Dear Editor, why have you rejected my article?

Summary

The experience of rejection of an article submitted for publication to a scientific journal can be particularly anxiety provoking, especially when the furtherance of an academic career or the gaining of a permanent post might be riding on getting it published. Many papers fail to get past the first hurdle and are not sent out for peer review, often as a result of the most basic of errors: the results are not generalisable, the paper adds nothing new to the subject, there are flaws in the study design or inappropriate statistics were used. Attention paid to formulating a clear research question and the adoption at the outset of a doable, interesting project will often help to avoid disappointment.

Authors often wonder why a paper they have submitted to a journal, over which they have laboured for months and which may have been preceded by many months of research, was rejected. The short answer is that the paper was either not interesting or not believable, or both uninteresting and non-believable.

Problems with methodology

More specifically, if an article is rejected despite purporting to report ground-breaking research, it was obviously judged to have a significantly flawed methodology. Widespread errors include small sample sizes, inappropriate statistical methods or a lack of a valid control group. ^1-3 The last is a particular problem in studies submitted to The Psychiatrist, which often report health outcomes before and after the introduction of a new practice, for example a psychological intervention. Unfortunately, the before/after study design is not especially robust and commonly produces misleading results; it is difficult to control for all potential confounding factors, and without a good control, the studies are difficult to interpret. Before/after studies are not themselves the problem, as they can be the only feasible study design in a particular situation, but the investigators must be extremely cautious in their interpretation of the findings and be willing to acknowledge other possible explanations. ⁴ Failing to do so results in rejection without external review. This principle also applies to other study designs.

Is the paper interesting?

Assuming the authors have satisfactorily explored other possible explanations for their results, there is still the question of whether the paper is interesting and comprehensible to the journal’s readership (including the Editor). Is there a logical structure? What are the aims and objectives of the study? What is the hypothesis? What are the outcomes? Are the data summarised appropriately?

Systematic research please!

The Psychiatrist receives many reviews of the literature on a specific subject. These papers are often well written and reach believable conclusions. However, they are still rejected because the literature search has not been carried out with any systematic methodology. Systematic literature reviews enable other researchers to undertake the same search, come up with the same articles and therefore (hopefully) draw the same conclusions. ^5,6 Non-systematic reviews open the study to bias if not all the relevant information is considered.

Generalisability

Another common pitfall is results that are not generalisable, meaning that they are unlikely to hold true beyond the population included in that particular study. For example, a study is not generalisable if the study population is grossly unrepresentative of the general population. Case reports often fail the generalisability test. Clearly, there are some instances where reports of individual cases are important, for example in the investigation of newly emerging diseases. ⁷

Ethical concerns

The issue of consent and ethical approval is another reason for rejection. Following ethical guidelines is mandatory, ^8,9 and is a particular concern in the mental health field where stigma is an issue and where study participants may not have the full capacity to make their own decisions. It is not acceptable to label a research project an audit to avoid the relevant ethical approval.

Will The Psychiatrist publish qualitative work?

Yes, of course, but qualitative research does not imply a lack of scientific rigour. For example, asking six clinicians about their understanding of a new protocol using unstructured questionnaires may be sufficient if the data analysis adopts a recognised qualitative analysis methodology. But putting a few quotes to summarise the ‘general feeling of the participants’ is inadequate.

Will The Psychiatrist publish audits?

Yes, but ideally the study will investigate the use of novel services. Confirming the effectiveness of well-recognised policies may be enough to warrant acceptance only if the audit involves large numbers and if it has been conducted using a recognised tool.

Call for papers

The Psychiatrist is looking for research articles, commentaries and opinion pieces relating to the care of people who have mental illness. This includes papers on issues relating to the training, teaching and quality assurance of psychiatrists, psychologists and any other members of the multidisciplinary team. Papers on matters involving new technology, mental health law and public mental health, including sustainability, stigma and culturally informed psychiatry, are also encouraged.

Rejection can be distressing and is an unpleasant pill to swallow. But usually it is for good reason. The need for standards in healthcare and science is crucial and some articles fail to reach them. Interestingly, it has been found that articles are cited more frequently if their authors have had their papers previously rejected and they have had to resubmit them to another journal in order to get them published. ¹⁰