Determinants of adolescents’ Health-Related Quality of Life and psychological distress during the COVID-19 pandemic

Roxane Dumont; Viviane Richard; Hélène Baysson; Elsa Lorthe; Giovanni Piumatti; Stephanie Schrempft; Ania Wisniak; Rémy P. Barbe; Klara M. Posfay-Barbe; Idris Guessous; Silvia Stringhini; on behalf of the Specchio-COVID19 study group

doi:10.1371/journal.pone.0272925

Peer Review History

Original SubmissionMarch 25, 2022
21 Jun 2022 Decision Letter - Cecilia Acuti Martellucci, Editor PONE-D-22-08850Determinants of adolescents’ Health-Related Quality of Life and psychological distress during the COVID-19 pandemicPLOS ONE Dear Dr. Stringhini, 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 Aug 05 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. 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Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Additional Editor Comments: Please address the concerns expressed by the reviewers. [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: Partly 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: This study examined the psychological well-being of adolescents in relation to COVID-19 infection and socioeconomic status. The topic is intriguing. The sample size is not large but acceptable because it reached statistical significance. I have some comments below. Major ・Although the authors adopted many variables, my suspicion is multicollinearity. I would control for confounding more carefully. For example, the authors showed the association between parents’ Covid-19 positive and a lower HRQoL of the adolescent. I would control for the economic status in this association because it is associated with both HRQoL and risk for infection. On another note, I would conduct principal component analyses to see how many components exist in these variables. ・Regarding the question about sadness and loneliness, my concern is that they are self-assessments only. I wonder if some have a psychiatric diagnosis (such as developmental disorder or attachment disorder). The authors are encouraged to control for the diagnosis. ・Since a child's well-being is also affected by the family environment, it would be better to consider not only income but also, for example, whether the child is a single parent, whether the child is adequately educated, and the level of nurturing. ・The authors found being a girl was a risk factor for the sadness. If so, I would classify the children as not both sexes together but each sex separately because boys and girls would have a different distribution of well-being. Identifying being a girl as a risk factor is, in my opinion, an oversimplification of their aim is to assess the determinants of adolescents’ Health-Related Quality of Life and psychological distress (self-reported and parent-reported) during COVID-19. Reviewer #2: Dear authors, Thank you for giving me the opportunity to review this interesting manuscript on the impact of the COVID-19 pandemic on adolescents wellbeing. While the introduction and methods are clear and well written, from my point of view the discussion has to be better developed: authors do not detail enough the practical implications of their findings. It would be nice to know their insights on how to further develop clinical guidelines or future projects on these issues. Best regards and thanks ****** 6. 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Revision 1
12 Jul 2022 Author Response Dear Editor, On behalf of my co-authors, I am pleased to submit our revised manuscript entitled “Determinants of adolescent’s Health-Related Quality of Life and psychological distress during the COVID-19 pandemic” (Manuscript PONE-D-22-08850R1). We would like to thank the editor and the reviewers for their careful reading and judicious comments that helped us improve this work. We have now addressed all of the reviewers’ concerns and journal requirements and feel the manuscript has much improved as a consequence. Point-by-point responses (see the attached file) Page and line numbers refer to the version of the manuscript with revisions. 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 Response: The manuscript was adapted according to the PLOS ONE guidelines. 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. Response: Due to the fact that we are reporting information on a relatively small sample of adolescents from a specific geographic location, our data contains potentially identifying information, despite all precautions taken. Therefore, the study steering committee members decided to make these data accessible to researchers who meet the criteria for access to confidential data upon reasonable request for data sharing to the Unit of Population Epidemiology (uep@hcuge.ch). All requests will be evaluated by the Data Access Committee and approved on the basis of their scientific quality. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Response: The ethics statement was put in the Methods section. Comments from Reviewer #1 This study examined the psychological well-being of adolescents in relation to COVID-19 infection and socioeconomic status. The topic is intriguing. The sample size is not large but acceptable because it reached statistical significance. I have some comments below. 1. Major. Although the authors adopted many variables, my suspicion is multicollinearity. Response: We thank the Reviewer for this important comment. In addition to a careful descriptive analysis of the covariates that was conducted before running the models, we computed the Variance inflation Factor, a widely used statistical tool that identifies multicollinearity. The Variance Inflation Factor of each covariate was considered acceptable as values were under 5, confirming that there was no multicollinearity (Table 1). Thus, although our covariates may represent close concepts, multicollinearity did not seem to be an issue in our models. Accordingly, the following statement was included: “The risk of multicollinearity was considered acceptable as the variance inflation factor (VIF) was under five.” (page 9, line 241-242) 2. I would control for confounding more carefully. For example, the authors showed the association between parents’ Covid-19 positive and a lower HRQoL of the adolescent. I would control for the economic status in this association because it is associated with both HRQoL and risk for infection. Response: We thank the review for this constructive remark. The association between the anti-SARS-CoV-2 serological status and the HRQoL of the adolescent was adjusted for socio-economic conditions. However, we agree with the Reviewer’s suggestion about careful confounding control. Accordingly, we ran minimal models only adjusted for age and sex, or age, sex, household financial situation and crowding index when appropriate. Estimates were similar compared with the fully adjusted model and added in the Appendix. We edited the Methods and Results sections as follow: “[…multivariable models were performed for each outcome] as follow: minimal model adjusted for age and sex, or age, sex, financial situation and household density when appropriate, and full model adjusted for […].” (page 