Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions

Gregory Armstrong; Georgina Sutherland; Eliza Pross; Andrew Mackinnon; Nicola Reavley; Anthony F. Jorm

doi:10.1371/journal.pone.0244091

Peer Review History

Original SubmissionSeptember 21, 2020
10 Nov 2020 Decision Letter - Danuta Wasserman, Editor PONE-D-20-29679 Talking About Suicide: an uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid program on knowledge, attitudes and intended and actual assisting actions PLOS ONE Dear Dr. Armstrong, 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 Dec 25 2020 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. 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Thank you for stating the following in the Acknowledgments Section of your manuscript: "We have some sincere acknowledgements to make for several people. We would like to acknowledge the important role of the Aboriginal and Torres Strait Islander Project Reference Group, comprised of Professor Kerry Arabena, Ms Leilani Darwin, Mr Les Baird and Mr Jonathan Link. They provided essential cultural guidance and support throughout this study and the development of the training course. We would also like to acknowledge the participating Aboriginal Community-Controlled Organisations that were integral to both piloting the training course and implementing this evaluation study. We would like to acknowledge the authors of the training manual that formed the basis of the training course, Ms Eliza Pross, Dr Claire Kelly, Ms Fiona Blee and Ms Katrina Dart. We would like to thank the contributors to the lived experience films, which formed a critical element of the training materials, and the Instructors and study participants for sharing their time and passion for suicide prevention. We would also like to thank Mr Lewis Gould-Fensom for his contribution to data collection as a research assistant. The study was funded by a National Health and Medical Research Council grant (#1076796) funded under the grant scheme “Mental Health Targeted Call for Research into Suicide Prevention in Aboriginal and Torres Strait Islander Youth”. We would like to thank Dr Betty Kitchener, Dr Claire Kelly, Professor Kerry Arabena and Dr Laura Hart for their contributions as investigators on the grant who are not authors on this paper. The lead author is funded by an Early Career Fellowship (GNT1138096) from the National Health and Medical Research Council in Australia.". i) We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. ii) Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." iii) Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. Thank you for stating the following in the Competing Interests section: "AFJ is unpaid Chair of the Board of Mental Health First Aid Australia, which is a not-for-profit organization.". i) Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. ii) Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. 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Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files Additional Editor Comments (if provided): Please address the comments from the reviewers and revise the manuscript before resubmitting. [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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 3. 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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: Interesting study on a topic of general interest not only as regards suicide prevention in indigenous populations. It is not easy to evaluate suicide prevention programmes and this is an example of how it can be done. It is also interesting and good that the authors present a rather short programme that has a chance to be used in a more long lasting suicide prevention programme which is needed. Suicide prevention is probably something that needs to be not too complicated if it should survive and not just be one of many "projects". Table 4 and 5 should change place I think in the presentation. Reviewer #2: Very interesting and important paper. However, the authors should write more in the discussion about the limitations in this study due to few subjects included and short follow-up. Recommendations for future research should also be added. In the reference list, and cite somewhere in the text, please include the following references: - Gergö Hadlaczky, Sebastian Hökby, Anahit Mkrtchian, Vladimir Carli & Danuta Wasserman (2014) Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis, International Review of Psychiatry, 26:4, 467-475, DOI: 10.3109/09540261.2014.924910 - Zalsman G, Hawton K, Wasserman D et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016; (published online June 8.) http://dx.doi.org/10.1016/S2215-0366(16)30030-X - Wasserman D, Hoven CW, Wasserman C et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536-1544. - Wasserman, C., Postuvan, V., Herta, D., Iosue, M., Värnik, P., & Carli, V. (2018). Interactions between youth and mental health professionals: The youth aware of mental health (YAM) program experience. PLoS ONE, 13(2). https://doi.org/10.1371/journal.pone.0191843 - Wasserman, C., Hoven, C. W., Wasserman, D., Carli, V., Sarchiapone, M., Al-Halabí, S., … Poštuvan, V. (2012). Suicide prevention for youth - A mental health awareness program: Lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study. BMC Public Health, 12(1). https://doi.org/10.1186/1471-2458-12-776 ****** 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
15 Nov 2020 Author Response Response to reviewers and editorial requests Editorial requests 1. “Funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.” We have now removed the funding information from the acknowledgements section and moved it to the funding statement. Please find the new statements below: Acknowledgements: We have some sincere acknowledgements to make for several people. We would like to acknowledge the important role of the Aboriginal and Torres Strait Islander Project Reference Group, comprised of Professor Kerry Arabena, Ms Leilani Darwin, Mr Les Baird and Mr Jonathan Link. They provided essential cultural guidance and support throughout this study and the development of the training course. We would also like to acknowledge the participating Aboriginal Community-Controlled Organisations that were integral to both piloting the training course and implementing this evaluation study. We would like to acknowledge the authors of the training manual that formed the basis of the training course, Ms Eliza Pross, Dr Claire Kelly, Ms Fiona Blee and Ms Katrina Dart. We would like to thank the contributors to the lived experience films, which formed a critical element of the training materials, and the Instructors and study participants for sharing their time and passion for suicide prevention. We would also like to thank Mr Lewis Gould-Fensom for his contribution to data collection as a research assistant. Finally, we would like to thank Dr Betty Kitchener, Dr Claire Kelly, Professor Kerry Arabena and Dr Laura Hart for their contributions as investigators on the grant funding this study. Funding statement: The study was funded by a National Health and Medical Research Council grant (#1076796) funded under the grant scheme “Mental Health Targeted Call for Research into Suicide Prevention in Aboriginal and Torres Strait Islander Youth”. The lead author is funded by an Early Career Fellowship (GNT1138096) from the National Health and Medical Research Council in Australia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 2. “Please include your tables as part of your main manuscript and remove the individual files.” We have now included the tables and figures in the main manuscript and removed the individual files. 