Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review

Eleonora P. Uphoff; Chiara Lombardo; Gordon Johnston; Lauren Weeks; Mark Rodgers; Sarah Dawson; Catherine Seymour; Antonis A. Kousoulis; Rachel Churchill

doi:10.1371/journal.pone.0254821

Peer Review History

Original SubmissionApril 28, 2021
20 May 2021 Decision Letter - Ali Rostami, Editor PONE-D-21-14122 Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: a rapid systematic review PLOS ONE Dear Dr. Rodgers, 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 Jul 04 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. 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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 [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: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 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: No 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: Signs and symptoms are not listed separately for the disease. Has there been substance abuse in patients?in any articles? What are the study exclusion criteria? It would be better to compare the results of studies of different ethnicities. What is the most important finding of this study?The result of study that shows the emotional support of people involved with Covid ,has been obvious before. What were the differences between ages groups in the type of mental disorders? The findings of the article are generalized and not compared to the required extent. Most of the data was not used. Not all topics are explained in the same way. There are not mentioned to the limitations of the articles, such as medical history of the subjects, family disputes, economic status, etc. Providing a well-organized and complete view of the work done on a research topic is not summarized. introduction did not mentioned the ignorance of the subject or its problems and complications. There is relationship between the results and discussion, and the reasons for the differences in mental disorders were not mentioned in different articles. Reviewer #2: This is interesting topic. However, there are some problems should be address well. I mentioned some issues as below: Introduction: -The introduction needs a major revision and improvement. -Introduction should be focus on previous review studies. -Why did you conduct a systematic review of reviews? -Is there any previous review in this topic? Methods: -Why did you select two groups of different population of mental problems (adults and children)? - Why did you select the reviews of five different population including healthcare workers, children and adolescents, patients with pre-existing conditions, and homeless? - The mental problems are different in adults and children. Also, risk of affected with Coronavirus was different between adult and children. How did you select children and adult as population study? Also, healthcare workers were as high-risk while the children were low- risk group. Results -Please discuss how did not this systematic review of reviews lead to meta-analysis? Discussion The study included five population studies, but the discussion and conclusion focused on one population (healthcare workers). How did the authors miss children, homeless from the study? ****** 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. https://doi.org/10.1371/journal.pone.0254821.r001
Revision 1
21 Jun 2021 Author Response Reviewer #1 1 Signs and symptoms are not listed separately for the disease. Thank you for this suggestion. On page 6, we have added that we included studies on ‘any signs or symptoms’ of the eligible mental health conditions. 2 Has there been substance abuse in patients in any articles? We only found one mention of substance abuse linked to the COVID 19 pandemic, which is mentioned on page 13: “Reports of mental health symptoms in college students included anxiety, depression, substance abuse, sleeping disorders, and eating disorders [21].” 3 What are the study exclusion criteria? The reviewer is right that we mostly state our inclusion criteria; studies which did not meet these criteria were not included. In addition, as stated on page 7: “Abstracts and titles for which no full-text manuscript could be obtained within two weeks of starting data extraction were excluded.” 4 It would be better to compare the results of studies of different ethnicities We agree that there would be merit in exploring differences in results by ethnicity. Unfortunately, we were unable to do this as included reviews mostly considered a range of ethnic groups, without presenting results separately by ethnicity. 5 What is the most important finding of this study? The result of study that shows the emotional support of people involved with Covid ,has been obvious before. We hope our abstract states the most important findings. Firstly, it is important to realise that evidence was lacking for many vulnerable groups and for interventions. Secondly, we highlight risk and protective factors, although mostly for healthcare workers, which could be used in the development of interventions. 6 What were the differences between ages groups in the type of mental disorders? Because we report on findings from systematic reviews, we were restricted by the presentation of results in those reviews. We were therefore unable to extract data on differences between age groups. We do present findings for children and for adults separately, but reviews were too different in their focus, design and methods to be able to make meaningful comparisons. 7 The findings of the article are generalized and not compared to the required extent. Most of the data was not used. Not all topics are explained in the same way Unfortunately, the format of our ‘review of reviews’ meant that we did not have access to data from individual studies. Also, we present more evidence (and discussion) on healthcare workers because this is what we found in the literature. We completely agree with the reviewer that more evidence on specific population groups is needed. 8 There are not mentioned to the limitations of the articles, such as medical history of the subjects, family disputes, economic status, etc. We agree with the reviewer that these factors could influence the results and are important to consider where possible. Due to the nature of our ‘review of reviews’ we were unable to assess individual studies within the included reviews. However, we used the CASP checklist to assess the quality of included reviews. 9 Providing a well-organized and complete view of the work done on a research topic is not summarized. We are not entirely sure what the reviewer is referring to. Perhaps they were wondering whether other reviews of reviews exist on this topic. To clarify, we have added a statement on page 5: “At the time of conducting our study, we were not aware of another review of systematic reviews on this topic.” See also response to comment #12. 10 introduction did not mentioned the ignorance of the subject or its problems and complications. We hope to have addressed the importance of the topic in the following ways: - The first paragraph highlights the enormous burden of disease and deaths from COVID-19. - The third paragraph discusses the problems vulnerable groups may encounter. If required, could the editor please advise what other information may be needed? 11 There is relationship between the results and discussion, and the reasons for the differences in mental disorders were not mentioned in different articles. We agree with the reviewer that it is interesting to note the differences in prevalence rates between mental disorders. However, as the included reviews were heterogenous in terms of aims, methods, and selection criteria, we cannot explain nor speculate on reasons for these differences. We hope future research will be able to provide these answers. Reviewer #2 12 Introduction: -The introduction needs a major revision and improvement. -Introduction should be focus on previous review studies. -Why did you conduct a systematic review of reviews? -Is there any previous review in this topic? Thank you for your observations. As stated on page 5, “We used rapid review methodology based on guidance from the Cochrane Rapid Review Methods Group, to ensure a pragmatic yet high quality systematic review.” We did not identify other reviews of reviews on this topic. The purpose of our reviews of reviews was to identify previously published systematic reviews; we therefore did not discuss these reviews as part of the introduction. To clarify, we have added a statement on page 5: “At the time of conducting our study, we were not aware of another review of systematic reviews on this topic.” 13 -Why did you select two groups of different population of mental problems (adults and children)? We did not select these groups a priori; our results reflect the literature we identified. Since exposure to the pandemic and mental health problems may differ between children and adults, we present results separately for these groups. 14 Why did you select the reviews of five different population including healthcare workers, children and adolescents, patients with pre-existing conditions, and homeless? We agree with the reviewer that other groups are important. However, we did not select these five populations; unfortunately, we did not find any review evidence for other groups which fitted our selection criteria. On page 20 of the discussion section, we therefore state: “Evidence was lacking for vulnerable groups other than healthcare workers.” 15 The mental problems are different in adults and children. Also, risk of affected with Coronavirus was different between adult and children. How did you select children and adult as population study? See response to comment no. 13. 16 Also, healthcare workers were as high-risk while the children were low- risk group. To guide us as to the perceived vulnerability of specific groups, we used the paper by Holmes et al (ref 1). We agree that today, the latest available evidence may make a case for children being a vulnerable group too. 17 Results Please discuss how did not this systematic review of reviews lead to meta-analysis? As stated on page 8, a meta-analysis was not deemed appropriate for this study (a priori): “The extracted data were used to produce a narrative synthesis of results by type of inequality group, as we expected the study designs and data to be too heterogeneous for meta-analyses to be appropriate.” 18 Discussion The study included five population studies, but the discussion and conclusion focused on one population (healthcare workers). How did the authors miss children, homeless from the study? The ‘summary of findings’ on page 19 briefly reports on the results on all population groups we encountered. Since most of the evidence we found was on healthcare workers, a panel of healthcare workers was asked to help us interpret findings. The discussion summarises their input, as well as pointing out that little evidence was available for other population groups. In the ‘Implications for research and practice’ section we call for future research with “attention for those belonging to multiple vulnerable or minority groups, such as older people with physical health problems, ethnic minorities facing job insecurity, or intersectionality relating to healthcare workers.” https://doi.org/10.1371/journal.pone.0254821.r002
5 Jul 2021 Decision Letter - Ali Rostami, Editor Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: a rapid systematic review PONE-D-21-14122R1 Dear Dr. Rodgers, 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, Ali Rostami 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: (No Response) 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 #1: (No Response) Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: Dear Authors I think that you improved well the revised manuscript. I thank you for sufficient response/correction. ****** 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 https://doi.org/10.1371/journal.pone.0254821.r003
Formally Accepted
13 Jul 2021 Acceptance Letter - Ali Rostami, Editor PONE-D-21-14122R1 Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: a rapid systematic review Dear Dr. Rodgers: 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. Ali Rostami Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0254821.r004

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