ONE

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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: No

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: No

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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 manuscript examines age, period, and cohort effects on suicide by methods used among women in Brazil.

I find the paper well-written; it has the potential to contribute to the existing literature on the topic. However, I have some concerns I would like the authors to consider.

Introduction

1.) “These ideals are constantly conveyed to individuals through gender technologies performed by family, religion, school, art, media, among others [6,10,13,19]. Zanello [19] asserts that men's subjectivity is configured by gender technologies that emphasize the devices of sexual and economic efficiency, while women's subjectivity is shaped by love and maternal devices.”

What do the authors consider as relevant gender technologies in this context? Please consider clarifying by using some examples.

2.) “…mortality in women according ccording to the most common means of perpetration…”

Please correct this sentence.

Materials and methods

3.) The authors have included in their study women aged ten years and older. While it is quite a frequent practice to combine data on adults and adolescents when examining suicide, there is ample evidence showing significant differences in the suicide behavior of adolescents compared to adults. Why did the authors decide to include the population aged 10–19? Taking into account the potentially different etiology behind suicide in adolescents, please consider excluding these age groups or justifying in the text the decision to include them. In addition, among the limitations, the authors mentioned fewer observations in younger generations.

4.) Table 1: “W75 e W76”

Please correct the typographical error.

5.) “Here, i = 1, ..., I; j = 1, ... J; k = 1, ..., K; and where K = I + J-1.”

Since lowercase letters i, j, and k are only used in the equation presented later in the text, this sentence might make more sense after introducing Holford's proposal.

6.) “… the effect of period …”

Unlike in the main text, this is in the equation.

7.) “cohort (k = 1, . . . , k = I + J − 1 = 22)”

Here, the second lowercase k in the brackets seems to be a typographical error.

Results

8.) All results were shown after correcting the death records. Did the authors assess the trends – not the death rates – using the data before correction? Were there any notable differences between trends based on corrected versus uncorrected records (including potential regional differences)?

Discussion

9.) “In developing countries, the XX (1965-1979), late Y (1973-1980), and Millennial (1981-1991) generations are experiencing cohort discontinuity.”

Usually, in the literature, Generation X refers to people born between 1965 and 1980, while Generation Y – also known as Millennials – refers to those born from the early 1980s to mid-1990s. Therefore, this sentence might be somewhat confusing.

10.) “…a pattern that was maintained when estimating the APC models. drift trend…”

Please correct the typographical error.

11.) “During the study period, Brazil went through several economic crises [72-74,82]…”

Please consider explaining a bit more about the mentioned economic crises, especially about the specific timing of these events.

Supporting Information

12.) S1. Table

Please correct the typographical errors, such as:

“Lon-term consequences…”

“(Stage 6):- ”

“aP roportion of…”

“CID-9 and CID-10 Codes”

Reviewer #2: ID: PONE-D-24-08405

Title: Suicide Methods Among Brazilian Women from 1980 to 2019: Influence of Age, Period, and Cohort

Thank you for providing a chance to review this manuscript.

Detailed information:

Abstract

Overall: If the journal does not have special requirements, I recommend presenting the abstract section in order of background/objective, methods, results, conclusions.

Line 25-27, Page 2: What is the meaning of this sentence placed here? Also, please add the research purpose.

Line 31, Page 2: What is the purpose of using model estimation? Please provide a detailed description of the research design in the methodology section and what data indicators were collected. What is the sample size?

Line 31-45, Page 2: 1) Is this the results section? There are no transitional words. Please pay attention to the division of each section in the abstract to help readers clarify. 2) Please provide the numerical values of key indicators as evidence support, not just language expression. 3) Display the main results. Reduce excessive elaboration.

Please explain the conclusion in one to two sentences.

Keywords: There are no keywords in the text you provided, please pay attention to the details.

Introduction

Line 52, page 3: Complex? Where is it reflected? The first paragraph only shows the high incidence of suicidal behavior. Please modify and improve. Also, this is a new paragraph, what does "it" refer to? This statement does not seem to have a causal relationship with the preceding text.

Line 53-54, Page 3: What is the significance of emphasizing the different impacts on different genders? Where are the different impacts reflected? This is abrupt. Please modify.

