PONE-D-21-38828Suicidal ideation and attempt among Post-9/11 Veterans with mild traumatic brain injury and complex painPLOS ONE

Dear Dr. Song,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately 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?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). 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: No

Reviewer #2: No

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

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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: This is an interesting and rare paper focusing on the association of pain and suicdal behaviour and specifically if pain phenotypes are independently associated with suicidal idation or attempts, or via comoribidites, in a longitudinal retrospective cohort study in 9/11 veterans. The objectives are both sicentifically and clinically relevant, methods well chosen and described, results are well presented, thoroughly discussed, limitations are exhaustively addressed and the conclusions are fully supported by the data.

As this is a very well designed study and the results are reported in a simialry excellently written paper I only have a few renarks:

1. Please make the title more espressive of the actual major findings of the study.

2. In the abstract methods section please describe pain phenotypes and also provide some iformation on the statistical analyses performed.

3. Given the reluctance of psychiatric patients to seek help in part due to stigma but also as a symptom of their psychiatric morbidity, and knowing that the risk of suicidal behaiovur is higher among untreated psychiatric patients (including PTSD patients), this should be mentioned as a limitation.

4. What was the reason for not including completed suicides as an outcome?

5. Why were alcohol or substance use disorders not included as covariates?

Reviewer #2: The authors reported original research results derived from their investigation on suicidal ideation and attempt among Post-9/11 Veterans with mild traumatic brain injury and complex pain. The article is overall well-written and of interest to the journal. However, it is unclear how authors assessed suicidal ideation and suicide attempts. Especially for suicidal ideation, the assessment might be more critical. Furthermore, I suggest providing some understanding of the mental pain occurring in the suicidal mind, discussing papers such as Critical appraisal of major depression with suicidal ideation. Ann Gen Psychiatry. 2019

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Reviewer #1: No

Reviewer #2: No

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Complex pain phenotypes: suicidal ideation and attempt through latent multimorbidity

PONE-D-21-38828R1

Dear Dr. Song,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Marco Innamorati

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). 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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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE 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

**********

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 comments and recommendations. The paper can be accepted in its present version.

Reviewer #2: The authors addressed my comments and the article appears suitable for possible publication in the journa.

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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.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No