3. Requested updates to competing interest statement New competing interest statement: AFJ is unpaid Chair of the Board of Mental Health First Aid Australia, which is a not-for-profit organization. This does not alter our adherence to PLOS ONE policies on sharing data and materials. 4. Title consistency The correct title is: Talking About Suicide: an uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid program on knowledge, attitudes and intended and actual assisting actions We have updated this in the online submission system. Peer reviewer comments Reviewer one 1. “Interesting study on a topic of general interest not only as regards suicide prevention in indigenous populations. It is not easy to evaluate suicide prevention programmes and this is an example of how it can be done. It is also interesting and good that the authors present a rather short programme that has a chance to be used in a more long lasting suicide prevention programme which is needed. Suicide prevention is probably something that needs to be not too complicated if it should survive and not just be one of many "projects". Thank you for these encouraging remarks. 2. “Table 4 and 5 should change place I think in the presentation.” Without a rationale provided by the reviewer we are unclear as to how this would improve the presentation. We have elected to keep the current order of the tables, such that Table 4 still precedes Table 5. We understand this is an issue of style and there may be divergent views, but we feel it is appropriate to first focus on guideline concordant skills before focusing on guideline discordant skills. Reviewer two 3. “Very interesting and important paper. However, the authors should write more in the discussion about the limitations in this study due to few subjects included and short follow-up. Recommendations for future research should also be added.” The limitations section includes statements that address the issues caused by the short follow-up period and the sample size issues related to attrition (page 21), as per the text below: ‘Thirdly, while our study was strengthened by the collection of follow-up data, four-months is a relatively short time period and there are no data on whether the positive effects of the training were maintained over longer time periods. In addition, our follow-up findings need to be interpreted cautiously due to a high rate of attrition.’ Despite the issue of attrition, the sample size of 192 for pre/post data makes it one of the larger trials in Australia of a suicide prevention intervention for Aboriginal and Torres Strait Islander people. 4. “Recommendations for future research should also be added.” The manuscript includes a paragraph (page 21-22) discussing recommendations for future research, as below: ‘In terms of future research, there are several potential avenues of exploration including looking at a broader range of health-related outcome measures, for example, referral and treatment patterns and rates of suicide attempts. There is also value in extending understanding of cultural relevance beyond what we could derive from a single post-course question. It would be valuable to have a more nuanced understanding of the extent to which the cultural adaptation was acceptable, safe and relevant and the extent to which further cultural adaptations could be embedded in the course to extend its effectiveness and reach. Further research might also explore the extent to which non-Indigenous participants gained knowledge of contextual, social and cultural factors around suicide for Aboriginal and Torres Strait Islander people even though this was not an explicit learning objective. Finally, future AMHFA programs should consider as a matter of urgency recalibrating approaches to evaluation by giving Aboriginal and Torres Strait Islander researchers greater control of the research process, including determining evaluation methodologies.’ 5. “In the reference list, and cite somewhere in the text, please include the following references: - Gergö Hadlaczky, Sebastian Hökby, Anahit Mkrtchian, Vladimir Carli & Danuta Wasserman (2014) Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis, International Review of Psychiatry, 26:4, 467-475, DOI: 10.3109/09540261.2014.924910 - Zalsman G, Hawton K, Wasserman D et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016; (published online June 8.) http://dx.doi.org/10.1016/S2215-0366(16)30030-X - Wasserman D, Hoven CW, Wasserman C et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536-1544. - Wasserman, C., Postuvan, V., Herta, D., Iosue, M., Värnik, P., & Carli, V. (2018). Interactions between youth and mental health professionals: The youth aware of mental health (YAM) program experience. PLoS ONE, 13(2). https://doi.org/10.1371/journal.pone.0191843 - Wasserman, C., Hoven, C. W., Wasserman, D., Carli, V., Sarchiapone, M., Al-Halabí, S., … Poštuvan, V. (2012). Suicide prevention for youth - A mental health awareness program: Lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study. BMC Public Health, 12(1). https://doi.org/10.1186/1471-2458-12-776” Thank you for the suggested list of additional citations. We have reviewed them and included two; Hadlaczky et al 2014 and Zalsman et al 2016. The Hadlackzy et al 2014 article provides a meta-analysis of mental health first aid interventions. We have also inserted the reference below, which represents a more recent meta-analysis. Morgan, A. J., A. Ross and N. J. Reavley (2018). "Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour." PLoS One 13(5): e0197102. The remaining suggestions were considered to be interesting studies although less directly relevant for inclusion in our manuscript. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0244091.r002
3 Dec 2020 Decision Letter - Danuta Wasserman, Editor Talking About Suicide: an uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid program on knowledge, attitudes and intended and actual assisting actions PONE-D-20-29679R1 Dear Dr. Armstrong, 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, Danuta Wasserman Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0244091.r003
Formally Accepted
7 Dec 2020 Acceptance Letter - Danuta Wasserman, Editor PONE-D-20-29679R1 Talking About Suicide: an uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander Mental Health First Aid program on knowledge, attitudes and intended and actual assisting actions Dear Dr. Armstrong: 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. Danuta Wasserman Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244091.r004

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