Line 58-60, Page 3: Please use appropriate transitional sentences to continue the two paragraphs.

Line 86-87, Page 4: Please elaborate more on "crucial". And clarify the significance of conducting this research.

Line 92-97, Page 5: The introduction of the keywords "age period cohort effect" or "age period cohort" in this paragraph is too concise. Please provide more explanation to assist in explaining the significance of the research.

Line 102, Page 5: Please propose reasonable research hypotheses based on your research objectives.

Overall: Overall, the logic of the preface needs to be strengthened, and some keywords are not even elaborated in the preface section. 1) As you mentioned in your keyword about mental health, it was not elaborated on in the introduction section. 2) Previously, it was often mentioned that "the first two decades of the 1980s". Is there any difference or connection between the data from this period and the data from your research period?

Materials and Methods

Study design and data sources

Line 107, Page 5: Please provide a detailed explanation of which recommendations.

The research design is too brief to fully understand your research ideas and strive for perfection.

Study variables:

I don't quite understand. The title is called Study Variables, but the content does not clearly summarize all the research variables and introduce the collection of key variables. Please indicate which variables and indicators were collected for this study.

Table 1: A three-line table is recommended if not specifically required by the journal.

Results

1) Tabulate and summarize the demographics of the study population, if available in the database, such as the age distribution.

2) I think the use of a heat map to depict the distribution of different suicide methods among women would be a much clearer and more intuitive way to visualize the results of the study.

3) All the figures in the text seem like they could be further optimized to make them more aesthetically pleasing.

4) The descriptions of the results in each section seem somewhat confusing and lengthy, please summarize the findings in summary terms.

Discussion

Line 370-385, page 18-19: The discussion in this article should be addressed to women in the Brazilian region. Is it possible to find more theories to support the results of this study?

Overall: 1) Please integrate and summarize some of the passages according to content and logic. 2) Based on the findings of this study, what actions or measures can be taken by the relevant authorities or the government to improve the situation of female suicide?

I'm sorry to say that I think this article only shows descriptive results of the impact of APC on female suicide in Brazil, and does not reflect the actual value and further improvements.

Thank you and my best,

Your reviewer

Reviewer #3: Dear authors,

I really enjoy reading your paper. Addressing changes in suicide methods adopted by women over the time and the regional differences are really important to implement public policies to fight this public health problem. However, bellow I include some some suggestions to improve this manuscript.

Abstract

I suggest the authors go direct to the goal of the paper.

The results about age differences in suicide rates should be included.

Introduction:

I suggest the authors excluding lines 92-102 since the subjects were addressed in paragraphs above.

I didn’t see nothing about policies in fighting gender inequities or promoting women health in Brazil in the introduction and in discussion. It is essential to this paper to address this theme.

Results

OK

Methods

I only suggest you to include your data sheet in a repository where others can have free access.

Discussion

Discussion should be more focused on your main results. In lines 236-237 you brought your main goal. So, please, be focused on it. Additionally, you should brought these results to the first paragraph of the discussion.

In addition, the discussion is confused and needs to be reorganized. First discuss all results about age, methods of suicide and, then, cohort.

Are there no studies in Latin America in the same subject? Why to compare results with other countries with greater sociocultural and economic differences?

I didn’t see the point to the paragraph in lines 441-445.

No need to mention COVID-19 here.

Where is the limitation of this study?

Again, I suggest you discuss about public policies fighting gender inequities in Brazil as possible regional barriers to the policies implementations.

Conclusion

It needs to be rebuild answering the main goal of your study.

Minor point:

Please, the text should be review by native English speakers.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Suicide Methods Among Brazilian Women from 1980 to 2019: Influence of Age, Period, and Cohort

PONE-D-24-08405R1

Dear Dr. Meira,

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,

Claudio Alberto Dávila-Cervantes, Ph.D.

Academic Editor

PLOS ONE

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: (No Response)

Reviewer #3: 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

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #3: Yes

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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

Reviewer #3: 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

Reviewer #3: Yes

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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: Most of my comments have been addressed. The only minor concern is related to the following comment:

6.) “… the effect of period …”

Unlike in the main text, this is in the equation.

I believe this issue remained in the manuscript.

Reviewer #3: (No Response)

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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

Reviewer #3: No

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