In January 2011 Dr. William Carpenter, editor in chief of Schizophrenia Bulletin, decided negatively on publication of our manuscript entitled "Improved insight affects social outcomes in psychotic patients: a one-year follow-up study". The decision stands, of course, because none of the referees gave the manuscript the highest rating and editors also review the material and reach their own conclusions. However, the negative comments of two anonymous referees clearly showed that they commented on statistical analyses they didn’t fully understand.

Two out of four reviewers were positive: “Hypothesis raised by the authors seemed to me well defined and they used a sound methodological approach with new but complex statistical analyses” (referee 2) and “The study will contribute significantly to the existent literature on this clinically and scientifically relevant topic” (referee 3).

We used mixed models in a longitudinal analysis of the effect of change in illness insight on change in social outcomes. However, referee 1 was confused about the dependent variables used: “Are they the final scores of the social outcome variables or the change from baseline to final score?”. “Are the scores used in the models raw scores or changes in scores from baseline to 12-month?”. Apparently the only analyses this referee is familiar with is the variance-covariance OLS-regression analysis or the analysis of change scores (which is often inappropriate even in a pre-post test analysis). Likewise, referee 4 seemed only at comfort with good old repeated measures ANOVA: “The graphs are inappropriate. It can't and shouldn't show months 2-11, nor have data points (black circles) at these points - they don't have the data to do that.” The fact that we graphically illustrated a statistical model based on 1, 6 and 12 month assessments and even included a reference to support our approach, apperently was beyond the intellectual capability of this anonymous referee.

The editor in chief of Schizophrenia Bulletin reached his own conclusion on our manuscript, but failed to apologize for this substandard review process. It encouraged me to accept a review invitation in future only on the condition that the authors will receive the exact review text including my name. It seems to me that signed reviews are the only way to get rid of the review process that gives a platform to arrogant and unskilled researchers.


Post scriptum. The paper was published in Comprehensive psychiatry:

Antoon W B van Baars, André I Wierdsma, Michiel W Hengeveld, Cornelis L Mulder (04/2013). Improved insight affects social outcomes in involuntarily committed psychotic patients: A longitudinal study in the Netherlands. DOI:10.1016/j.comppsych.2013.03.016


In a case study in continuity of mental health care, medical records showed that over the years 81 social workers or nurses, spread over 25 health and social services, had been involved in the rehabilitation process of an addicted couple. Problems in continuity of care are linked to lack of information, missing procedures and guidelines, fragile relationships with the patient, and a reluctant public health approach. Take home message was that case presen­tation in psychiatric journals should give syste­matic at­ten­tion to sources of error in continuity of mental health­care.

One of the reviewers was not impressed:

"The paper is poorly written even allowing for the fact that it may be written by someone who has Dutch as their mother tongue (I have considerable experience of working with Dutch authors). The reliance on a single case study which is not well presented and on unsupported generalisations about care is weak. The analysis is not particularly clear and the recommendations are insufficiently concrete. They are more “motherhood and apple pie”. There is weak consideration of what might be done to ameliorate such discontinuities via commissioning, joint training, information technology and other mechanisms well documented in the literature. I have thought about whether extensive revision is feasible but I fear that this would not be a good use of the authors’ time therefore I suggest that the paper is not publishable."

IJIC editors accepted this version for publication:

Breakdown of continuity in public mental healthcare in the Netherlands: a longitudinal case study. André Wierdsma, Meta van der Schee, Cornelis L. Mulder - International Journal of Integrated Care, 11(2011), URN:NBN:NL:UI:10-1-101573