Sir,
The article by Mandal et al.[1] aims to address the knowledge, attitude, and practice of lithium among a subset of psychiatrists in India. To find out the lithium prescribing practice among psychiatrists, the authors chose an online survey through E-mail, WhatsApp, Facebook, and other messenger systems. The authors sent the online survey to only 424 psychiatrists out of 9000 plus qualified psychiatrists in India, as reported by Garg et al., 2019.[2] It raises a question on which subset of psychiatrists were included in the study. Is it a regional study or is it a study limited to the psychiatrists in online contact with the investigators? It would be worthwhile to know if the approach is different from the two mentioned earlier. If it is the psychiatrist in online contact with investigators based survey, the title of the study saying 'perspectives, attitude, and practice of lithium prescription among psychiatrists in India' would be misleading and cannot be generalized to the lithium prescribing practice among psychiatrists across India. Authors also used a subtitle of “Declining Lithium Use in India” in the manuscript. This is not congruent with their aims, objectives, results, and discussion of the study. It would be better if they had used the short title as lithium prescription practice among psychiatrists.
If respondents received the online survey form through E-mail, WhatsApp, Facebook, and other messenger systems from the investigator,[1] it raises the question of how the investigator ensured respondents could fill the survey through the predesigned questionnaire only once. It is also important for the author to address how they removed the duplicate entries since there were multiple social media platforms involved. The authors had also not mentioned whether the survey is voluntary or not, after conveying the purpose of the survey to the respondent and giving them the option of an opt-out from the survey even after receiving an online link. It is also important to know whether the first reminder was sent only to those who did not respond or to all 424 contacts again. There is also no mention of Institutional Review Board approval for the survey.
In this survey, the response rate was 31%, which is almost twice as compared to the previous survey, where the response rate was only 16% among 3381 psychiatrists in India, even after the investigators sent E-mail reminders twice during the weekends for 4 consecutive weekends.[3] It would be better for the readers understanding if the authors explained the higher survey response rates, so that it can be adopted in future surveys.
An important limitation in any survey-based study is that the person may give socially desirable answers and it is difficult to eliminate such bias. It is imperative for the authors to mention the purpose of the survey and its implications on clinical practice as this would go a long way in improving the quality of the survey and its clinically relevant outcomes.
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Mandal S, Mamidipalli SS, Mukherjee B, Hara SK. Perspectives, attitude, and practice of lithium prescription among psychiatrists in India. Indian J Psychiatry. 2019;61:451–6. doi: 10.4103/psychiatry.IndianJPsychiatry_451_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
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