Reviewer’s report
Title: 
“It was like nobody cared about what I said?” Iranian women committed
self- immolation: A qualitative study
Version: 
0 
Date: 
14 Jun 2020
Reviewer's report:
The authors have undertaken a study of great public health importance. Self
immolation in many countries in the Asiatic region is of great interest and so a
qualitative study of this issue has the potential to add to our understanding of
this method of suicide. The authors have presented some interesting results but I
feel that it needs a more substantial interrogation of the themes to add value to
the literature. 
General comments
I feel the authors need to consider a broader range of literature on suicide to be
able to interpret their findings. It may be useful to consider the themes identified
in this study against a theoretical frame such as Integrated Motivational-
Volitional model of suicidal behaviour http://www.suicideresearch.info/the-imv.
This would allow the authors to consider how some of their themes are linked to
suicidal processes. One of the least explored issues in the data is the role that the
method played. The authors cite this as a major aim of the study yet there is very
little analysis on the factors influencing self immolation. Understanding of the
pathways to selecting such a method is very important for prevention and so
more detailed understanding of this aspect is crucial for such a paper.
Comments on the manuscript
Abstract - Please remove the first sentence it is incorrect and refuted by your
own data. 
Background - This section needs a complete re-write. Attention needs to be paid
to a clear structure for the paragraphs and link to relevant literature. Each
paragraph should have an identified purpose leading to the reasons for the study.
The authors have clearly read important local studies but have not presented the
rationale clearly.
Methods
The use of purposive selection is warranted however it is not clear why the
authors selected married women only. There is a section needed on reflexivity
especially given that the only interviewer was male and all participants were
female. I would also suggest that there is a further coder reviewed some of the
transcripts. Unconscious bias is an important issue to address in qualitative
research and these transcript would benefit from someone else verifying the
coding structure.
Results
The five themes identified do appear to be grounded in the data however there is
confusion and duplication across the themes that leaves the reader to feel that
only a cursory analysis of the themes was undertaken. More substantial analysis
of the themes is needed. A suggestion would be to re-analyse the themes into
antecedents, defeat/humiliation and entrapment, suicidal ideation and volitional
factors including choice of method. This would give the reader a clear
understanding of the pathway and may suggest possible points of intervention in
the pathway.
Discussion
The discussion draws on some relevant literature and draws out some important
findings. The issue of suicide as a form of communication is very relevant to
other studies. A study is Sri Lanka may be useful here.
https://journals.sagepub.com/doi/10.1177/006996671104600204. Again the
authors note that method is very important to understand but do not give us any
reflections from the data.
Conclusion
I found the conclusions difficult to reconcile as i felt the data needed a clearer
analysis to interpret.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
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