Impact of the COVID-19 pandemic on the mental health of professionals in 77 hospitals in France

Alicia Fournier; Alexandra Laurent; Florent Lheureux; Marie Adèle Ribeiro-Marthoud; Fiona Ecarnot; Christine Binquet; Jean-Pierre Quenot

doi:10.1371/journal.pone.0263666

Peer Review History

Original SubmissionJuly 2, 2021
2 Nov 2021 Decision Letter - Jianguo Wang, Editor PONE-D-21-21660Impact of the COVID-19 pandemic on the mental health of professionals in 77 hospitals in FrancePLOS ONE Dear Dr. Fournier, 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 Dec 17 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. 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. Thank you for stating in your Funding Statement: “The authors thank the French Ministry for Health, who partially funded this study through the national programme for hospital research (Programme Hospitalier de Recherche Clinique National, PHRC-COVID 2019). We also thank all the professionals who participated in the study, and the members of the CIC-EC1432 involved in the project, namely Emilie Galizzi, for practical coordination, and Delphine Pecqueur, for database management.” Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. 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. [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: This large-scale study examines the frequency of psychological distress, post-traumatic stress disorder (PTSD) and pandemic-related stress in a broad spectrum of professionals across multiple regions of France, and their relationship to demographic and work-related variables as well as to coping skills. Though there are several individual studies addressing this question, including some from France, the current study is meritorious in view of its size and scope. Nevertheless, there are certain minor issues that require correction on the part of the authors: 1. In the abstract, it is stated that "about two-thirds" (i.e., around 66.7%) of the sample screened positive for psychological distress; in the text, the figure given is around 57%, which is much lower. Please check this and ensure that the two statements are uniform. 2. In the Introduction, it would be helpful to refer to the multiple meta-analyses of psychological distress / depression / anxiety / PTSD in professionals (particularly healthcare professionals) during this pandemic, in addition to the individual studies cited in references 5-9. 3. The authors have used a threshold of 3 for the GHQ-12 to identify psychological distress in their sample; other researchers have sometimes used a cut-off value of 2. What was the rationale for selecting the former? Would the study's findings be substantially altered if the lower value was adopted? 4. There are several instruments besides the IES-R which have been used to screen for PTSD during the pandemic. What were the perceived advantages / merits of this instrument, according to the authors? 5. Was the modified version of the Khalid questionnaire (i.e., the one modified by the current authors as mentioned in line 159) subjected to testing or validation in a smaller sample prior to its use in the study? 6. Line 252: as the IES-R is a screening instrument, it would be more accurate to say that the subjects "screened positive for PTSD", or "scored above the cut-off for probable PTSD". 7. Lines 366-371: it would be beneficial, in addition to the general discussion that follows, to compare the current study's findings to those of others in France and adjacent European countries, both in the general population and in professionals or healthcare workers. ****** 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:** Ravi Philip Rajkumar [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.0263666.r001
Revision 1
17 Dec 2021 Author Response Dear Editor, Dear reviewer, We would like to thank the reviewer for his constructive comments, which helped us to improve the article. All his suggestions and remarks have been taken into account, and our point-by-point responses are described in the attached document. The changes have been made within the text in green to make them visible. We thank you again for your interest in our work. PhD Alicia Fournier On behalf of all authors Reviewer #1: Ravi Philip Rajkumar 1. In the abstract, it is stated that "about two-thirds" (i.e., around 66.7%) of the sample screened positive for psychological distress; in the text, the figure given is around 57%, which is much lower. Please check this and ensure that the two statements are uniform. Thank you for pointing out this error. We have made a correction in the abstract 2. In the Introduction, it would be helpful to refer to the multiple meta-analyses of psychological distress / depression / anxiety / PTSD in professionals (particularly healthcare professionals) during this pandemic, in addition to the individual studies cited in references 5-9. Thank you for this advice. We have added meta-analyses lines 40-46. 3. The authors have used a threshold of 3 for the GHQ-12 to identify psychological distress in their sample; other researchers have sometimes used a cut-off value of 2. What was the rationale for selecting the former? Would the study's findings be substantially altered if the lower value was adopted? The choice of a cut-off value of 2/3 was made following a brief review of the literature. Goldberg and colleagues (1997) [1] recommend a cut-off of 2/3. However, depending on the population studied, the cut-off may vary. Since then, other studies have been carried out on the cut-off value. Most studies use a cut-off of 2/3 [2–6]. Some use a cutt-off of 3/4 ([7], for more details see [8]). In view of the literature, we have not made any changes to the cut-off in the paper. However, we have carried out new analyses in response to the author's comment. With a cut-off of 1/2, 71% of professionals show psychological distress (71.05% among the medical/caregiving staff vs. 70.70% among the non-medical staff, p=.848). QHSE were the most affected (79.2%), followed by midwives (79.2%), and professionals working in the pharmacy (79.1%), while psychologists (62.4%),clinical research staff (60.8%) and those working in technical maintenance/computer networks had the lowest levels (60.2%). Thus, the frequency of distress increases in all groups, but does not change the rationale of the study. For the regression analyses, we considered the linear score and not the cut-off. 1. