PONE-D-24-20993The drivers of mental health service utilisation among public primary healthcare workers in Negeri SembilanPLOS ONE

Dear Dr. Mohd Noor,

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Academic Editor

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: Yes

Reviewer #2: Yes

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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

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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: In the introduction, it is unclear what the authors mean by target 3.8 in sustainable developmental goals. It would be helpful if the authors could explicitly state what the specific goal or target is that they are referring to in here

The authors should further elaborate the rationale for this study

The introduction of this study is very lengthy. Authors can benefit by reducing and excluding unnecessary or redundant information that they have discussed in the intro, - a lot of these points can be added to the discussion or be summarized and discussed in a concise manner

Was an external review board certification/permission required for this study?

Confidence interval abbreviation can be added in the data analysis part

The abbreviated and full form of MHSU should be provided

Even though the authors have mentioned the income categories in the table they need to provide the definitions for the income categories B40, M40 and T20 within the results text to ensure clarity for the readers

The statement “This is consistent with the findings of a systematic review and meta-analysis on mental health screening...” is very confusing. It is not clear what specific results or points the authors are referring to. The sentence should be restructured to clearly indicate which findings are being referenced in here.

This paper can also benefit from a 'brief' paragraph on future directions for investigators and physicians, and how future studies could explore and use more rigorous analysis to further improve the findings/observations of this study.

Reviewer #2: In their study, " The drivers of mental health service utilization among public primary healthcare workers in Negeri Sembilan," Noor et al. investigated the prevalence and predictors of MHSU among HCWs. Their findings revealed that low supervisor support, high co-worker support, mental health training, and household income were significant predictors of MHSU. To further improve the study, I would suggest the authors to incorporate the following edits:

1. Page 3 Introduction Section: Its hard to understand which percentage refers to which mental health condition in this sentence. Please consider restructuring this sentence to “The systematic review of mental health among HCWs managing the COVID-19 pandemic revealed varying prevalence rates: anxiety had the highest rate at 67.6%, followed by stress at 62.9% and depression at 55.9%. While the lowest rates were observed for depression at 12.1%, stress at 29.8%, and anxiety at 24.1%”.

2. Page 4, Introduction Section: While its good that the authors have mentioned the ABMHSU in the introduction section, I would recommend shifting the details about the factors influencing this model to the methods section. By doing so the content will be streamlined, making it easy to understand and avoiding any unnecessary details in the introduction.

3. Page 4-5, Introduction Section: The paragraph discussing the impact of low MHSU contains a lot of repetitive information about the negative consequences experienced by HCWs. Hence, I would recommend the authors to condense these points to improve the clarity and focus of the text.

4. Methodology Section: Please consider briefly elaborating on what the Cronbach's alpha and Cohen's kappa values represent and what their importance is in the study. This will help readers appreciate the methodology of the study.

5. Page 18, Discussion Section: The sentence, "The high prevalence in our study was attributed to the utilisation of services for screening purposes which accounted for 96.3%."is ambiguous. Please explicitly state whether the 96.3% refers to the percentage of total MHSU or any other measure to ensure clarity.

6. Discussion Section: To improve the organization of the discussion section I would recommend the authors to divide it into further subsections like “impact of mental health training”, “socioeconomic factors” “supervisor support,” etc. This will make it easier for the readers to understand and navigate through the topics discussed.

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Reviewer #1: No

Reviewer #2: No

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The drivers of mental health service utilisation among public primary healthcare workers in Negeri Sembilan

PONE-D-24-20993R1

Dear Dr. Ariffin,

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,

Tariq Jamal Siddiqi

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 #3: (No Response)

Reviewer #4: (No Response)

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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 #3: Yes

Reviewer #4: Yes

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

Reviewer #3: Yes

Reviewer #4: Yes

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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 #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: Yes

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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)

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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 #3: Yes: Akash Kumar

Reviewer #4: Yes: Ahmed Kamal Siddiqi

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