PONE-D-21-40627Prevalence and associated risk factors for mental health problems among patients with polycystic ovary syndrome in Bangladesh: A nationwide cross- sectional studyPLOS ONE

Dear Dr. Islam,

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 major concerns about your manuscript. Please revise your manuscript according to reviewer's comments.

Please submit your revised manuscript by Jun 03 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,

Kenji Hashimoto, PhD

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. 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: 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. 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: No

**********

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: I reviewed the manuscript entitled 'Prevalence and associated risk factors for mental health problems among patients withpolycystic ovary syndrome in Bangladesh: A nationwide cross-sectional study' and definitely this has merits in terms of women's health care.However, the following points have to be considered very seriously regarding the manuscript.1. In the abstract, focus on the method and result in more details. Do not put more words in the introduction. Secondly, the conclusion should be concise and must be a very accurate reflection of the study 2. The introduction section is written like a literature review. Reduce a minimum of 35 % of the unnecessary content. This would also help you in reducing a number of references.3. The aim of the study is very superficially presented. It should be very clear and concise.4. In the study design, what is the meaning od expected to have. It means you have not considered it yet.5. The mentioned sentence 'Furthermore,when we gathered the data, all respondents were of Bangladeshi nationality and lived inBangladesh' is one of the example of poor language editing. Revise whole manuscript for English grammar and language.6. What about the validation of the questionnaire.7. The details mentioned in DATA COLLECTION SUBHEADING are really annoying to the readers.8. Remove the unnecessary sentences or repeating sentences form the method section. make it more presented scientifically.9. For one method or instrument used, put one valid reference only. I do not understand why there is too many references are used in Generalized Anxiety Disorder Scale and Loneliness Scale.10. We also utilized bar graphs to compare the distribution of mental health problemsaccording to the severity.---Not needed here to write.11. , HA (hyperandrogenemia) and IR (insulin resistance)- First write full form then abbreviations.12. Remove this-----However, this study contains several noteworthy findings. To begin, the current study assessedthe three primary psychological difficulties associated with women having PCOS. As we usedGoogle forms for data collection, which allowed for the collecting of data from people of allsocioeconomic backgrounds and educational levels in a timely manner. Moreover, we employedthe mental health assessment scales in Bangla, which ensured that the questions were clearlyunderstood.---from the manuscript.13. Conclusion looks lengthy. I recommend making it concise.14. All the references must mention the DOI.

Reviewer #2: This is a valuable study about the mental health problem of PCOS women from the perspective of socio-demographic profile and lifestyle-related factors in Bangladesh.

However, there are some comments to the author.

1. What is the novelty of this study? Is it only that it is the first study in Bangladesh? The author should clearly state the novelty.

2. What is the message in Figure 1? The author should provide a discussion comparing the results with previous reports.

3. In Results, the description “Regression analysisのRespondents who took morning or afternoon snacks sometimes were more likely to have the depressive disorder than the respondents who never took snacks (OR=2.00, 95% CI 0.75-5.32, p=0.007)” is inappropriate because the 95% CI straddles 1.

4. In Discussion, there is the description “According to our analysis, from the perspective of the socio-demographic profile, we concluded that marital status, education, financial background, area of residence, smoking habit, and family history of PCOS might be responsible for developing mental health issues among our participants.” More consideration should be given to each of these factors. How does this compare to previous reports? The background of significant differences in each factor should be examined in detail.

5. In Discussion, repeated mention of the result is not required. “About 59.86%, 62.40%, and 57.79% of participants with low economic backgrounds were suffering from loneliness, anxiety, and depressive disorder. Almost half of the women among our participants have complained about their married life which was responsible for their poor mental health. According to our findings, women living in urban area (loneliness=79.58%, generalized anxiety disorder=78.67%, depressive disorder=78.69%), having no smoking habit (loneliness=95.85%, generalized anxiety disorder=95.54%, depressive disorder=95.08%), and having no family history of PCOS (loneliness=53.74%, generalized anxiety disorder=81.06%, depressive disorder=79.51%) might be more at risk of mental health problems.”

6. In Discussion, what is the meaning of a, b and c in the description “As per our analysis, the a%, b%, and c% of respondents are struggling with loneliness, anxiety, and depression, respectively”?

**********

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: Dr. Mumammad Sayeed Akhtar

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.

Attachments

Attachment

Submitted filename: review1.docx

Prevalence and associated risk factors for mental health problems among patients with polycystic ovary syndrome in Bangladesh: A nationwide cross- sectional study

PONE-D-21-40627R1

Dear Dr. Islam,

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,

Kenji Hashimoto, PhD

Section 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 #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: 1. Look for PLOSONE policies regarding data and publication.

2. Please go thoroughly again regarding any typographical errors.

Thanks

Reviewer #2: The authors have adequately addressed my comments and made all data underlying the findings in their manuscript fully available. I think this study is acceptable for publishing in PLOS ONE.

**********

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

**********

Attachments

Attachment

Submitted filename: Final Comments EMID.docx