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C, (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27: 191–197 2. Lundin A, Hallgren M, Theobald H, Hellgren C, Torgén M, (2016) Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population. Public Health 136: 66–74 3. Makowska Z, Merecz D, Mościcka A, Kolasa W, (2002) The validity of general health questionnaires, GHQ-12 and GHQ-28, in mental health studies of working people. Int J Occup Med Environ Health 15: 353–362 4. Ruiz-Frutos C, Delgado-García D, Ortega-Moreno M, Duclos-Bastías D, Escobar-Gómez D, García-Iglesias JJ, Gómez-Salgado J, (2021) Factors Related to Psychological Distress during the First Stage of the COVID-19 Pandemic on the Chilean Population. J Clin Med 10: 5137 5. Sun Y, Chen X, Cao M, Xiang T, Zhang J, Wang P, Dai H, (2021) Will Healthcare Workers Accept a COVID-19 Vaccine When It Becomes Available? A Cross-Sectional Study in China. Front Public Heal. doi: 10.3389/fpubh.2021.664905 6. Gelaye B, Tadesse MG, Lohsoonthorn V, Lertmeharit S, Pensuksan WC, Sanchez SE, Lemma S, Berhane Y, Vélez JC, Barbosa C, Anderade A, Williams MA, (2015) Psychometric properties and factor structure of the General Health Questionnaire as a screening tool for anxiety and depressive symptoms in a multi-national study of young adults. J Affect Disord 187: 197–202 7. Fattori A, Cantù F, Comotti A, Tombola V, Colombo E, Nava C, Bordini L, Riboldi L, Bonzini M, Brambilla P, (2021) Hospital workers mental health during the COVID-19 pandemic: methods of data collection and characteristics of study sample in a university hospital in Milan (Italy). BMC Med Res Methodol 21: 163 8. Marvaldi M, Mallet J, Dubertret C, Moro MR, Guessoum SB, (2021) Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Neurosci Biobehav Rev 126: 252–264 4. There are several instruments besides the IES-R which have been used to screen for PTSD during the pandemic. What were the perceived advantages / merits of this instrument, according to the authors? IES-R is one of the most common used questionnaire for assessing post-traumatic stress symptoms across different cultures, settings and types of trauma [9]. A total score of 33 on the IES-r yielded diagnostic sensitivity of 0.91 and specificity of 0.82 [10]. Although the IES-R does not fully align with the DSM-V criteria, it does align with three criteria. 9. Weiss DS, Marmar CR. The Impact of Event Scale-Revised. In Wilson JP, Keane TM (Eds.), Assessing psychological trauma and PTSD. New York: Guilford Press;1997. 10. Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale - revised. Behav Res Ther. 2003;41(12):1489–96. https://doi.org/10.1016/j.brat.2003.07.010. 5. Was the modified version of the Khalid questionnaire (i.e., the one modified by the current authors as mentioned in line 159) subjected to testing or validation in a smaller sample prior to its use in the study? In a previous study of ICU professionals, we showed that these items constitute a single factor [11]. However, here, we did not pre-test the questionnaire. The changes correspond to the name of the disease (MERS-CoV became COVID-19) and we deleted items that did not concern non-medical professionals (e.g., “Seeing your colleagues getting intubated”) or items that reflected the consequences of stress and not the stressors e.g., You had physical stress/fatigue). « You were emotionally exhausted » item was replaced by an item that reflected a reality in the field in France “Recommendations and protocols are evolving/changing rapidly”. [11] Laurent A, Fournier A, Lheureux F, Louis G, Nseir S, Jacq G, et al. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic. Ann Intensive Care 2021;11:90. https://doi.org/10.1186/s13613-021-00880-y. 6. Line 252: as the IES-R is a screening instrument, it would be more accurate to say that the subjects "screened positive for PTSD", or "scored above the cut-off for probable PTSD". Thank you for this clarification. We have made the changes (e.g., lines 9, 116, 211, 214, 321, 394, 405) 7. Lines 366-371: it would be beneficial, in addition to the general discussion that follows, to compare the current study's findings to those of others in France and adjacent European countries, both in the general population and in professionals or healthcare workers. Thank you for the improved discussion. We have added a paragraph comparing our results to the literature (lines 324-346). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0263666.r002
25 Jan 2022 Decision Letter - Jianguo Wang, Editor Impact of the COVID-19 pandemic on the mental health of professionals in 77 hospitals in France PONE-D-21-21660R1 Dear Dr. Fournier, 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, Jianguo Wang, 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 #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: 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 ****** 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: The revisions made by the authors are satisfactory in my opinion. I have no further major changes or corrections to suggest. ****** 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:** Ravi Philip Rajkumar https://doi.org/10.1371/journal.pone.0263666.r003
Formally Accepted
8 Feb 2022 Acceptance Letter - Jianguo Wang, Editor PONE-D-21-21660R1 Impact of the COVID-19 pandemic on the mental health of professionals in 77 hospitals in France Dear Dr. Fournier: 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. Jianguo Wang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0263666.r004

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