PONE-D-19-23360

Should social disconnectedness be included in primary-care screening for cardiometabolic disease? A review of the relationship between everyday stress, social connectedness, and allostatic load

PLOS ONE

Dear Dr Larrabee Sonderlund,

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.

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Kenzie Latham-Mintus, PhD, FGSA

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: This manuscript presents a review of 20 studies concerning the stress-buffering effect of social connection. Despite heterogeneous measurement approaches regarding aspects of social relationships, the majority of studies reviewed found that positive and supportive social relationships are associated with reduced allostatic load. In view of this, the authors make the case that a measure of ‘social connectedness’ would have some utility when screening for risk of cardiometabolic diseases, alongside the more widely-used lifestyle factors.

Overall it looks like the review was done with care, and the manuscript is presented very clearly - I enjoyed reading it. However, my main concern is that the concept of ‘social connectedness’ is left poorly-defined. The authors keep the concept intentionally broad for the purposes of the review, but they do not then go on to distill it down to a concrete, workable definition that could be used for screening purposes. As the authors acknowledge, the stress-buffering effects of social relationships appear to be a matter of quality over quantity – clearly, not all social relationships are necessarily supportive, and indeed some relationships can themselves be source of stress. The implication, presumably, would be that administering a social support scale would be more appropriate than asking people how big their social network is?

Overall I think the paper would make a good contribution to the literature, but the authors could refine their recommendations by, for example, devoting more attention to which measurement approaches tended to yield stronger effects.

Reviewer #2: I really enjoyed reviewing this paper as it is an interesting area of research with huge implications for health. It was very well-written and easy to follow, I thought the methodology was very rigorous and followed PRISMA guidelines, and all of the conclusions were well-supported, both by past literature & from findings of the review itself. I have only one minor revision suggested (see comments below) and recommend this manuscript for publication.

1. What are the main claims of the paper and how significant are they for the discipline?

The main findings from the review are that social connectedness (i.e. having important relationship with other people or groups) is protective against the effects of everyday stressors & development of AL. As an AL researcher myself, I am well-versed on this construct and really liked the way that the authors framed the importance of stress and how the maladaptive physiology contributes to a variety of chronic diseases (not just cardiometabolic disease, which was the authors’ interest). It really has immense implications for population health and has been well-validated for decades now, but because stress is often viewed as a “psychological” problem, rather than a physiological one by clinicians, it is often overlooked until chronic disease has emerged. I think the conclusion the authors make that social connectedness should be viewed as a major health risk factor is well-supported and hopefully will help change the mentality about the effects of chronic stress when it comes to screening and primary prevention.

2. Are the claims properly placed in the context of the previous literature? Have the authors treated the literature fairly?

This paper adequately summarized past literature in this field and I think fairly assessed the findings and limitations of that body of work.

3. Do the data and analyses fully support the claims? If not, what other evidence is required?

I think the data & analyses for the most part support the claims. The one thing I would be careful about when interpreting findings across the AL literature is directly comparing findings in papers that used completely different indicators of AL in their construct measures. For example, some of the studies you discussed used neuroendocrine/immune biomarkers to represent AL, while others used cardiometabolic indices to represent AL. Ideally, an AL measure would include all of those, but that isn’t always possible, so the indices vary widely across the literature, which is a known weakness of this field. So just interpret carefully when studies are using completely different metrics to represent this stress construct. And I would mention this as a study limitation too because it could skew your interpretations when synthesizing the findings of the included studies.

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The PRISMA methodology was well-explained and they reference the website if someone needs to see all of the specific steps. No suggestions here.

5. If the paper is considered unsuitable for publication in its present form, does the study itself show sufficient potential that the authors should be encouraged to resubmit a revised version?

I would recommend for publication with just a minor revision that I mentioned above about adding a study limitation (interpretation of AL indices that use different biomarkers).

6. Are original data deposited in appropriate repositories and accession/version numbers provided for genes, proteins, mutants, diseases, etc.?

Not applicable.

7. Are details of the methodology sufficient to allow the experiments to be reproduced?

Yes, methodology well-described and I believe the search could be easily reproduced with the information given.

8. Is the manuscript well organized and written clearly enough to be accessible to non-specialists?

Very well-written, great paper!

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Reviewer #1: No

Reviewer #2: No

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Should social disconnectedness be included in primary-care screening for cardiometabolic disease? A systematic review of the relationship between everyday stress, social connectedness, and allostatic load

PONE-D-19-23360R1

Dear Dr. Larrabee Sonderlund,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Kenzie Latham-Mintus, PhD, FGSA

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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: 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

Reviewer #2: 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: Thank you for the opportunity to review this revised submission. I am satisfied with the authors' response and have no further comments to raise. I believe the paper will make an interesting contribution.

Reviewer #2: (No Response)

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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 #1: No

Reviewer #2: No