Accessing mental health services for a child living with anxiety: Parents’ lived experience and recommendations

Roberta L. Woodgate; Miriam Gonzalez; Pauline Tennent

doi:10.1371/journal.pone.0283518

Peer Review History

Original SubmissionJanuary 15, 2023
27 Feb 2023 Decision Letter - Nelsensius Klau Fauk, Editor PONE-D-23-01298Accessing mental health services for a child living with anxiety: Parents’ lived experience and recommendationsPLOS ONE Dear Dr. Woodgate, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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. Please submit your revised manuscript by 26/03/2023. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Comments & suggestions to the authors This study investigated the mental health services for a child living with anxiety, experienced by the parents. The Introduction clearly mentioned the seriousness of the problem and the rest of the paper have given detailed explanation of the study. However, some development could be used: - The terminology for anxiety disorder should refer to ICD or DSM to make a clear distinction with anxiety as a symptom - Do update the prevalence rate of anxiety disorder among adolescence as the one cited came from 2005 (WHO has more updated data) - It is great to read the effort of the authors to explain/describe any methods used in this paper for the learning process of the readers - What was the reporting guideline use by the authors? - For the recruitment, the authors used the maximum variation technique of purposive sampling. Please elaborate more. - Data collection: better if the data collection can be divided into two parts, to make a clearer understanding of the data collection process, between the semi-structured interviews and open-ended interviews. Was the AIDS-IV-C/P used for the parents or the children? What was the diagnostic criteria of it? Who did the interview for the diagnosis? (credentials) What were the purposes of each either semi-structured interviews and open-ended interviews? Also for the open-ended interviews, who did the interviews? - How about the trustworthiness of the study? - Data analysis: the first and second author did the data analysis. Describe the background of the authors, including gender and experience in qualitative study. - Results: start with the process of the data analysis (how many codes into themes?) It is good as the authors have provided the coding tree into the tables. - Overall, it is an interesting study for a better health care services and policy. Reviewer #2: The paper reports very important findings. It is well written and easy to follow. I have only a few minor points on the method section to be addressed. Please used the COREQ checklist to guide the report of the method section. What is the qualification and research experience of the research assistant who conducted the interviews? Who took the field notes during the interviews? Was it the RA/interviewer of somebody else? If the same person did the interviews and at the same time took notes, then any reflections of the difficult experience? It is not easy to interview and probe information from a participant if the interviewer has to take notes as well. Who did the transcription of the audio recordings? Was it the RA or one of the authors? If it was not the RA, then how did you integrate the field notes into the transcripts? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
7 Mar 2023 Author Response We thank reviewers for their insightful comments. We believe our manuscript has benefited from your suggestions. Reviewer #1: Comments & suggestions to the authors This study investigated the mental health services for a child living with anxiety, experienced by the parents. The Introduction clearly mentioned the seriousness of the problem and the rest of the paper have given detailed explanation of the study. However, some development could be used: - The terminology for anxiety disorder should refer to ICD or DSM to make a clear distinction with anxiety as a symptom We have added a definition of anxiety disorders using the DSM-5. Please see track changes on p. 3, lines 66-72. We have added the new reference citation (see Reference List) and adjusted all reference citations accordingly (in-text and reference list). - Do update the prevalence rate of anxiety disorder among adolescence as the one cited came from 2005 (WHO has more updated data) We have provided information from a 2015 meta-analysis of the worldwide prevalence of mental disorders (including anxiety) for children and adolescents. Prior to this meta-analysis, there was no information as to a worldwide-pooled prevalence for this population specifically. We checked WHO resources but found it challenging finding the reference citations provided (e.g, links no longer worked etc) or reference citations for anxiety disorders were not provided. For instance, for the following WHO resource: Mental health of adolescents (who.int) , although a reference citation is provided for the global prevalence of mental health conditions, the year of this source was not provided. Further, for emotional disorders including anxiety, no reference citation was provided. Thus, given the robust methodology used in the meta-analysis cited above, we decided to use that reference instead. - It is great to read the effort of the authors to explain/describe any methods used in this paper for the learning process of the readers. What was the reporting guideline used by the authors? We have used the COREQ checklist. Under the “Supporting Information” section of the manuscript, we note we are including an additional file labeled “S1 File. Consolidated criteria for reporting qualitative studies (COREQ) checklist”. Please see p. 36, line 914. Also see the additional file. The document highlights where in the manuscript (page number) checklist items are reported. - For the recruitment, the authors used the maximum variation technique of purposive sampling. Please elaborate more. We have noted that to facilitate capturing the complexity and variation of parental experience, we used purposive sampling and refer readers to an excellent reference citation that guided our decision regarding sampling strategy and sample size. Please see p. 7, lines 165-166 We have also added that to identify and select information-rich cases related to our phenomenon of interest (parents of a child living with anxiety), we recruited from both clinical and community settings. We then provide additional information as to recruitment approach in each setting (e.g., Clinical setting: through wait list of a specialized anxiety clinic; Community setting: youth centres, teen clinics, and schools). Please see p.7, lines 168-173. - Data collection: better if the data collection can be divided into two parts, to make a clearer understanding of the data collection process, between the semi-structured interviews and open-ended interviews. Was the AIDS-IV-C/P used for the parents or the children? What was the diagnostic criteria of it? Who did the interview for the diagnosis? (credentials) What were the purposes of each either semi-structured interviews and open-ended interviews? Also for the open-ended interviews, who did the interviews? We have divided that paragraph into two paragraphs. Please see p. 7, lines 180-198. We hope this facilitates readers’ understanding of the data collection process. In the first paragraph we provide information about the semi-structured interviews. We note that: (1) the AIDS-IV-C/P was used with parents, (2) we used the Clinician Severity Rating (range -0-8; > 4 required to assign a diagnosis), and (3) that we used the ADIS-IV-C/P (purpose) to ensure our sample included parents of youth with a clinical diagnosis of anxiety. See p. 7, lines 183-189. We also specify that our findings emerged from a larger study that explored the lived experience of Canadian youth living with anxiety for which both youth and their parents were interviewed. Please see p. 5, lines 131-132. In the Methods section, we highlight the questions that guided the open-ended interviews. Please see p. 8, lines 193-196. We also note that the third author, a PhD trained research associate who has qualitative research training and experience administering the ADIS-IV-C/P conducted all interviews with guidance from the first author. Please see p. 8, lines 201-203. - How about the trustworthiness of the study? We have additional information about strategies used to enhance methodological rigour and trustworthiness. Please see p. 9 and 10, lines 234-242. - Data analysis: the first and second author did the data analysis. Describe the background of the authors, including gender and experience in qualitative study. We have added this information. Please see p.9, lines 231-233. - Results start with the process of the data analysis (how many codes into themes?) It is good as the authors have provided the coding tree into the tables. Yes, we have provided the coding tree in the tables. Please see Table 1 on p. 11, Table 2 on p.20, and Table 3 on p. 24. - Overall, it is an interesting study for a better health care services and policy. Reviewer #2: -The paper reports very important findings. It is well written and easy to follow. I have only a few minor points on the method section to be addressed. Please used the COREQ checklist to guide the report of the method section. We have used the COREQ checklist. Under the “Supporting Information” section of the manuscript, we note we are including an additional file labeled “S1 File. Consolidated criteria for reporting qualitative studies (COREQ) checklist”. Please see p. 36, line 914. -What is the qualification and research experience of the research assistant who conducted the interviews? We present this information on p. 8, lines 201-203. -Who took the field notes during the interviews? Was it the RA/interviewer of somebody else? If the same person did the interviews and at the same time took notes, then any reflections of the difficult experience? It is not easy to interview and probe information from a participant if the interviewer has to take notes as well. We note that field notes were recorded by the interviewer after each interview. Please see p. 8, lines 209-211. -Who did the transcription of the audio recordings? Was it the RA or one of the authors? If it was not the RA, then how did you integrate the field notes into the transcripts? Interviews were sent to a Professional Transcription Service used by the first author. We have provided additional information as to how field notes and transcripts were integrated. Please see p.9, lines 226-229. Attachments Attachment Submitted filename: ResponsetoReviewers.docx https://doi.org/10.1371/journal.pone.0283518.r002
12 Mar 2023 Decision Letter - Nelsensius Klau Fauk, Editor Accessing mental health services for a child living with anxiety: Parents’ lived experience and recommendations PONE-D-23-01298R1 Dear Dr. Woodgate, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. 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 onepress@plos.org. Kind regards, Nelsensius Klau Fauk, S.Fil., M., MHID, MSc, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0283518.r003
Formally Accepted
15 Mar 2023 Acceptance Letter - Nelsensius Klau Fauk, Editor PONE-D-23-01298R1 Accessing mental health services for a child living with anxiety: Parents’ lived experience and recommendations Dear Dr. Woodgate: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Nelsensius Klau Fauk Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283518.r004

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