Relationship between initial self-perceived depressive symptoms and disease severity in working patients with first-onset major depressive disorder

Tomoyuki Hirota; Yasuhiko Deguchi; Shinichi Iwasaki; Aya Sakaguchi; Akihiro Niki; Yoshiki Shirahama; Yoko Nakamichi; Koki Inoue

doi:10.1371/journal.pone.0255084

Peer Review History

Original SubmissionApril 25, 2021
24 May 2021 Decision Letter - Kenji Hashimoto, Editor PONE-D-21-13717 Relationship between initial self-perceived depressive symptoms and disease severity in working patients with first-onset major depressive disorder PLOS ONE Dear Dr. Deguchi, 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 reviewers addressed several minor concerns about your manuscript. Please revise your manuscript carefully. Please submit your revised manuscript by Jun 28 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. 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Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In this study the authors examined which initially perceived depressive symptoms predicted later disease severity in working patients with first-onset MDD. The results showed that non-somatic depressive symptoms were associated with severe MDD. The results of this paper are clearly presented and seem to be clinically suggestive. Overall, the manuscript is well-written, and the English is good enough to be read. The paper is of interest for the journal. However, I have some shortcomings to mention as follows; 1. The authors asked patients to report the first depressive symptom they subjectively felt, but it would be an overstatement to label it as a depressive symptom before the onset of MDD symptoms. (Page 14, Line 204-206) 2. The authors state that non-somatic symptoms may be related to the severity of depression, whether the patient is aware of it or not. In the following paragraph, they do not discuss whether people are aware of their depressive symptoms or not. (Page 14-15, Line 207-214) 3. The authors state that the presence or absence of non-somatic symptoms may affect the treatment strategies, but this seems rather abrupt. The rationale for this should be stated. (Page 15, Line 226-227) Reviewer #2: To the authors This study aimed to clarify the association between initial depressive symptoms and MDD severity in working patients. The aim of the study is clinically significant and unique. There are some points to be clarified. This study investigated the relationship between early depressive symptoms (or initial self-perceived non-somatic symptoms) and disease severity in working patients with MDD. However, it is not clear when early depressive symptoms occurred. The severity of depressive symptoms was evaluated at the initial visit by HAM-D17. When did initial self-perceived depressive symptoms arise? Did patients recall the first one symptom or the first two or more symptoms in their index depressive episodes? The definition of initial self-perceived depressive symptoms (When, How, What, etc.) is not clearly described and should be described in the Abstract, Introduction, and Methods. In the Methods section, "fatigue" belongs to non-somatic symptoms by citing Petersen et al. However, Petersen et al. regarded "fatigue" as somatic symptoms. I also feel "fatigue" as somatic symptoms. Did the authors make a mistake? If so, the results should be re-analyzed. Abstract: In "between initial depressive symptoms and MDD severity in working patients", "and" was lost. ****** 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:** Hiroyuki Toda 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.0255084.r001
Revision 1
25 Jun 2021 Author Response RESPONSES TO REVIEWER #1: The authors would like to thank the reviewer for his constructive critique and for providing these insightful comments, which have helped us significantly improve the quality of our work. We have made every effort to address the issues raised and to respond to all comments. The revisions are indicated in red font in the revised manuscript. Please, find next a detailed, point-by-point response to the reviewer's comments. Comment 1: The authors asked patients to report the first depressive symptom they subjectively felt, but it would be an overstatement to label it as a depressive symptom before the onset of MDD symptoms. (Page 14, Line 204-206) Response 1: We agree with the reviewer’s comment. Therefore, we have toned down our statement and we have revised this sentence as follows (Lines 206–208): From “For the first time, our study highlights that early depressive symptoms that occur before the onset of MDD may affect its severity.” to “To our knowledge, our study is the first to highlight that the earliest subjective symptoms felt around the MDD onset may affect its severity.” Comment 2: The authors state that non-somatic symptoms may be related to the severity of depression, whether the patient is aware of it or not. In the following paragraph, they do not discuss whether people are aware of their depressive symptoms or not. (Page 14-15, Line 207-214). Response 2: We agree with the reviewer that this point requires clarification. Following the reviewer’s suggestion, we have added the following part to the Discussion section of the revised manuscript (Lines 208–211) From “Non-somatic symptoms may be associated with MDD severity, irrespective of whether the patient is aware of them at disease onset or at the time of initial diagnosis.” to “Non-somatic symptoms may be associated with MDD severity, irrespective of whether their symptoms exist at disease onset or at the time of initial diagnosis. Especially, regardless of when non-somatic symptoms exist, their presence may be