PONE-D-20-38720

Examining anxiety level in medical team members in Shahid Dr. Gholipour Hospital, Bukan, Iran during COVID 19 pandemic

PLOS ONE

Dear Dr. mollararahimi,

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.

Thank you for submission in PLOS ONE. Manuscript has now been assessed by relevant experts. Referees find the draft interesting piece of work but raised major concerns in presentation of results, study instrument validity and reliability and methodological aspects. I will suggest authors to please consider the manuscript for revisions.

Please submit your revised manuscript by Apr 19 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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We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

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2. Please add the reference for teh Spielberger questionnaire.

3. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants. Please ensure you have provided sufficient details to replicate the analyses such as:   

-    a statement as to whether your sample can be considered representative of a larger population,

-    a description of how participants were recruited.

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"In addition, the authors thank the Department of

Research and Technology of Urmia University of Medical Sciences for approving the research plan and

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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: Partly

Reviewer #2: No

Reviewer #3: Partly

Reviewer #4: Yes

Reviewer #5: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: No

Reviewer #5: No

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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: No

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: No

**********

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 research highlights an area which has been extensively covered by recent published literature including systematic reviews which are higher on the hierarchy of evidence. examples of recent published literature in similar settings and across the globe include:

Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Globalization and health. 2020 DJahanshahi AA, Dinani MM, Madavani AN, Li J, Zhang SX. The distress of Iranian adults during the Covid-19 pandemic–More distressed than the Chinese and with different predictors. Brain, behavior, and immunity. 2020 Jan 1.ec;16(1):1-1.

Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre RS. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders. 2020 Aug 8.

Yıldırım M, Arslan G, Özaslan A. Perceived risk and mental health problems among healthcare professionals during COVID-19 pandemic: exploring the mediating effects of resilience and coronavirus fear. International journal of mental health and addiction. 2020 Nov 16:1-1.

Although the manuscript is scientifically sound it unfortunately doesn't add anything new or significant to existing knowledge base.

Reviewer #2: PONE-D-20-38720:

Introduction,

Line 5 in the introduction, what is the “O”

Line 11 in the introduction, check 41-9-45.7%

Methodology,

The design of the study is descriptive cross sectional not descriptive analytical

Line 7, it should be “participate” not “participant”

Regarding Spielberger questionnaire, where is the reference of the used questionnaire

“Validity and reliability of the questionnaire were examined by Mahran and P-value was obtained equal to 0.81 with confidence level of 95%.”. P-value is not correct in this sentence. It should be Cronbach’s alpha

Results,

Titles of the tables and figures are short and non-explanatory

Table (1): in education, the sum is 360 not 358. It should be 358

Table (4): the factors related to hidden or obvious anxiety??

Figure (1) is not clear at all

The results should include logistic regression analysis to determine the significant predictors of anxiety.

Discussion,

Deficient with no enough comparable results

Reviewer #3: Dear Authors,

The title is good area to recommend health care workers to prevention of anxiety. But the paper lacks certain analytic methods and coherence. Please respond accordingly from attached comments

Reviewer #4: This manuscript sheds light on an under-scrutinised issue since the onset of the COVID-19 pandemic, namely anxiety amongst frontline healthcare workers. It is a well-developed and executed study. Not unlike numerous Chinese studies examining anxiety and depression throughout the pandemic (1-4), this study adds to the literature on the mental health of frontline healthcare workers.

From a general perspective, this manuscript was well-written and the outline was clear and easy to follow. However, In the first paragraph of the introduction, one sentence reads “Total number of deaths and diagnosed cases in the east Mediterranean region are 605026 and 14024 respectively”. Shouldn’t this sentence read “Total number of diagnosed cases and deaths in the east Mediterranean region are 605026 and 14024, respectively”? In the final sentence of the paragraph, the phrase “so far” is mistakenly spelled “o far”.

The paragraph describing the Spielberger questionnaire, used to assess anxiety, in the Methods section could have been crafted better and definitely could have used some references. Additionally, the authors should expand on the specific tests utilised for their statistical analyses in the Methods section.

Overall, this manuscript was well-written and included a comprehensive suite of variables. It manages to shed light on factors contributing to anxiety amongst medical staff throughout the COVID-19 pandemic. Furthermore, it highlights the need for tailored psychological interventions for frontline healthcare workers deployed to COVID-19 wards in hospitals.

References

1. Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, et al. Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Frontiers in psychiatry. 2020;11.

2. Zhang Z, Zhang L, Wang Y. COVID‐19 indirect contact transmission through the oral mucosa must not be ignored. Journal of Oral Pathology & Medicine. 2020;49(5):450-1.

3. Liu Y, Chen H, Zhang N, Wang X, Fan Q, Zhang Y, et al. Anxiety and depression symptoms of medical staff under COVID-19 epidemic in China. Journal of Affective Disorders. 2021;278:144-8.

4. Liu C-Y, Yang Y-z, Zhang X-M, Xu X, Dou Q-L, Zhang W-W, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiology & Infection. 2020;148.

Reviewer #5: Abstract introduction Research gap was not indicated.

Data collection method was not clear main body materials and Methods Data analyses were not specified Results Outcome result was not stated Discussions

The finding was not contrasted.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Adem Abdulkadir Abdi

Reviewer #4: Yes: Shady Abdelsalam

Reviewer #5: 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.]

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Attachments

Attachment

Submitted filename: comments.docx

Attachment

Submitted filename: Reviewer comments Examining anxiety level in medical team members.docx

PONE-D-20-38720R1Evaluation of anxiety level and the factors Affecting Anxiety in health care workers in Shahid Dr. Gholipour Hospital, Bukan, Iran during COVID-19 pandemicPLOS ONE

Dear Dr. mollararahimi,

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 06 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Dear Authors, Thank you for submitting the revising version. The revised draft have been assessed by referees again and found some more concerns which are needed to be addressed. Please consider the comments of the reviewer and respond the queries related to statistical analysis and tool validity.

[Note: HTML markup is below. Please do not edit.]

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 #3: All comments have been addressed

Reviewer #4: All comments have been addressed

Reviewer #5: (No Response)

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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 #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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 #3: Yes

Reviewer #4: Yes

Reviewer #5: 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 #3: Yes

Reviewer #4: Yes

Reviewer #5: No

**********

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 #3: Comments in the first review are incorporated adequately. Try to rewrite results and discussion. Other issues were addressed

Thank You

Reviewer #4: Thank you for submitting this revised manuscript. I am satisfied that my earlier comments have been appropriately addressed.

Reviewer #5: The authors should state the appropriate mode they used for their data analysis. If logistic regression analysis was used, how?

Method should be clearly stated.

Have you checked internal consistency?

How did you assess your outcome of interest to use logistic regression model?

What are assumptions of your appropriate model for data analysis?

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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 #3: No

Reviewer #4: Yes: Shady Abdelsalam

Reviewer #5: 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.

Evaluation of anxiety level and the factors Affecting Anxiety in health care workers in Shahid Dr. Gholipour Hospital, Bukan, Iran during COVID-19 pandemic

PONE-D-20-38720R2

Dear Dr. mollarahimi,

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,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for revising the draft.

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 #4: All comments have been addressed

Reviewer #5: 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 #4: Yes

Reviewer #5: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

Reviewer #5: 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 #4: Yes

Reviewer #5: 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 #4: Yes

Reviewer #5: 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 #4: (No Response)

Reviewer #5: The authors have addressed MAJORITY of the raised issues. Nevertheless, the authors need to refine through out the manuscript.

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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 #4: Yes: Shady Abdelsalam

Reviewer #5: No