Psychological distress during the COVID-19 epidemic in Chile: The role of economic uncertainty

Fabián Duarte; Álvaro Jiménez-Molina

doi:10.1371/journal.pone.0251683

Peer Review History

Original SubmissionSeptember 15, 2020
3 Mar 2021 Decision Letter - M. Harvey Brenner, Editor PONE-D-20-29130 Psychological distress during the COVID-19 epidemic in Chile: the role of economic uncertainty PLOS ONE Dear Dr. Jiménez-Molina, 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 address the concerns and recommendations by reviewers 1 and 2. Please pay close attention to the following issues: (1) Reviewer 1 states that the main weakness of the study is its cross-sectional nature, and therefore lack of pre-pandemic measures. This weakness could be tackled, somewhat, if the authors quoted in the discussion some comparable statistics, from the same measure, taken before the pandemic. This would ideally come from a Chilean sample, but could come from a demographically similar sample. If this is not available, then this should be said in the discussion. (2) Reviewer 2 states that the adequacy of the sample is poorly described. What is the statistical rationale for the sample size in terms of power considerations? Please follow up on the issues raised by reviewer 2 with respect to sampling. Please submit your revised manuscript by 4/5/2021. 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). 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If the need for consent or parental consent was waived by the ethics committee, please include this information. 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. 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. 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. [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 Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 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 ****** 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 ****** 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 study presents mental health measured during the Cv19 pandemic using a telephone survey. It is a well written and nicely presented study, and I enjoyed reading it. A key strength of is its setting (Latin America), lending weight to analyses from western European and north American survey’s. Also, the use of probability sampling sets it apart from many surveys undertaken since the pandemic. The main weakness is its cross-sectional nature, and therefore lack of pre-pandemic measures. This weakness could be tackled, somewhat, if the authors quoted in the discussion some comparable statistics, from the same measure, taken before the pandemic. This would ideally come from a Chilean sample, but could come from a demographically similar sample. If this is not available, then this should be said in the discussion. Minor comments: The summary of the background literature is clear, although I think you could mention the increased impact that the pandemic has had on young people (see Pierce et al “Mental health before and during the COVID19 pandemic…” Lancet Psychiatry). Please report all percentages to the same number of decimal places (I suggest 1 dp). Table 1 would benefit from having the weighted population for comparison Generally I do not like seeing standard errors next to estimates in tables, they are difficult to interpret confidence intervals are much more preferable. It is not clear from looking at the table3 or the results section whether the regression models are adjusted. The finding for household income is interesting but a little hard to interpret: are you saying the richer you get for men the worse the mental health is, and vice versa for women? It would be good to see age in table 3 broken down in to categories. Again, it’s a little hard to interpret the coefficient just looking at table. Reviewer #2: The statistical analysis is routine. However, the adequacy of the sample is poorly described. What is the statistical rationale for the sample size in terms of power considerations? The authors state that the sampling is representative, but abandon any further explanation of this statement. Why is the sample representative of the population? Are proportions of certain representative groups adequate? No detail is described on how the sample was chosen and what factors were adequately provided beforehand for inclusion in the sampling plan. How were strata set? Age groups and gender are considered. What other relevant factors were considered, if any? How exactly were household and education stratified in the sampling? ****** 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:** Matthias Pierce 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. https://doi.org/10.1371/journal.pone.0251683.r001
Revision 1
7 Apr 2021 Author Response Dear editor and reviewers, We are grateful for the reviewers’ valuable comments and suggestions, which have allowed us to improve the manuscript. In the new version of the manuscript, we include some new references in the background and discussion section. We clarify the verbal consent procedure for participants, and we made some minor corrections to the English. We also attach a new file with the new tables. We revised all tables. The income variable in Table 1 was corrected with a new exchange rate between Chilean peso and US dollar. We used the average exchange rate between May and June 2020. In Table 2, we detected an error in the chi2 of the variable Psychological distress: it said 6.89, but it is 16.78. We also detected an error in the results for expectation increased debt. These changes did not imply changes in the final results of the article. All changes have been underlined in red in the manuscript (track changes) and some comments have been added when it was necessary to clarify a change made. We have made the database of the study open access, and we also attach the do file that allows replication of the results. Here we respond to each of the comments and questions raised by the reviewers (these answers can also be found in the response letter to the reviewers): 1. For comparison with pre-pandemic data, prevalence of depressive symptoms (PHQ-2) was calculated from a previous longitudinal study (ELSOC), which covers the 2016-2018 period and uses a similar community sample in Chile. Unfortunately, data from this survey for 2019 are not yet available. 2. The prevalence of depressive symptoms according to the ELSOC (2016-2018 average) was compared with that of our 2020 study. Prevalence was also compared by sex and age groups. The average prevalence of depressive symptoms between 2016-2018 (ELSOC) was 20.6%. The prevalence of depressive symptoms in our study in 2020 was 23.3%. For the 2016-2018 ELSOC, the average prevalence of depressive symptoms by group were: Women: 24.1% vs Men: 16.9% Age groups: 18-35: 21.2% ; 36-59: 20.1% ; 60+: 20.6% In our study (2020), we obtained the following results: Women: 30.8% vs Men: 15.5% Age groups: 18-35: 31.5% ; 36-59: 18.5% ; 60+: 18.5% These results suggest that there may have been an increased burden of depressive symptoms, especially among women and young people. These results were integrated into the discussion, pointing out the limitations of the comparison as they are different samples. 3. The impact of the pandemic on young people's mental health was included in the background section, using the reference noted by the reviewer. This point is discussed in more detail in the discussion. 4. Weighted population data were included in table 1. 5. Expansion factors were included in the calculations of all the regression models and tables, except table 2. 6. We ran a regression using dummy variables for age categories. The results are similar in general. Regarding age, we see an increase in anxiety for age group 60+, a decrease in depression for age group 36-59 and 60+, and no effect on psychological distress. The omitted variable is age group 18-35 (See Table 3) 7. We indicate all percentages to the same number of decimal places, as suggested. 8. We include confidence intervals in each table. 9. Reviewer #1. The finding for household income is interesting but a little hard to interpret: are you saying the richer you get for men the worse the mental health is, and vice versa for women? Authors: No, the interpretation is the opposite: for men, higher household income is related to lower burden of depressive symptoms. For women, higher household income is related to higher burden of depressive symptoms. We have rewritten the interpretation of this result in the discussion section to make it clearer. 10. The sample size was selected to get absolute sampling errors below 5% for a proportion of 0.5 and assuming a simple random sampling, when dividing the sample into men and women. The sampling frame arises from a probabilistic, geographically stratified, and multistage sampling, where "municipalities" are selected in the first stage, "census blocks" in the second stage, "occupied dwellings" in the third stage, and "persons aged 18 years and over”, in the fourth stage according to the random method. The first part of the Method describes the multi-stage sampling process. Representativeness is achieved for two reasons: 1 First, the probability of selection of each surveyed unit is known, since the sample design is probabilistic (two-phase), where in a first stage a survey is carried out to collect telephone numbers, based on a census sampling frame. From the surveys obtained in this stage, a second sampling is carried out where telephone calls are made to carry out the final survey. 2 Second, the sample size reached ensures sampling errors within the standards. Regarding the sample errors, they were computed considering a simple random sampling, for a proportion of 0.5. The following levels are reached: 1.a National, with an absolute error of 2.98%. 1.b Men and women with absolute errors of 4.31% and 4.14%, respectively. 1.c Age Group 15-35, 36-59 and 60+ years old, with relative errors between 5.77%, 4.49% and 5.57%, respectively. Strata were not defined in the sample design, but post-stratification adjustments were included in the expansion factors to reach the population values in the groups of men and women, and for the age groups of 15-35, 36-59, and 60+ years. Another element that was considered in the calculations of the expansion factors is the inclusion of telephone non-response rates, to include possible effects of the survey method. 11. The sampling design did not include household or education stratification. Post-stratification adjustments were included to estimate the expansion factors. Attachments Attachment Submitted filename: Response to reviewers PONE.docx https://doi.org/10.1371/journal.pone.0251683.r002
3 May 2021 Decision Letter - M. Harvey Brenner, Editor Psychological distress during the COVID-19 epidemic in Chile: the role of economic uncertainty PONE-D-20-29130R1 Dear Dr. Jiménez-Molina, 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, M. Harvey Brenner, PhD 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 #2: 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 #2: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: (No Response) ****** 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 #2: (No Response) ****** 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 #2: (No Response) ****** 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 #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No https://doi.org/10.1371/journal.pone.0251683.r003
Formally Accepted
21 Oct 2021 Acceptance Letter - M. Harvey Brenner, Editor PONE-D-20-29130R1 Psychological distress during the COVID-19 epidemic in Chile: the role of economic uncertainty Dear Dr. Jiménez-Molina: 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 Professor M. Harvey Brenner Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0251683.r004

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