9, lines 236-237) “In the fully adjusted model, […]” (page 11, lines 271-272) “The magnitude of results was similar with the minimally adjusted model (Appendix 1 and 2).” (page 12, line 288) “Results of the minimally adjusted model were of the same magnitude (Appendix 1 and 2).” (page 12, lines 297-298) 3. On another note, I would conduct principal component analyses to see how many components exist in these variables. Response: We thank the Reviewer for the interesting suggestion. Indeed, the included covariates may have close underlying concepts. When performing the Factor Analysis for Mixed Data (as covariates are mixed, continuous and discrete), it appears that parent’s and adolescent’s serology, as well as the financial situation vary together on the first dimension (Figure 1). On the other hand, it is mostly explained by the adolescent’s age and time spent on social media. However, the variability explained by the factorial analysis remains relatively small, and as confirmed by the VIF above, the correlation between the covariates is not high enough for multicollinearity to be an issue. Fig 1. Factor Analysis for Mixed Data of the models’ covariates 4. Regarding the question about sadness and loneliness, my concern is that they are self-assessments only. I wonder if some have a psychiatric diagnosis (such as developmental disorder or attachment disorder). The authors are encouraged to control for the diagnosis. Response: Thank you for this comment. Our goal was to evaluate adolescents’ general well-being and psychological distress, and to better understand how adolescents feel during the pandemic. Thus, we believe that self-report is adequate in this regard. Furthermore, the point of view of another informant was provided with the parent-reported adolescent’s emotional well-being. As acknowledged by the reviewer, controlling for existing psychiatric diagnosis would have been relevant. However, in our sample, only 3 adolescents were reported to have a psychiatric disorder; making it impossible to control for this. 5. Since a child's well-being is also affected by the family environment, it would be better to consider not only income but also, for example, whether the child is a single parent, whether the child is adequately educated, and the level of nurturing. Response: We fully agree with the Reviewer on this important point. In addition to the financial situation, parent mood was also included in our models to take the family environment into account. Following the Reviewer’s comment, we further added the parents’ marital status as a covariate. There was no significant association with any of our five outcomes. Although very interesting, child-rearing and nurturing were not assessed in our study and could not be included in the analyses. The Methods section was edited with the additional variable, as were the tables 2 and 3 in the Results section. “Parents’ marital status was dichotomized into married or as couple on one hand and divorced, separated, single or widowed on the other hand.” (page 9, lines 230-231) “[…] full model adjusted for […] referent parents’ […] marital status […]. (page 9, lines 237-240) 6. The authors found being a girl was a risk factor for the sadness. If so, I would classify the children as not both sexes together but each sex separately because boys and girls would have a different distribution of well-being. Identifying being a girl as a risk factor is, in my opinion, an oversimplification of their aim is to assess the determinants of adolescents’ Health-Related Quality of Life and psychological distress (self-reported and parent-reported) during COVID 19. Response: Thank you for making this point. Stratifying our analyses by sex could have given an additional insight into the association between sex and health-related quality of life, but it was not possible due to the small sample size. Also, we believe that a study specifically designed to answer this question would be more appropriate to understand this relationship. However, we agree that we could discuss further the fact that girl’s health-related quality of life is lower compared to boys. The discussion was developed accordingly. “[…] different factors such as the onset of menstruation, inwards coping patterns and high, sometimes contradictory, social expectations may contribute to this discrepancy among adolescents.” (page 17, lines 47-49) Comments from Reviewer #2 Dear authors, Thank you for giving me the opportunity to review this interesting manuscript on the impact of the COVID-19 pandemic on adolescents’ wellbeing. While the introduction and methods are clear and well written, from my point of view the discussion has to be better developed: authors do not detail enough the practical implications of their findings. It would be nice to know their insights on how to further develop clinical guidelines or future projects on these issues. Best regards and thanks Response: We thank the Reviewer for making this important point. We elaborated on the potential measures that could be implemented to protect adolescents’ well-being. We also acknowledge that further studies are needed to adequately identify relevant protective factors and interventions. The discussion section has been edited accordingly. “[Early intervention is needed to improve adolescents’ well-being,] especially for girls and those living in disadvantaged households. Indeed, these adolescents seem particularly at risk for high psychological distress, which is also more likely to remain unidentified by their parents. […] In view of our results, it also seems important that the increase in time spent on social networks during the pandemic does not become established as a new habit. Measures could promote and facilitate access to alternative leisure such as sport, art and music.“ (pages 18-19, lines 88-95) “Finally, we did not study potential protective factors of adolescents’ well-being and psychological distress, such as physical activity or family cohesion. Further studies should focus on these aspects to design effective prevention and mitigation measures.” (page 19, lines 106-109) Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0272925.r002
29 Jul 2022 Decision Letter - Cecilia Acuti Martellucci, Editor Determinants of adolescents’ Health-Related Quality of Life and psychological distress during the COVID-19 pandemic PONE-D-22-08850R1 Dear Dr. Stringhini, 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, Cecilia Acuti Martellucci, M.D. 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: No ****** 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: (No Response) ****** 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 ******** https://doi.org/10.1371/journal.pone.0272925.r003
Formally Accepted
3 Aug 2022 Acceptance Letter - Cecilia Acuti Martellucci, Editor PONE-D-22-08850R1 Determinants of adolescents’ Health-Related Quality of Life and psychological distress during the COVID-19 pandemic Dear Dr. Stringhini: 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. Cecilia Acuti Martellucci Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0272925.r004

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