PONE-D-20-19419

PTSD-symptoms Among Health Workers and Public Service Providers During the COVID-19 Outbreak

PLOS ONE

Dear Dr. Johnson,

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.

The submission received three thoughtful reviews yielding three different decisions (Accept, Minor Revision and Major Revision). After carefully considering the reviews, and my own thoughts, I am making a decision of Minor Revision. This decision to me reflects the essence of the reviewers' comments.  Specifically, all reviewers noted strengths of this work, but varied in the extent to which they had suggestions for revision. The Major Revision decision (Reviewer 3) includes important suggestions, but addressing the feedback of Reviewer 3 will not require extensive re-writing or numerous data analyses. Even the reviewer who offered an Accept decision did pose a suggestion (to make the data more available if possible). 

I will not repeat all of the reviewers' comments here, but ask you to attend carefully to each suggestion. In your revision, please explain how the comments were addressed. If you decide not to action a particular comment, please explain why. Two of the three reviewers (Reviewers 2 and 3) both asked about the availability of the data. I understand the grave importance of following the ethics board's rules, but data availability is extremely important. If you would please consider trying to find a way to enable access to the de-identified data without restriction (after consultation with the ethics board), that would be appreciated.  I look forward to receiving your revision. Thank you again for submitting this research to PLOS ONE.

Please submit your revised manuscript by August 23. 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.

Please include the following items when submitting your revised manuscript:

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• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Kristin Vickers, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments:

Dear Dr. Johnson,

Thank you for submitting your timely research (“PTSD-symptoms Among Health Workers and Public Service Providers During the COVID-19 Outbreak”) to PLoS ONE. The submission received three thoughtful reviews yielding three different decisions (Accept, Minor Revision and Major Revision). After carefully considering the reviews, and my own thoughts, I am making a decision of Minor Revision. This decision to me reflects the essence of the reviewers' comments. Specifically, all reviewers noted strengths of this work, but varied in the extent to which they had suggestions for revision. The Major Revision decision (Reviewer 3) includes important suggestions, but addressing the feedback of Reviewer 3 will not require extensive re-writing or numerous data analyses. Even the reviewer who offered an Accept decision did pose a suggestion (to make the data more available if possible).

I will not repeat all of the reviewers' comments here, but ask you to attend carefully to each suggestion. In your revision, please explain how the comments were addressed. If you decide not to action a particular comment, please explain why. Two of the three reviewers (Reviewers 2 and 3) both asked about the availability of the data. I understand the grave importance of following the ethics board's rules, but data availability is extremely important. If you would please consider finding a way to enable access to the de-identified data without restriction (after consultation with the ethics board), that would be appreciated. Please note the limitations that Reviewers 1 and 3 each suggested, as well as the additional information that each felt would be important to include. I look forward to receiving your revision. Thank you again for submitting this research to PLos ONE.

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

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b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

3. Please upload a copy of the Supporting Information which you refer to in your text on page 8.

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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

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #3: No

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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

Reviewer #3: 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: The authors present findings from a large cohort size, reporting the prevalence of PTSD symptoms amongst their cohort. This manuscript may not be novel, but it does add to the body of literature to help understand the psychological impact of covid both in Norway and Globally. The overall methodology and analyses is robust. A few minor amendments is suggested.

1. In discussion, please attempt to compare PTSD symptom prevalence to other countries and discuss accordingly: e.g. Chew NW, Lee GK, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain, behavior, and immunity. 2020 Apr 21.

---Although other papers may use different instruments to measure PTSD and this is an inherent limitation.

--did factors like case volume in the country, healthcare resources strain, mortality rate play a role?

2. one major limitation is that it is a cross-sectional study. we are unsure how much of this is related to covid directly, or may have been pre-existing prior to covid. the authors should include this as a limitation. further longitudinal study in a similar cohort can also be used to assess the long-term PTSD impact once the pandemic blows over.

Reviewer #2: The authors present a timely examination of PTSD, depression, and anxiety in relation to COVID-19 pandemic in a large sample of healthcare providers out of Norway. While this is a large study with self-report data, the timeliness of the topic combined with efficient and well-done study design (in choice of measures, etc.) make this manuscript a useful contribution to the literature as we try to figure out what needs to be done to reduce the mental health impacts of the current pandemic.

Introduction is concise and well written to support the design.

Methods are good and results clearly presented.

Discussion is well reasoned, sticks to the results presented and provides a key contribution to the literature.

Given the journal requirements to provide data or a rationale why data cannot be provided, I believe additional rationale beyond ethics needs to be provided, but that is my only hesitation.

Reviewer #3: Thank you for the opportunity to review this manuscript. The authors conducted a timely examination of self-reported symptoms for front-line workers during the current global pandemic. The novelty of examining public service workers is unique to the study, but not as distinguished in both the methodology nor discussion. Rather, the study methodologies, in particular, the recruitment of target populations was not supported by, or in line with the strong theoretical rationale. Below, I outline some of my thoughts.

Background and introduction:

1. Background is well-written, with strong rationale in conducting this research.

Methods:

1. Some clarifications are needed as there seems to be a disconnect between the background rationale and study methodology. While the examination of healthcare and public service providers are clear from the background and rationale, the exact recruitment and populations reached are not. For example, which groups were considered healthcare professional – those working in ER/COVID units? Nurses in long-term homes? What about other healthcare professionals, and particularly for elective procedures, like mental health professionals, family physician, physiotherapists, pharmacists, etc.

2. Similarly, for public service professionals, what is considered "public service"? What about essential workers such as bus drivers, grocery store clerks, who likely have less protection compared to healthcare professionals, earn a lower wage, and are still required to work during the pandemic? Are they factored into your recruitment strategy?

3. The recruitment strategy is missing some details. For example, what did the Facebook algorithm determine for health personnel and public service providers, and who were the politicians reached?

4. For public service providers, there was only options for social workers and politicians. This is not reflective of the diversity of public service providers nor exhaustive enough to draw conclusions from.

5. Demographic variables did not consider contact and exposure to covid-19, which may be central to this line of research.

6. Please clarify experimental groupings and rationale. Which groups/professions were considered healthcare workers vs. public service workers. These were not mentioned until demographic characteristics in the results section.

7. I was not able to locate the supplementary file for the single item measure of burnout. How was this construct quantified/operationalized? If it’s a single item, please insert item right into text.

Results:

1. Unclear about direct vs indirect work relationships with COVID-19 from both methodology and results. How was this operationalized, was frequency of contact, size of hospital/healthcare institution, presence of outbreaks, and other variables considered?

2. Please fix "other predictors of treatment outcome". This is a cross-sectional inferential analysis, no treatment was offered.

Discussion:

1. Given the focus of the discussion on distinctions between public service vs. healthcare professionals, it is important to clearly operationalize and provide clear details about recruitment strategies and conditions for inclusion/exclusion.

2. With small proportion of public service professionals sampled, and lack of clarify regarding the types and diversity of profession, I caution the authors in drawing such strong conclusions from data collected. Would recommend to highlight as a limitation in data interpretations.

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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

Reviewer #2: No

Reviewer #3: 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.

PONE-D-20-19419R1

PTSD-symptoms Among Health Workers and Public Service Providers During the COVID-19 Outbreak

PLOS ONE

Dear Dr. Johnson,

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 November 15, 2020. 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Kristin Vickers, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments:

Dear Dr. Johnson,

Reviewers were very satisfied with your revisions; thank you for your efforts. The reason for the Minor Revision decision is that I need to ask you to clarify the extent to which there is overlap (if any) between this manuscript and the work by Ebrahimi et al. Specifically, in the Response to Reviewers document, the following is noted:

"We did have questions about contact and exposure to Covid-19 and whether the person was in quarantine, but we did not use the variables in this paper, because we think the variables are less central for the questions asked in this study and the variables were used in another publication:

Ebrahimi OV, Hoffart A, Johnson SU. The mental health impact of nonpharmacological interventions aimed at impeding viral transmission during the COVID-9 pandemic in a general adult population and the factors associated with adherence to these mitigation strategies. 2020, May 9. doi: " ext-link-type="uri" xlink:type="simple">https://doi.org/10.31234/osf.io/kjzsp."

PLOS ONE has guidelines when different publications are related. If there is no overlap between this manuscript and the other publication (Ebrahimi et al.), please let me know that. If there is any overlap, please follow the PLOS ONE guidelines at

https://journals.plos.org/plosone/s/submission-guidelines#loc-related-manuscripts

Specifically, upon your submission of your revised manuscript, please indicate whether there are any related manuscripts under consideration or published elsewhere. If related work has been submitted or published elsewhere, please include a copy of it with your revised manuscript and describe its relation to the submitted work. I will also ask that that the authors make it clear in the revised manuscript that results from a related dataset have been published previously or are under consideration for publication, if applicable.

Thank you for submitting your research to PLOS ONE and I look forward to receiving your revision. Please let me know if you have any questions.

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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

Reviewer #3: 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

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: No

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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 #1: Yes

Reviewer #2: Yes

Reviewer #3: 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: The authors have responded appropriately to the comments. I have no further comments, and I feel the manuscript is now suitable for publication.

Reviewer #2: All reviewer comments have been adequately addressed. The bypass was not working for me to bypass entering all fields.

Reviewer #3: The authors have addressed my feedback. This will make a timely contribution to our understanding of the literature surrounding global COVID19 responses.

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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

Reviewer #3: 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.

PTSD-symptoms Among Health Workers and Public Service Providers During the COVID-19 Outbreak

PONE-D-20-19419R2

Dear Dr. Johnson,

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,

Kristin Vickers, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you to the authors for fully explaining the nature of the different papers coming from this project. I also appreciate that the authors re-did analyses. This is timely and important research.