Prevalence of anxiety and depression during COVID-19 pandemic among healthcare students in Jordan and its effect on their learning process: A national survey

Iman A. Basheti; Qassim N. Mhaidat; Hala N. Mhaidat

doi:10.1371/journal.pone.0249716

Peer Review History

Original SubmissionAugust 21, 2020
26 Jan 2021 Decision Letter - Mohammed Saqr, Editor PONE-D-20-26311 Prevalence of anxiety and depression following COVID-19 pandemic among healthcare students in Jordan and its effect on their learning process: a national survey PLOS ONE Dear Dr. Basheti, 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 expert reviewer raised concerns regarding the questionnaire, the discussion and the response rate among others that need to be addressed. Please submit your revised manuscript by Mar 05 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, Mohammed Saqr, Ph.D Academic Editor 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 https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please ensure that your conclusions are supported by data. For example, remove any suggestions that the anxiety levels recorded are a consequence of the pandemic since pre-pandemic anxiety levels were not measured. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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: The authors in this study explored the impact of COVID-19 on healthcare students in several universities in Jordan using an online survey. The pandemic had a negative impact on students and their learning process. However, I have the following comments and concerns: 1- The response rate was not calculated in this study, I believe this should be stated. Also, what is the estimated number of healthcare students in this year in Jordan. The sample might not be truly representative. 2- Respondents self-selected themselves in the survey which could be considered a selection bias 3- Was the survey tested in a pilot study ? 4- The sentences in the Introduction from line (97-104) needs to be rephrased (some errors: China, severe ..needs to be corrected, it should be clear that SARS-CoV 2 is the virus name, and COVID-19 is the disease that was declared a pandemic) 5- Authors can add a sentence regarding the current status of COVID-19 infection in Jordan, and the timing of quarantine. 6- The graph (Figure 1) quality is poor and needs to be enhanced 7- I think the discusson can be enriched with the following references: Choi, B., Jegatheeswaran, L., Minocha, A. et al. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Med Educ 20, 206 (2020). https://doi.org/10.1186/s12909-020-02117-1 Is it Just About Physical Health? An Internet-Based Cross-Sectional Study Exploring the Psychological Impacts of COVID-19 Pandemic on University Students in Jordan Using Kessler Psychological Distress Scale Ala'a B. Al-Tammemi, Amal Akour, Laith Alfalah medRxiv 2020.05.14.20102343; doi: https://doi.org/10.1101/2020.05.14.20102343 ****** 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: Yes:** Ismail Ibrahim Ismail [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.0249716.r001
Revision 1
2 Mar 2021 Author Response Revision for the manuscript number ‘PONE-D-20-26311’ titled ‘Prevalence of anxiety and depression following COVID-19 pandemic among healthcare students in Jordan and its effect on their learning process: a national survey’, to be published in PLOS ONE. Dear Dr. Mohammed Saqr, Ph.D. Academic Editor, PLOS ONE. We would like to thank you and the reviewer for your evaluation and suggestions about the manuscript. Please find attached our point-by-point responses to the reviewer’s comments. Revised/additional text within the manuscript has been marked with tracked changes, and a clean copy has been uploaded. Editor’s comments: C1. 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 https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf R1. Done. C2. Please ensure that your conclusions are supported by data. For example, remove any suggestions that the anxiety levels recorded are a consequence of the pandemic since pre-pandemic anxiety levels were not measured. R2. Done. The conclusion now reads as follows: Abstract: ‘Conclusions: Anxiety and depression levels amongst university healthcare students in Jordan were found to be high when assessed during the COVID-19 pandemic. In addition, the learning process during the pandemic was not accepted by more than half of the students. Implementing psychological interventions for healthcare students during pandemics is strongly recommended in order to optimize students’ mental health and their learning process alike.’ Manuscript: ‘In conclusion, this study is the first to highpoint that healthcare students from numerous disciplines and universities in Jordan report to have symptoms of anxiety and depression during the COVID-19 pandemic. Outcomes show that the learning process during the pandemic has also been affected, with the majority of students reporting dissatisfaction with the online learning process that replaced the face-to-face educational process followed prior to the pandemic in the universities. Results of this study have important international applicability, as the universities worldwide shared comparable changes during the recent pandemic, specifically with regards to the taken measures with regards to turning to distant online healthcare education and training [46]. Findings of this study call onto the policymakers and healthcare educators at the universities to implement different interventions and conduct workshops targeting the mental health of healthcare students, and to identify and implement resolutions that aim to optimize the learning process during the pandemic and maintain its efficiency.’ Reviewers' comments: The authors in this study explored the impact of COVID-19 on healthcare students in several universities in Jordan using an online survey. The pandemic had a negative impact on students and their learning process. However, I have the following comments and concerns: C1. The response rate was not calculated in this study, I believe this should be stated. R1. The following was added to the limitation section: ‘This study comes with some limitations. With the methodology involving an online questionnaire, it meant that participants were not met face-to-face, and the response rate could not be assessed.’ C2. Also, what is the estimated number of healthcare students in this year in Jordan. The sample might not be truly representative. R2. The following sample size calculation section was added to the manuscript: ‘Sample size According to the Ministry of Higher Education and Scientific Research, the number of the healthcare students in Jordan in 2020 was 16, 214. Based on this number, the sample size was calculated using a margin of error of 5%, confidence level of 95%, and response distribution of 50%, to be a minimum of 375 students.’ C3. Respondents self-selected themselves in the survey which could be considered a selection bias. R3. The following comment was added to the limitation section: ‘Also, the respondents self-selected themselves in choosing to answer the survey, which could be considered a selection bias.’ C4. Was the survey tested in a pilot study? R4. Yes. The following sentence was added to the methodology section. ‘Following development by the research team, the online survey was tested during a pilot phase of this study, which was conducted over three days before the actual study data collection period was initiated. The online survey was completed by students (n= 5) and academics (n= 5) who gave their feedback and recommendations regarding the survey. The research team studies these recommendations and feedback provided, and a final version of the survey was prepared before the study started. Results of the pilot phase of the study were not included in the analysis of this study.’ C5. The sentences in the Introduction from line (97-104) needs to be rephrased (some errors: China, severe ..needs to be corrected, it should be clear that SARS-CoV 2 is the virus name, and COVID-19 is the disease that was declared a pandemic). R5. The sentence was corrected as follows: ‘In March 2020, the World Health Organization (WHO) announced the corona virus disease, termed COVID-19 disease, as an international pandemic, which was caused by the infectious virus ‘severe acute respiratory syndrome (SARS) coronavirus 2’’ C6. Authors can add a sentence regarding the current status of COVID-19 infection in Jordan, and the timing of quarantine. R6. The following sentence was added to the introduction: ‘On July 29, 2020, the Jordan Ministry Of Health reported that the COVID-19 outbreak has resulted in 1,187 confirmed cases in Jordan, and 11 cases of confirmed deaths [8].’ C7. The graph (Figure 1) quality is poor and needs to be enhanced. R7. Done. C8. I think the discussion can be enriched with the following references: - Choi, B., Jegatheeswaran, L., Minocha, A. et al. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Med Educ 20, 206 (2020). https://doi.org/10.1186/s12909-020-02117-1 - Is it Just About Physical Health? An Internet-Based Cross-Sectional Study Exploring the Psychological Impacts of COVID-19 Pandemic on University Students in Jordan Using Kessler Psychological Distress Scale Ala'a B. Al-Tammemi, Amal Akour, Laith Alfalah medRxiv 2020.05.14.20102343; doi: https://doi.org/10.1101/2020.05.14.20102343. R8. These references were used to update the discussion of the manuscript as shown. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0249716.r002
24 Mar 2021 Decision Letter - Mohammed Saqr, Editor Prevalence of anxiety and depression during COVID-19 pandemic among healthcare students in Jordan and its effect on their learning process: a national survey PONE-D-20-26311R1 Dear Dr. Basheti, 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, Mohammed Saqr, Ph.D 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 ******** 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: I Don't Know ****** 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: All comments have been addressed properly. The authors added most of the comments to the Limitations section in the study. They also updated the manuscript with the suggested references. I have no further recommendations. ****** 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: Yes:** Ismail Ibrahim Ismail https://doi.org/10.1371/journal.pone.0249716.r003
Formally Accepted
26 Mar 2021 Acceptance Letter - Mohammed Saqr, Editor PONE-D-20-26311R1 Prevalence of anxiety and depression during COVID-19 pandemic among healthcare students in Jordan and its effect on their learning process: a national survey Dear Dr. Basheti: 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. Mohammed Saqr Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0249716.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .