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PONE-D-22-02706Family cohesion predicts long-term health and well-being after losing a parent to cancer as a teenager: A nationwide population-based study.PLOS ONE

Dear Dr. Birgisdóttir,

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 address comments made by the reviewers specially regarding concepts of " family composition " and "family cohesion".

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Amir Radfar, MD,MPH,MSc,DHSc

Academic Editor

PLOS ONE

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We would also like to thank the Swedish Cancer Foundation [2008–758], The Gålö Foundation, The Kamprad Family Foundation for Entrepreneurship, Research and Charity, and The Mats Paulssons Stiftelse for supporting the research project with grants. 

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Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: 

The Swedish Cancer Foundation (2008–758), https://www.cancerfonden.se (GS);

The Kamprad Family Foundation for Entrepreneurship, https://familjenkampradsstiftelse.se/in-english/ (CJ); The Mats Paulsson Foundation, https://www.matspaulssonstiftelserna.com (CJ), and the Gålö Foundation, https://www.galostiftelsen.se (UK) supported the research project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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: Yes

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 manuscript “Family cohesion predicts long-term health and well-being after losing a parent to cancer as a teenager: A nationwide population-based study” is very well written, the results are very well presented, the statistical analysis is well done, and it will potentially promote preventive interventions in bereaved teenagers.

However, the concept of family has been changing during the last decades. IMHO the authors started from a traditional family concept without considering different families, socio-economical and educational levels, cultural and religious backgrounds etc.

In addition, the composition of families was not described at all. The concept of living together when the parent dies is an administrative requirement, but what about brothers and sisters, grandparents, etc.? There are no specifications.

Consequently, the definition of family cohesion should be described to understand what we are discussing as a potentially protected factor.

I highly recommend considering these questions face to future generations of family members. I suggest briefly defining the “family” you managed and why. Furthermore, what do you consider “family cohesion” to mean? You also should include some discussion about these concepts and your results.

Reviewer #2: Parentally bereaved children are an underserved population. This study is important as it adds information to help healthcare professionals understand the need for family support after the death of a parent and highlights the long term impact of parental loss during during adolescence.

The only question I have concerns using the cutoff of 16 versus 18 years old for age at the time of parental death. Why not include adolescents who had lost a parent between the ages of 13-18 years old?

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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: Vilma Adriana Tripodoro

Reviewer #2: No

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Family cohesion predicts long-term health and well-being after losing a parent to cancer as a teenager: A nationwide population-based study.

PONE-D-22-02706R1

Dear Dr. Birgisdóttir,

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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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,

Amir Radfar, MD,MPH,MSc,DHSc

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

**********

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

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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

**********

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: The authors have been adressed all querries. The limitations and future researchs were considered.

Congratulations for the article.

Reviewer #2: Children who lose a parent to cancer are an underserved population and this article fills an important void. The authors have addressed the concerns/suggestions.

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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: Vilma Adriana Tripodoro

Reviewer #2: No

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