PONE-D-22-05990Depression and anxiety and their associated factors among care givers of children and adolescents with epilepsy in selected three hospitals of Amhara region, Ethiopia.PLOS ONE

Dear Dr. BIRESAW,

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PLOS ONE

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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

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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: No

Reviewer #2: Yes

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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 fact that this is an institution-based study among caregivers of patient with epilepsy at public hospitals is a great strength of the investigators' approach. While this is not clearly stated, and I strongly encourage the investigators to state this clearly and underscore the contribution of this study to the overall literature. focus on important elements of the methods section, grammar, and language use. Comments are provided from here with 1-16, look there all

1. Abstract background line 26, say depression and anxiety disorders are also today’s silent health crises in primary caregivers of children and adolescents with epilepsy? Tell as some thing that you consider silent health crisis unless you must rewrite and revise the statement as well.

2. Abstract method part line33-34, Binary logistic regression was employed to carry out bivariate and multivariate analyses were fitted independently for both depression and anxiety. please either separate or rewrite it again.

3. Why nonresponse rate is high? which is around 10%

4. Be consistent when you write a statement especially “depression and “anxiety” or anxiety and depression”. When we see the topic, it says Depression and anxiety and their associated factors but, in abstract part of result line 38, prevalence of anxiety and depression were found to be 10.4% and 13.7% respectively. Which one is correct?

5. Please define it what mean by unmarried? line 39

6. Similar with the above one “having history of chronic medical illness” who are they chronic medical illness? do they have followed up or simply report of care giver?

7. Do you have any suggestion why duration classification with this “duration of care 6-11years”?

8. Avoid such a kind of words” almost” rather put the number or percent alone.

9. Be consistent either use “general anxiety disorders” or “anxiety” line 96

10. Occupational status classification “other “is greater than housewife which is 8%, it is not advisable this number of individuals to put with term other rather put with their own classification or put remark below the table.

11. Line 211 what is the term” Gad” mean?

12. Line 213 “P-value “repeated two times.

13. In logistic regression the value after a point should be two digits.

14. On table -3 of logistic regression model, you must put the value of each variable respondents.

15. Please put confidence interval of the prevalence unless it is difficult to know and compare with others.

16. It is difficult to understand the English language

Reviewer #2: Dear authors, I revised with interest your manuscript entitled “Depression and anxiety and their associated factors among care givers of children and adolescents with epilepsy in selected three hospitals of Amhara region, Ethiopia” for PLOS ONE, where you present a cross-sectional analysis on the risk of developing anxiety and depression in relation to caregiving activity of children with epilepsy.

In general, the manuscript is well written: the analytic plan is simple but consistent with the aims and results are clearly presented. I have few comments for your which I hope you can exploit to enhance the overall quality of your paper.

1. In general, a revision on the use of English is needed in different sections of the manuscript: in some places, I had difficulties in understanding what you meant.

2. Please ensure that abbreviations are given in full at the first use, abstract included.

3. Lines 83-90: a revision on the use of English is essential

4. Lines 205-209: please give means and SD for both GAD-7 and PHQ-9.

5. Liens 211-258: these sections largely duplicate tables 3 and 4, and by this I mean that at least 50% of the text could be deleted. You have to reduce redundancy as it makes reading difficult: just focus on the results of the multivariable regression analysis and do not repeat OR values.

6. With regard to OR, please just refer to them as “OR” and not to AOR (I presume “adjusted” OR) or COR (unclear what does the C stand for).

7. Table 3 and 4: I do not see the utility of the “COR” column, and my suggestion is to delete it.

8. An important element that is missing here is a measure of model goodness. You have the OR, however how much of anxiety/depression is explained by your predictor. Instead of using Nagelkerke pseudo R-squared, please use the C-Statistic (i.e. the area under the receiver operating curve - ROC - for the predicted versus the actual data) used to assess the whole explanatory power of the model.

9. Also, please include the intercept in the model and provide the -2 log likelihood difference with chi-square to test the difference between the full model and the model based on the intercept only.

10. Please begin discussion with a paragraph stating the most relevant results. Do not repeat results (with data), but state what was found in “practical terms”. Once this is done, you can start discussing against relevant literature.

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Reviewer #1: No

Reviewer #2: No

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Depression and anxiety and their associated factors among caregivers of children and adolescents with epilepsy in three selected hospitals in the Amhara region, Ethiopia: A cross-sectional study

PONE-D-22-05990R1

Dear Dr. BIRESAW,

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.

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Kind regards,

Francesco Deleo, MD

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 #2: All comments have been addressed

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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 #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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

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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: That is excellent all the comments that i raised is addressed and got adequate information from your research especially the revised one.

Reviewer #2: Dear authors, I revised the new version of your manuscript on depression and anxiety in caregivers of children with epilepsy in Ethiopia. I think the revisions are satisfactory and have no other ones for you.

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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 #1: Yes: Wondale Getinet Alemu(PhD Fellow ,Flinders University,South Australia)

Reviewer #2: No

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