Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis

Alexandre Wullschleger; Leonel Gonçalves; Maya Royston; Othman Sentissi; Julia Ambrosetti; Stefan Kaiser; Stéphanie Baggio

doi:10.1371/journal.pone.0289310

Peer Review History

Original SubmissionFebruary 1, 2023
7 May 2023 Decision Letter - Jahida Gulshan, Editor PONE-D-23-02930 Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric Department: an interrupted time-series analysis PLOS ONE Dear Dr. Wullschleger, 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 Jun 21 2023 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 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. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic 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'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jahida Gulshan Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 3. 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. [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: No ****** 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: Yes Reviewer #2: No ****** 4. 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 ****** 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: Review Report This paper may be recommended for publication subject to the following minor modifications/corrections: 1. The novelty of the research must be clearly shown at the end of the introduction section. 2. The innovation should be clear in abstract. Improve it. 3. All assumptions and limitations for the current study should be stated point-wise. 4. Improve the paper grammar wise 5. What are the limitations of the defined problem? 6. Outlook and further perspective can be included in the conclusion part. 7. Literature review is also to be enriched with recent articles. Reviewer #2: The current article investigated the effects of COVID outbreak on psychiatric admission. By using the data gathered over 2019-20 in the department of psychiatry at the Geneva University Hospitals, an interrupted time series analysis was performed, and discussion is made around the number of hospitalisations during COVID pandemic being correlated with a greater use of seclusion and higher use of coercion. This article is based on an important topic and can contribute in knowing the pattern of mental health associated with COVID outbreak and use of coercive measures, the study still needs improved presentation of results and overall strengthen the methodology part. Introduction: a) Though a number of published article was cited in Introduction, I believe some more relevant articles culd be reviewed, specifically the choice of analysis method could be supported by evidence from literature. If not changing or improving the method, at least some review of what other analysis methods have been used in similar datasets and to fulfill similar objectives could be reported. For instance, please see the articles below: 1. Aragonés-Calleja, M., & Sánchez-Martínez, V. (2022). Current State of Research on Coercion in Mental Health: Umbrella Review Protocol. Journal of Psychosocial Nursing and Mental Health Services, 60(10), 49-55. 2. Wiegand, H. F., Bröcker, A. L., Fehr, M., Lohmann, N., Maicher, B., Röthke, N., ... & Adorjan, K. (2022). Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany–Results From the COVID Ψ Psychiatry Survey. Frontiers in psychiatry, 13. b)The rationale of the study needs to be more clearly stated. How will this study help to contribute, is there anything novel about the study, what will be the impact? Methods: While introducing he data and variables, some tabular and/or graphical representations of the variables, their interrelationships should be presented as part of the exploratory analysis. The choice of analysis method should be informed by the result of the exploratory analysis. I suggest adding these in this section. Results: While the result has been described in words using the coefficient values and P values, I still felt some tabular representation of all the necessary coefficients, their standard errors, P values will be more accessible to readers and will complement the descriptions made. In the text, it is mentioned that ARIMA models showed inversed relationship between symptom severity and psychiatric hospitalizations, however, there is no table or figure to support the statement, apart from values mentioned in text line 207. I would recommend the author to review few papers to see how adequately model results are presented using tables and figures to strengthen the interpretation and revise the presentation of results in this article accordingly. ****** 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. 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 ******** [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. https://doi.org/10.1371/journal.pone.0289310.r001
Revision 1
2 Jun 2023 Author Response Dear Sir or Madam, We thank you for the opportunity you gave us to submit a revised version of our manuscript. The reviewers’ comments helped us improve the quality of our work. As to the general editor’s comments, we adapted the manuscript to the PLOS ONE style templates. The reference list was also enriched through the revision process. As to the availability of data, after checking with the local ethics committee, we are now able to provide the raw data and code as supplementary material. Following the reviews for our manuscript, we are submitting a new version of the present work. The manuscript has been thoroughly revised and modified according to the very valuable comments made by the reviewers. All aspects and questions raised by the reviewers have been addressed, as stated below. Answers to the reviewers’ comments Reviewer #1: This paper may be recommended for publication subject to the following minor modifications/corrections: 1. The novelty of the research must be clearly shown at the end of the introduction section. We thank the reviewer for his/her general appraisal of the paper. The introduction has been modified according to this comment. 2. The innovation should be clear in abstract. Improve it. The abstract has been modified accordingly, stating more clearly the innovation of the present work. 3. All assumptions and limitations for the current study should be stated point-wise. The issue of coercion in psychiatric care has been contextualized in the introduction. The limitations section has been completed and should now be clearer. 4. Improve the paper grammar wise The manuscript underwent a thorough correction process. 5. What are the limitations of the defined problem? The limitations section has been modified and completed, as mentioned above. 6. Outlook and further perspective can be included in the conclusion part. The conclusion now includes a paragraph on further scientific and clinical perspectives. 7. Literature review is also to be enriched with recent articles. According to the reviewer’s comment, the literature review now includes more recent papers. Reviewer #2: 1. The current article investigated the effects of COVID outbreak on psychiatric admission. By using the data gathered over 2019-20 in the department of psychiatry at the Geneva University Hospitals, an interrupted time series analysis was performed, and discussion is made around the number of hospitalisations during COVID pandemic being correlated with a greater use of seclusion and higher use of coercion. This article is based on an important topic and can contribute in knowing the pattern of mental health associated with COVID outbreak and use of coercive measures, the study still needs improved presentation of results and overall strengthen the methodology part. We thank the reviewer for his/her positive general appraisal of the manuscript and his/her useful comments. 2. Introduction: a) Though a number of published article was cited in Introduction, I believe some more relevant articles culd be reviewed, specifically the choice of analysis method could be supported by evidence from literature. If not changing or improving the method, at least some review of what other analysis methods have been used in similar datasets and to fulfill similar objectives could be reported. For instance, please see the articles below: 1. Aragonés-Calleja, M., & Sánchez-Martínez, V. (2022). Current State of Research on Coercion in Mental Health: Umbrella Review Protocol. Journal of Psychosocial Nursing and Mental Health Services, 60(10), 49-55. 2. Wiegand, H. F., Bröcker, A. L., Fehr, M., Lohmann, N., Maicher, B., Röthke, N., ... & Adorjan, K. (2022). Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany–Results From the COVID Ψ Psychiatry Survey. Frontiers in psychiatry, 13. Answer: The introduction now includes more recent papers contextualizing the present research. This also includes methodological aspects of previous works and articles using a similar approach as the one used in this wok. b) The rationale of the study needs to be more clearly stated. How will this study help to contribute, is there anything novel about the study, what will be the impact? Answer: The introduction and conclusion sections now state more clearly the rationale of the study and its anticipated impacts. 3. Methods: While introducing he data and variables, some tabular and/or graphical representations of the variables, their interrelationships should be presented as part of the exploratory analysis. The choice of analysis method should be informed by the result of the exploratory analysis. I suggest adding these in this section. Answer: We added graphical representations of the variables to the figures. The graphical representation of hospitalizations is presented in Figure 1, of coercive measures in Figure 2, and of the relationship between hospitalizations and coercive measures in Figure 3. We chose during study conception to use pre-planned analyses in the study that were in our opinion optimally designed to answer our research question. We wanted to avoid the risk of confirmatory analyses that might increase when choosing a data-driven analysis process. 4. Results: While the result has been described in words using the coefficient values and P values, I still felt some tabular representation of all the necessary coefficients, their standard errors, P values will be more accessible to readers and will complement the descriptions made. Answer: For the objective 2 (association between the number of psychiatric hospitalizations and the proportion of coercive measures), we added a table presenting the results of the regression output. Please see Table 2: Association between the number of psychiatric admissions and the proportion of coercive measures over time. In the text, it is mentioned that ARIMA models showed inversed relationship between symptom severity and psychiatric hospitalizations, however, there is no table or figure to support the statement, apart from values mentioned in text line 207. I would recommend the author to review few papers to see how adequately model results are presented using tables and figures to strengthen the interpretation and revise the presentation of results in this article accordingly. Answer: This was presented in Figure 3. However, the values were presented as standardized values, to make the scale of the different variables equivalent. In the new version of the manuscript, we changed Figure 3, now using the variables in their original scale. Please see Figure 3: Psychiatric hospitalizations and proportion of coercive measures over time. In addition, we added a Table were the values on the study variables (number of hospitalisations, proportion of coercive measures, and severity of symptoms) by year are presented. The table includes the observed values, plus the predicted proportion of coercive measures along with their 95% CI based on the results from the regression analysis. Please see Table 1: Study variables by year. Finally, we added a figure illustrating the proportion of coercive measures over time, including observed and predicted values, based on the results from the regression model (using the number of psychiatric admissions as a predictor). Please see Figure 4: Proportion of coercive measures over time as a function of psychiatric admissions. This figure serves to confirm that the prediction model (objective 2) fits the data well. The values on the graph correspond to the values presented in Table 1: Study variables by year. We sincerely hope that this new version will now suit the reviewers and the editors. We are looking forward to your feedback. Best regards, For the research team Alexandre Wullschleger Attachments Attachment Submitted filename: Response_Wullschleger.docx https://doi.org/10.1371/journal.pone.0289310.r002
6 Jul 2023 Decision Letter - Jahida Gulshan, Editor PONE-D-23-02930R1Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric Department: an interrupted time-series analysisPLOS ONE Dear Dr. Wullschleger, 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 Aug 19 2023 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 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. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic 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'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jahida Gulshan Academic Editor PLOS ONE Journal Requirements: 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: 1. Move table 1 to appendix. 2. A thorough grammar check is necessary. [Note: HTML markup is below. Please do not edit.] [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. https://doi.org/10.1371/journal.pone.0289310.r003
Revision 2
12 Jul 2023 Author Response Dear Prof. Gulsham, We thank you for the opportunity you gave us to submit again a revised version of our manuscript. We addressed the two comments you made. Table 1 has been moved to the Appendix, and the manuscript has been thoroughly checked regarding language and grammar. We sincerely hope that this new version will now fully comply with the publication standards of PLOS One. We are looking forward to your feedback. Best regards, For the research team Alexandre Wullschleger Attachments Attachment Submitted filename: Response_Wullschleger_20230711.docx https://doi.org/10.1371/journal.pone.0289310.r004
17 Jul 2023 Decision Letter - Jahida Gulshan, Editor Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric Department: an interrupted time-series analysis PONE-D-23-02930R2 Dear Dr. Wullschleger, 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, Jahida Gulshan Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you very much for your revised version. Reviewers' comments: https://doi.org/10.1371/journal.pone.0289310.r005
Formally Accepted
20 Jul 2023 Acceptance Letter - Jahida Gulshan, Editor PONE-D-23-02930R2 Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric Department: an interrupted time-series analysis Dear Dr. Wullschleger: 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. Jahida Gulshan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289310.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .