PONE-D-20-25063

Cross-Sectional Study of the Relationship between the Spiritual Wellbeing and Psychological Health among University Students

PLOS ONE

Dear Dr. Chi Hung Leung and co-workers,

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.

Two items on the subject (more background on the SHALOM measure, a synopsis of the current literature on students' well-being and spirituality) and two minor issues on the statistics (add a power-analysis, combine the statistical methods in a section satisitical analysis). 

Please submit your revised manuscript by Dec 03 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. 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,

Jacobus P. van Wouwe, MD PhD

Academic Editor

PLOS ONE

Additional Editor Comments:

Your well written manuscript on a well performed study focuses on a relevant subject. Your findings make a nice contribution on the subject.

Two issues on the content: more emphasis on the SHALOM measures and its modifications and some more general context on spirituality among university students will both add to the impact of your manuscript. Reviewer #1 gives some valuable suggestions.

The statistical analysis is appropriate, a power analysis will explain your sample size and the statistical analysis could be combined in a separate section of your methods.

Journal Requirements:

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

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https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for stating the following financial disclosure:

"NIL"

At this time, please address the following queries:

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Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

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"NIL"

Please complete your Competing Interests on the online submission form to state any Competing Interests. If you have no competing interests, please state "The authors have declared that no competing interests exist.", as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now

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4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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: No

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 is a potentially useful contribution to the literature on college students, spirituality, and psychological outcomes, but it needs a more sophisticated and nuanced framing of spirituality (the central independent variable).

The authors write about spirituality in the same way a scholar might write about temperature (you can be high or low). This neglects the contested nature of spirituality and cultural differences in how spirituality is defined. The authors do briefly discuss the use of a modified SHALOM measure that has been adapted to Hong Kong. This is a missed opportunity to talk more about cross-cultural differences in spirituality.

To improve the paper, the author's should make this a paper about the SHALOM measure, rather than a general paper on how spirituality improves mental health. It is simply too large a claim to say spirituality is good for your health. Does all spirituality look the same? What about spirituality that might be attached to harmful ideas (a "morbid scrupulosity" in Catholicism, for example)? By narrowing the focus of the paper to SHALOM, the authors could avoid a lot of these problems.

The paper should be revised to include a section explaining the rationale for using SHALOM and the history of this concept (for example, the article in Religions by J. Fisher). Readers would benefit from a bit more of the back story of this item and why it is a good measure to use with college students. As it is written now, the paper assumes readers know about SHALOM. The literature review should justify why SHALOM is a good approach to use.

The paper should also say a bit more about the mental health crisis among college students, as well as efforts of religious professionals to respond to it (see Varun Soni's work, for example at USC). Mindfulness programs, yoga and meditation, as well as chaplaincy, have been used to respond to the campus mental health crisis. People in all of these programs would be interested in this paper. Finally, the paper should draw on the research of UCLA scholars Alexander Astin, Helen Astin, and Jennifer Lindholm, the most cited figures in U.S. research on spirituality and higher education, missing from this paper so far.

If these changes are made, this will be a much stronger paper. The findings seem sound. The framing is the area for improvement.

Reviewer #2: The paper is very well written, the statistics performed were fairly routine and the results follow from the analyses. Specifically, the findings of this study suggest that university students with high spiritual wellbeing are also likely to experience fewer symptoms of depression, anxiety and stress. All domains of spiritual wellbeing (personal and communal, environmental, and transcendental) were, in fact, associated with lower psychological distress.

There are two concerns.

1. The investigators note that Cross-sectional data was collected from 500 students. Although the work is mainly descriptive, analysis and p-values are given throughout. There is no statistical power motivation for the sample size. This should be addressed by the investigators.

2. On a minor note, the statistical approach is interspersed throughout the ‘Methods’ and ‘Results’ sections and should be in a separate ‘Statistical Analysis’ section describing the overall analysis approach.

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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

[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-20-25063R1

Cross-Sectional Study of the Relationship between the Spiritual Wellbeing and Psychological Health among University Students

PLOS ONE

Dear Dr. Chi Hung Leung and co-workers,

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 do pay full attention to the statistical shortcoming of your study design and the overall style and grammar of the mansucript.

Please submit your revised manuscript by Jan 22 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.

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,

Jacobus P. van Wouwe, MD PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Please pay proper attention toward the suggestion of a power analysis. This is a major shortcoming of your study that needs to be corrected. In a proper power analysis you need to calculate how valid the difference in the endpoints of your study need to be in order to draw valid conclusions.

Secondly, please notice the awkward distinction you seem to make between Christians and Catholics. This seems to be due to the errors in style and grammar. Please consult a professional review service.

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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: (No Response)

Reviewer #2: (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 #1: Yes

Reviewer #2: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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

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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: No

Reviewer #2: 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)

Reviewer #1: The paper is much improved. The addition of material on cross-cultural differences in spirituality is much appreciated. It helps give context.

Despite these improvements, there are still some necessary but less major changes that must be made:

1) There needs to be better labeling of religious groups (this is more about labels than the actual data analysis).

The paper distinguishes between "Catholics" and "Christians." This is a mistake in labeling because Catholicism is a form of Christianity. A better distinction would be between "Catholics" and "Other Christians."

This change would need to be made:

-Top of page 9 change "Christians" to "Other Christians" in both places

-Change "Christians" to "Other Christians" in the results on page 13 in Table 2

-Change "Christians" to "Other Christians" on page 17

2) There are still some writing mistakes that need to be corrected (this is especially important because the journal does not do copy editing):

-"Potential responds to the campus mental health crisis" should be changed to "Potential response to the campus mental health crisis" (change "responds" to "response")

-This sentence on page 18 is not grammatically correct: In the Asia-Pacific region, and it is the only study to contribute the links

between spiritual wellbeing and psychological disorders among university students.

It's possible that an extra "and" was inserted in the sentence. This may be the correct wording:

"In the Asia-Pacific region, it is the only study to contribute the links

between spiritual wellbeing and psychological disorders among university students."

I would urge the authors to proofread the manuscript for any grammar or writing mistakes (or solicit the services of a seasoned editor at their institution(s)).

Despite these minor changes, I believe this paper is ready for publication and would be a solid contribution to the literature. The discussion of spirituality and mental health on campus is very very timely and this paper presents some very relevant findings.

Reviewer #2: The authors address the power question in a very cavalier manner. They note that a power analysis of the sample size with a confidence level of 95% is 383 [99]. A sample of 500 Chinese university students is enough for the present study. This does not make any sense. What endpoint objectives were used in this calculation ?

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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

[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-20-25063R2

Cross-Sectional Study of the Relationship between the Spiritual Wellbeing and Psychological Health among University Students

PLOS ONE

Dear Dr. Chi Hung Leung and co-workers,

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.

We have given the statistics thorough attention and hope you agree on the suggestions for clarification. We are sorry it took longer.

Please submit your revised manuscript by Apr 30 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.

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,

Jacobus P. van Wouwe, MD PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

The statistical review has been thorough and please do follow these seven minor additional clarifications. Thank you.

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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 #3: (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

**********

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

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 #3: 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 #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 #3: This observational study tested the relationship between spiritual wellbeing and symptoms of psychological disorders (i.e., depression, anxiety and stress) among Chinese university students in Hong Kong. All domains of spiritual well being were negatively associated with psychological distress.

Minor revisions:

1- Words or two seems to be missing in the first paragraph under “Participants,” line begins with “median.”

2- In the paragraph beginning with, “A series of t-tests,” the statement indicates that no differences were observed but p-values were < 0.01. Clarify.

3- Consider categorizing age in the analyses.

4- In Table 3: Replace “Number” with frequency for clarity. Add formats or reform the table to easily distinguish between Depression, Anxiety, and Stress.

5- The p-value associated with a correlation is a test of the null hypothesis: correlation equal to zero; however, the absolute magnitude of the coefficient indicates the strength of the linear relationship between two variables. In general, the strength or correlation coefficient is the more important statistic to reflect upon.

Below is a table for interpreting correlation coefficients:

Coefficient (absolute value) Interpretation

0.90 - 1.0 Very Strong

0.70 - 0.89 Strong

0.40 - 0.69 Moderate

0.10 - 0.39 Weak

less than 0.10 Negligible correlation

6- Define all abbreviations on Table 5.

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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: 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.

Cross-Sectional Study of the Relationship between the Spiritual Wellbeing and Psychological Health among University Students

PONE-D-20-25063R3

Dear Prof Dr. Chi Hung Leung and co-workers,

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. The two changes above mentioned as suggested during the proofs (to delete 'very' twice) will be greatly appreciated.

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,

Jacobus P. van Wouwe, MD PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for responding to the reviewer's comments.

May I suggest you delete under Methods, Participants, the following two words:

'very precise' change to 'precise' and 'very small' change to 'small'. It would be greatly appreciated. Thank you.

Reviewers' comments: