PONE-D-23-36363New Brunswick’s Mental Health Strategy: A Quantitative Exploration of Program Efficacy in Children and Youth using the Canadian Community Health SurveyPLOS ONE

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Reviewer #1: Partly

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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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Reviewer feedback

Overall, the paper addresses an important topic – youth mental health and the effectiveness of mental health services in New Brunswick. Here are some critiques and suggestions for improvement:

Overall Feedback:

o Consider refining the language for greater clarity, especially for those less familiar with this specific area.

o Break down lengthy paragraphs into smaller ones for better readability.

o Limit the use of abbreviations.

o Ensure consistency in citation format throughout the paper.

o Check for grammatical and typographical errors.

Abstract:

o Ensure consistent terminology throughout, For example, In the abstract, the phrase "New Brunswick Mental Health Action Plan" is used, but later in the paper, it's referred to as the "2011 Mental Health Action Plan." Consider using consistent terminology throughout.

Introduction:

o Improve the transition between the abstract and the introduction. Consider adding a sentence or two to bridge the gap and provide a more cohesive flow between the abstract's summary and the detailed introduction.

o Briefly explain how theoretical frameworks relate to the study's objectives.

o Include more recent literature in the introduction.

o Enhance clarity and conciseness in sentence construction.

o For example: "Following the release of the action plan in 2011, two further progress reports were released in 2013 and 2015, highlighting the implementation status of the action plan" could be simplified for clarity.

o And "...impact of the 2011 New Brunswick Mental Health Action Plan on children and youth using two representative samples of New Brunswickers aged 12-19 from the Canadian Community Health Survey (CCHS) datasets." -> "...impact of the 2011 New Brunswick Mental Health Action Plan on children and youth, utilizing two representative samples of New Brunswickers aged 12-19 from the Canadian Community Health Survey (CCHS) datasets."

o Ensure consistent punctuation in phrases.

o For example: "New Brunswick Youth and youth in Canada." It should be "New Brunswick youth and youth in Canada."

o Improve sentence structure for better flow.

o For instance, in the introduction, the sentence starting with "While vague in their language..." is a bit hard to read.

Methodology:

o Enhance clarity and conciseness in various sentences.

o "Data from the Public Use Micro Data Files (PUMF) of 2005, 2007-2008, 2009-2010, 2011-2012, and 2015-2016 CCHS were used for the analyses." -> "Data from the Public Use Micro Data Files (PUMF) of the 2005, 2007-2008, 2009-2010, 2011-2012, and 2015-2016 CCHS were used for the analyses."

o "The CCHS comprised of four content components..." -> "The CCHS comprised four content components..."

o "We did not seek institutional ethics reviews for the current study as per exemption under article 2.2..." -> "We did not seek institutional ethics reviews for the current study, as per exemption under Article 2.2..."

o "In the current study, all included variables are selected from scores of questions in the core or optional content that remained consistent over the years." -> "In the current study, all included variables were selected from scores of questions in the core or optional content that remained consistent over the years."

o "The approach to the operationalization of vulnerable population status by previous psychiatric diagnoses and self-rated mental health was similar to approaches adopted by other contemporary studies on this subject (55)." -> "The approach to operationalizing vulnerable population status based on previous psychiatric diagnoses and self-rated mental health was similar to approaches adopted by other contemporary studies on this subject (55)."

o "All analyses were conducted with Stata17 software." -> "All analyses were conducted using Stata17 software."

o Provide rationale behind selecting certain variables and specifics about statistical methods.

o Include details about the regression models used.

o Discuss ethical considerations related to using survey data and ensuring participant confidentiality.

Results:

o Reduce the number of tables and figures, considering combining them.

o Ensure tables and figures do not repeat results discussed in the text.

o These tables and figures do not provide enough important and novel information to justify including that many.

Discussion:

o Include specific examples or case studies related to service delivery.

o Offer specific recommendations for improving outcome monitoring in future mental health strategies.

o Strengthen the connection between observed trends and the New Brunswick Mental Health Action Plan.

o Contextualize stressors specific to New Brunswick, such as Bill 713, struggles in recruiting mental health professionals, and the Lexi Daken Inquest.

o Discuss variations in sample sizes and their potential impact on study findings.

o Provide specific recommendations for future research directions or policy implications based on the study's findings.

Conclusion:

o Summarize key findings and their implications more explicitly.

o Clarity in language

o "Again, the COVID-19 pandemic response has since increased multiple co-existing stressors, i.e., physical isolation, household job loss, and learning disruptions, that have increased the cumulative risk for youth worldwide (57; 82; 116) including New Brunswick youth." -> "Furthermore, the COVID-19 pandemic response has increased multiple co-existing stressors, such as physical isolation, household job loss, and learning disruptions, thereby escalating the cumulative risk for youth worldwide (57; 82; 116), including New Brunswick youth."

Reviewer #2: While the article provides valuable insights into mental health patterns among young individuals in New Brunswick, there are areas where improvements could enhance its rigor and impact:

1. Clarification of Methodological Details: The article lacks clarity in explaining certain methodological aspects. For instance, a more detailed description of the rationale behind the selection of specific covariates or the reasoning behind the chosen statistical models could improve the readers' understanding.

2. Temporal Analysis and Trends: While the study examines various years of CCHS datasets, a more robust analysis of temporal trends and changes in mental health outcomes over time could strengthen the article. This would involve discussing any notable shifts or consistencies observed across different years.

3. Ethical Considerations: While the article mentions the exemption from seeking institutional ethics reviews due to using publicly available data, a brief discussion about potential ethical considerations related to using anonymized data and ensuring participant confidentiality could add depth to the methodology section.

4. Inclusion of Comparative Analyses: Incorporating comparative analyses with other regions or national averages could offer a broader perspective and help in understanding whether the observed trends are unique to New Brunswick or align with national trends. Please discuss.

5. Last but not least - the article lacks a clear presentation of the basics of the researched problem, especially the research questions with the stated hypotheses. Please complete this

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Reviewer #1: No

Reviewer #2: No

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New Brunswick’s Mental Health Action Plan:

 A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey

PONE-D-23-36363R1

Dear Dr. Yang,

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.

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Kind regards,

Syed Hassan Ahmed

Guest Editor

PLOS ONE

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