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PONE-D-21-27324Impact of COVID-19 on the mental health of public university hospital workers in Brazil: a cohort-based analysis of 32,691 workersPLOS ONE

Dear Dr. Mota,

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.

==============================

ACADEMIC EDITOR: please address the methodpgical and presentation issues raised by the reviewers./>==============================

Please submit your revised manuscript by 29 November 2021. If you will need more time than this to complet 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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Rosemary Frey

Academic Editor

PLOS ONE

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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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: No

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. 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: 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: Thanks for inviting me to review the paper titled “Impact of COVID-19 on the mental health of public university hospital workers in Brazil: a cohort-based analysis of 32,691 workers.”

Authors have conducted a meaningful study. There are some methodological issues and reporting of study findings. After going through the paper in its entirety, hereby sharing my comments on paper.

Abstract: Comprehensive

Main file

Introduction-

The sentence-“adding to work-related stress that prior to the pandemic was at its highest level since 2014.[2]” needs simplification.

Methodology-

Statistics: Though authors talk about using GEE and McNemar test, they have not be clearly shown in tables. I would suggest an opinion of biostatistician be taken for the same.

Results: Figure 2, please check the placement of favors pre-pandemic and pandemic. As per the figure, it seems that mental illness related leaves were higher in pre-pandemic period.

Figure 3 mentions log_rang in place of log-rank please correct it.

Tables: The tables has been represented as such it is produced by the SPSS. Authors need to present it properly.

Discussion: Discussion has been appropriate.

Conclusion: fine

Reference: Fine

Reviewer #2: Overall, this is a timely & important study, well-written, with an adequately-conceived design & analysis for the purposes. Should be published, with a few minor revisions. (see below)

//Abstract is too lengthy. Need to shorten/condense a bit.

79 COVID-19 pandemic. Many aspects relating to this topic remains sparse in the literature,

//remain

80 particularly in developing countries such as Brazil which has historically suffered from

//have

82 The objective of the present study was to investigate the indirect impact of COVID-19 on

83 the health system workforce by assessing absenteeism relating to all causes not directly

84 attributable to suspected or confirmed SARS-CoV-2 infection, with particular focus on

85 mental health-related absenteeism

//Not quite clear how one distinguishes genuine absenteeism due to mental illness, from the use of this as an 'excuse' due to fear of catching Covid.

111 donation; abortion and complications; occupational accidents. Leave due to suspicion or

112 confirmation of SARS-CoV-2 infection and conversion to teleworking were not counted

113 among the outcomes of interest in the study. In addition to data relating to leave

//Does not help with this problem...there is no clear way to differentiate...should include this in limitations section

142 100 healthcare professionals) was assessed by Spearman’s rho. p-values were deemed

// P

159 The average age of the workers was 39,2 years (SD 7,52). There was a predominance

160 of females 70,3% (n = 22,982). The sample was comprised of 82,5% health

161 professionals, 13,7% support professionals, while the remaining 3,8% with no

//Given that this will have an international audience, better to use the convention of '.' when citing decimals throughout the article. Otherwise (e.g. see line 160) there will be confusion for some readers, when mixing decimals and large whole numbers in the same sentence or paragraph--for those who use that convention in their cultures.

//The discussion and conclusion sections contain some speculations re causes of the results which have little or no support in the study's results.

//There needs to be a separate 'limitations of this study' section.

**********

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Reviewer #1: Yes: Dr. Snehil Gupta (M.D.)

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PLOS one _brazil_MH_leaves.docx

PONE-D-21-27324R1Impact of COVID-19 on the mental health of public university hospital workers in Brazil: a cohort-based analysis of 32,691 workersPLOS ONE

Dear Dr. Mota,

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 make minor grammatical corrections as per reviewer comments.

Please submit your revised manuscript by Apr 10 2022 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,

Rosemary Frey

Academic Editor

PLOS ONE

Journal Requirements:

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. 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 #3: 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 #3: Yes

**********

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

Reviewer #1: I Don't Know

Reviewer #3: 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 #3: 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 #3: 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 #1: Dear Authors, you have addressed the queries raised by me. However, if am not sure of the utility of the McNemar test here. I think chi-square test would be enough to support your finding. Similarly, the supporting information should be cited in the manuscript for readers to better comprehend that.

Reviewer #3: The author should correct grammatical errors and improve the writing.

Recommendation: Minor revision.

I do not have any potential conflict of interest to disclose.

Thank you for your consideration.

**********

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: Dr. Snehil Gupta, M.D., Assistant Professor, Dept of Psychiatry, AIIMS, Bhopal-462020

Reviewer #3: Yes: Silvio A. Ñamendys-Silva, MD, MSc, FCCP, FCCM

[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.

Impact of COVID-19 on the mental health of public university hospital workers in Brazil: a cohort-based analysis of 32,691 workers

PONE-D-21-27324R2

Dear Dr. Mota,

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,

Rosemary Frey

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

Reviewer #3: (No Response)

**********

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 #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: 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 #3: 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 #3: 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: Comments have been addressed, the article in its current form can be published. This is an important article from public health perspective. Large Data from Brazil would help policymakers to make appropriate COVID-19 related measures for the general public and health care professionals, thanks.

Reviewer #3: Dear Dr. Rosemary Frey

Academic Editor

I appreciate the opportunity to provide a review of the manuscript “Impact of COVID-19 on the mental health of public university hospital workers in Brazil: a cohort-based analysis of 32,691 workers” (PONE-D-21-27324R2).

Recommendation: Accept.

I do not have any potential conflict of interest to disclose.

Thank you for your consideration.

Best Regards.

Silvio A. Ñamendys-Silva, MD,MSc, FCCP, FCCM

Internal Medicine & Critical Care Medicine

http://orcid.org/0000-0003-3862-169X

**********

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: Dr. Snehil Gupta

Reviewer #3: Yes: Silvio A. Ñamendys-Silva, MD, MSc, FCCP, FCCM