related to MDD severity.” Comment 3: The authors state that the presence or absence of non-somatic symptoms may affect the treatment strategies, but this seems rather abrupt. The rationale for this should be stated. (Page 15, Line 226-227) Response 3: We agree with the reviewer that this point requires clarification. Please note that we have toned down our statement and removed the following part from the Discussion section (Lines 227–228) This specific part has been revised as follows: From “Determining the severity of MDD is important for predicting its outcome and selecting the appropriate treatment strategy. Furthermore, treatment strategies may differ between patients with non-somatic and somatic symptoms.” to “Determining the severity of MDD is important for predicting its outcome and selecting the appropriate treatment strategy [18].” RESPONSE TO REVIEWER #2: The authors would like to thank the reviewer for his/her constructive critique and for providing these insightful comments, which have helped us significantly improve the quality of our work. We have made every effort to address the issues raised and to respond to all comments. The revisions are indicated in red font in the revised manuscript. Please, find next a detailed, point-by-point response to the reviewer's comments. Comment 1: This study investigated the relationship between early depressive symptoms (or initial self-perceived non-somatic symptoms) and disease severity in working patients with MDD. However, it is not clear when early depressive symptoms occurred. The severity of depressive symptoms was evaluated at the initial visit by HAM-D17. When did initial self-perceived depressive symptoms arise? Did patients recall the first one symptom or the first two or more symptoms in their index depressive episodes? The definition of initial self-perceived depressive symptoms (When, How, What, etc.) is not clearly described and should be described in the Abstract, Introduction, and Methods. Response 1: We agree that this point requires clarification, and have added the following text to the Methods. (page 7, lines 114-117) From “The participants were asked to select their initial self-perceived depressive symptoms from a list based on the following nine DSM-5 diagnostic criteria for MDD. “ to “During the first visit, the physician presented the participants the nine diagnostic criteria for MDD, as listed in the DSM-Ⅳ, and asked them to recall the depressive symptoms that led them visit the physician. Then, he/she asked them to select the earliest depressive symptom among the following. “ It is also noted in the Limitations that there may be a recall bias since patients were asked to remember past symptoms. (page 16, lines 238-240) Moreover, we apologize for the mistake in writing "DSM-5" when we should have written "DSM-Ⅳ". This was corrected throughout the manuscript. Comment 2: In the Methods section, "fatigue" belongs to non-somatic symptoms by citing Petersen et al. However, Petersen et al. regarded "fatigue" as somatic symptoms. I also feel "fatigue" as somatic symptoms. Did the authors make a mistake? If so, the results should be re-analyzed. Response 2: We apologize for a mistake in writing "fatigue or loss of energy nearly every day" when we should have written "feelings of worthlessness or excessive guilt." This error has been corrected in accordance with the reviewer's comment. Nevertheless, the correct data was used in the statistical analysis. (page 7, lines 122-124) From “Depressed mood,” “loss of interest or pleasure,” “fatigue or loss of energy nearly every day,” and “suicidality” were considered non-somatic symptoms, while the others were considered somatic symptoms.” to “Depressed mood,” “loss of interest or pleasure,” “feelings of worthlessness or excessive guilt,” and “suicidality” were considered non-somatic symptoms, while the others were considered somatic symptoms.” Comment 3: Abstract: In "between initial depressive symptoms and MDD severity in working patients", "and" was lost. Response 3: This error has been corrected in accordance with the reviewer's comment. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0255084.r002
12 Jul 2021 Decision Letter - Kenji Hashimoto, Editor Relationship between initial self-perceived depressive symptoms and disease severity in working patients with first-onset major depressive disorder PONE-D-21-13717R1 Dear Dr. Deguchi, 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. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Yes 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: Yes 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: In this study the authors examined which initially perceived depressive symptoms predicted later disease severity in working patients with first-onset MDD. The results showed that non-somatic depressive symptoms were associated with severe MDD. In revised version, the authors have fulfilled all my requirements. Reviewer #2: To the authors The authors responded to the reviewers' comments adequately. Their manuscript is written well. ****** 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: Hiroyuki Toda Reviewer #2: Yes:** Takeshi Inoue https://doi.org/10.1371/journal.pone.0255084.r003
Formally Accepted
14 Jul 2021 Acceptance Letter - Kenji Hashimoto, Editor PONE-D-21-13717R1 Relationship between initial self-perceived depressive symptoms and disease severity in working patients with first-onset major depressive disorder Dear Dr. Deguchi: 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 Prof. Kenji Hashimoto Section Editor PLOS ONE https://doi.org/10.1371/journal.pone.0255084.r004

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