PMEN-D-24-00298

Emergency department care experiences among youth with mental health concerns

PLOS Mental Health

Dear Dr. Walker,

Thank you for submitting your manuscript to PLOS Mental Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Mental Health’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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EDITOR: Please insert comments here and delete this placeholder text when finished. Be sure to:

• Indicate which changes you require for acceptance versus which changes you recommend
• Address any conflicts between the reviews so that it's clear which advice the authors should follow
• Provide specific feedback from your evaluation of the manuscript

Please ensure that your decision is justified on PLOS Mental Health’s publication criteria and not, for example, on novelty or perceived impact.

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Please submit your revised manuscript by Sep 19 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at mentalhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pmen/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Rachel Dale, PhD

Academic Editor

PLOS Mental Health

Journal Requirements:

1. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Thanks to the authors for this paper. The reviewers and I suggest some minor revisions prior to publication.

Please pay particular attention to the reviewer’s comments regarding the use if abbreviations and the term ‘equity-deserving’.

In general, there is an extensive use of abbreviations that can make the manuscript a bit difficult to follow. For example on line 76, to what does EM refer? Additionally line 102, KHSC ED/UCC is a new abbreviation and since it is likely only used rarely, can perhaps be written out in full. Line 219: HCP?

Lines 200-201: here both sex and gender are referred to. Therefore I just want to check that in the focus groups participants were categorised according to sex and in the survey they were categorised according to gender? If not then this should be corrected such that female/male/intersex refer to sex and man/woman/gender-diverse refer to gender.

Results: please report full statistics rather than just the p-values.

Table 2: how is it possible that 29 participants had no ED visit in the prior 2 years when on line 106 it states that this is part of the inclusion criteria? As I understand it the purpose of this study is to assess people with direct ED visit experience (lines 124-125) so these 29 participants should have been excluded.

Minor points:

Line 69-70: some commas are missing - and improve YMHC experiences with, and interaction with, the health system,…

Line 140: The Chi-squared test is an inferential statistic.

Line 365: for suicidal behaviour? suicidal ideation?

Line 375: perhaps trauma-informed care could be very briefly explained.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Mental Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. 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

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Mental Health 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

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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: Thanks for the opportunity to review this paper. It adds to existing evidence regarding the need for improving ED support for young people with mental health problems.

There are some points which require amendment or clarification before publication:

Abstract:

- what do you mean by 'equity deserving'? - suggest leaving this terminology out if there isn't space to define it

- can you add something to the methods section about how you collected qualitative data? It's not clear if this was interviews, a qual survey etc

Introduction:

- line 83 - The last sentence of your introduction doesn't make sense

- in general I think the rationale for why the present research is needed could be made stronger. You have presented lots of previous research in this area already - why exactly is your study needed and how does it build on what has gone before?

Methods:

- is it correct that young people didn't need to have visited the ED with a concern relating to their mental health to be in the EDG group? please make this explicit in the text if so.

- how are you defining .'micronarratives'?

- your primary outcome of 'ED care experiences' isn't really an outcome - can you make this more specific?

- you should add references for the steps in your qualitative analysis

Results:

- can you add some information as participant identifiers after the quotes? This might read better than introducing each quote by participant characteristics.

Reviewer #2: The study is well presented and is very interesting for the mixed methodology used and its most relevant findings as well as for the proposals for improvement.

Please review the use of the abbreviation MH, so that it is explained the first time it is used.

Please explain why you included in the sample people who had no ED visits in the last 2 years (table2).

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6. 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.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Dr Rebecca Appleton

Reviewer #2: Yes: Vania Martínez

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PMEN-D-24-00298R1

Emergency department care experiences among youth with mental health concerns

PLOS Mental Health

Dear Dr. Walker,

Thank you for submitting your manuscript to PLOS Mental Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Mental Health’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.

==============================

The reviewers and I agree the revision has addressed all comments. Thanks to the authors for their responses!

As a final minor edit, it has come to my attention that PLOS Mental Health has specific guidelines for reporting qualitative research:

PLOS Mental Health considers qualitative and mixed-methods studies for publication. We recommend that authors use the Consolidated criteria for reporting qualitative research (COREQ) checklist or Standards for reporting qualitative research (SRQR) checklist. (http://journals.plos.org/plosmentalhealth/s/submission-guidelines#loc-qualitative-research).

Please check that your reporting follows the items of one of the above checklists and state in the methods section which checklist was adhered to. Apologies for not including this in the original review. However, I believe the manuscript mostly follows the checklist criteria so I hope this will not be too much work.

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Please submit your revised manuscript by Dec 05 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at mentalhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pmen/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Rachel Dale, PhD

Academic Editor

PLOS Mental Health

[Note: HTML markup is below. Please do not edit.]

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: All comments have been addressed

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2. Does this manuscript meet PLOS Mental Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. 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

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Mental Health 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

**********

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: The authors have addressed all my previous comments - no further edits required.

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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.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Dr Rebecca Appleton

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Emergency department care experiences among youth with mental health concerns

PMEN-D-24-00298R2

Dear Dr. Walker,

We are pleased to inform you that your manuscript 'Emergency department care experiences among youth with mental health concerns' has been provisionally accepted for publication in PLOS Mental Health.

Before your manuscript can be formally accepted you may need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they'll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact mentalhealth@plos.org.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Mental Health.

Best regards,

Rachel Dale, PhD

Academic Editor

PLOS Mental Health

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Reviewer Comments (if any, and for reference):