Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19

Summer Newell; Lauren Denneson; Annabelle Rynerson; Sarah Rabin; Victoria Elliott; Nazanin Bahraini; Edward P. Post; Steven K. Dobscha

doi:10.1371/journal.pone.0261921

Peer Review History

Original SubmissionJuly 9, 2021
1 Oct 2021 Decision Letter - Sarah A. Arias, Editor PONE-D-21-22480Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19PLOS ONE Dear Dr. Newell, 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 Nov 15 2021 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. 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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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 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 ****** 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 ****** 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: Overall, this was a well-written and thoughtful manuscript reporting clinical impressions of the VA transition to remote administration of Risk ID in the early stages of the COVID crisis. My primary concerns are: 1) that some of the background information about VA practices is not included and is not easily accessible to readers outside of that system, and 2) use of neutral language. Please see comments below: Materials and Methods: The opening paragraph of the methods refers to two VA initiatives (VA CSRE; PC-MHI) without providing citations or links to any online documentation. This information should be easily accessible to non-VA affiliated readers who may not be able to properly contextualize the methods and results without supplementary information. Results Language should be more neutral in places. Phrases like “deep concern” instead of just “concern” would be better. Though I agree with the sentiment, this statement from the Discussion read as a value judgement: "First, overall, staff exhibited ingenuity and flexibility as they attempted to cope with rapidly changing circumstances—their clear dedication to care and to Veterans was evident." Discussion The diversity of expertise among participants and hospital size and setting was a strength of the paper, but greater consideration of how those differences aligned with themes is warranted. For example, there is some discussion at length about a shift away from having nurses administer Risk ID. Was this occurring at larger hospitals, rural hospitals, etc.? Though COVID has been challenging across levels of expertise, did baseline staff experience impact decisions to shift assessment assignment? The discussion of changes in quality of care would be more useful if the results were contextualized in the hospital setting, e.g., were there particular types of hospitals, or staff makeup, that were more typical of hospitals that made the decision to not carry out parts or Risk ID? I agree with the passage below, but what kinds of evaluations do the authors recommend? As a closed health care system, there are some unique opportunities for addressing such questions at a depth that is more difficult to achieve when working in a majority private health insurance setting. It would be good if the authors made some more concrete recommendations. "Others struggled considerably and further analyses of reasons for this variation has potential to yield important insights about factors influencing system-level crisis response." In the discussion, the authors draw distinctions between hospitals who were, and were not, able to transition to virtual care, but the discussion of characteristics of both groups was shallow. I appreciate that this is a preliminary, hypothesis-generating piece, but I don't have a strong sense of where the next logical step in this line of research lies. How would qualitative work like yours be integrated into larger scale program evaluation efforts? ****** 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 [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.0261921.r001
Revision 1
9 Nov 2021 Author Response Reviewer #1: Overall, this was a well-written and thoughtful manuscript reporting clinical impressions of the VA transition to remote administration of Risk ID in the early stages of the COVID crisis. My primary concerns are: 1) that some of the background information about VA practices is not included and is not easily accessible to readers outside of that system, and 2) use of neutral language. Please see comments below: Author response: We will respond to specific comments where they occur below. Materials and Methods: The opening paragraph of the methods refers to two VA initiatives (VA CSRE; PC-MHI) without providing citations or links to any online documentation. This information should be easily accessible to non-VA affiliated readers who may not be able to properly contextualize the methods and results without supplementary information. Author response: Thank you for pointing out this oversight. We have provided additional description and added a relevant citation. Results Language should be more neutral in places. Phrases like “deep concern” instead of just “concern” would be better. Though I agree with the sentiment, this statement from the Discussion read as a value judgement: "First, overall, staff exhibited ingenuity and flexibility as they attempted to cope with rapidly changing circumstances—their clear dedication to care and to Veterans was evident." Author response: We agree that some of the language holds some value judgement. We have edited the language to be more neutral. Discussion The diversity of expertise among participants and hospital size and setting was a strength of the paper, but greater consideration of how those differences aligned with themes is warranted. For example, there is some discussion at length about a shift away from having nurses administer Risk ID. Was this occurring at larger hospitals, rural hospitals, etc.? Though COVID has been challenging across levels of expertise, did baseline staff experience impact decisions to shift assessment assignment? The discussion of changes in quality of care would be more useful if the results were contextualized in the hospital setting, e.g., were there particular types of hospitals, or staff makeup, that were more typical of hospitals that made the decision to not carry out parts or Risk ID? Author Response: Thank you for the suggestion to better describe the contextual differences in the focal clinics. The study was not designed for, and our qualitative sample did not allow for, meaningful comparison between sites. We intentionally sought out variation across these characteristics to ensure broad representation of ideas and experiences, which can lead to better identification of key themes and hypotheses for later study (Sofaer, 1999 p. 1104). We did reexamine our data, and as expected, due to substantial variation across site and provider characteristics we were unable to detect clear patterns of association. We do note in the discussion (line 367) that sites that had existing virtual care prior to the pandemic might have had an easier time adjusting. Further, we highlight the limited contextual data as a limitation. I agree with the passage below, but what kinds of evaluations do the authors recommend? As a closed health care system, there are some unique opportunities for addressing such questions at a depth that is more difficult to achieve when working in a majority private health insurance setting. It would be good if the authors made some more concrete recommendations. "Others struggled considerably and further analyses of reasons for this variation has potential to yield important insights about factors influencing system-level crisis response." In the discussion, the authors draw distinctions between hospitals who were, and were not, able to transition to virtual care, but the discussion of characteristics of both groups was shallow. I appreciate that this is a preliminary, hypothesis-generating piece, but I don't have a strong sense of where the next logical step in this line of research lies. How would qualitative work like yours be integrated into larger scale program evaluation efforts? Author Response: We agree that we did not outline clear next steps for further work. Given that we did not have sufficient data to identify contextual differences between sites that adapted their SI protocols versus those that did not, further work that more precisely measures contextual variables is suggested. We have outlined further recommendations on line 396. Reference Sofaer, S. (1999). Qualitative methods: what are they and why use them?. Health services research, 34(5 Pt 2), 1101. Attachments Attachment Submitted filename: PLOS response to reviewers 11.9.21.docx https://doi.org/10.1371/journal.pone.0261921.r002
14 Dec 2021 Decision Letter - Sarah A. Arias, Editor Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19 PONE-D-21-22480R1 Dear Dr. Newell, 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, Sarah A. Arias Academic Editor PLOS ONE 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 #1: All comments have been addressed ******** 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 #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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 #1: Yes ****** 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 #1: Yes ****** 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) Reviewer #1: (No Response) ****** 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 #1: No https://doi.org/10.1371/journal.pone.0261921.r003
Formally Accepted
17 Dec 2021 Acceptance Letter - Sarah A. Arias, Editor PONE-D-21-22480R1 Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19 Dear Dr. Newell: 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. Sarah A. Arias Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0261921.r004

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