PONE-D-22-12690Prevalence and factors associated with depression, anxiety and stress symptoms among construction workers of NepalPLOS ONE

Dear Dr. Adhikari,

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PLOS ONE

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Reviewers' comments:

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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

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

Reviewer #1: No

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: No

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: This is a cross-sectional study conducted with construction workers of Nepal. The authors aim to assess the prevalence of depressive, anxiety and stress symptoms and their association with socio-demographic, life-style and occupational factors among construction workers of Kavre district, Nepal. The biggest limitation of the study is the convenience sampling which makes it difficult to infer current conclusions. I have a number of suggestions below:

1. I recommend the objective be rephrased as “…..to assess psychological distress (depression, anxiety and stress) and associated factors among construction workers in Kavrepalanchok district, Nepal” instead of “…..to assess the prevalence of depressive, anxiety and stress symptoms and their association with socio-demographic, life-style and occupational factors among construction workers of Nepal. ”

2. Please provide references for lines 83-87.

3. Methods section should be more detailed. For example, how was the study area selected, how many wards were there in each municipality and how many were targeted for data collection, and who collected the data, etc.

4. Authors defined construction workers as members of specialist trades such as builders, electricians, carpenters, bricklayer, manual labor, armature fixing workers, internal finish workers and plumbers in the introduction. As stated in the inclusion criteria, is it only building construction workers who were interviewed in the present study? Please clarify.

5. Could the authors explain how current smokers and current drinker were defined in the study? How did the authors decide which risk factors to investigate in this study? I suggest writing a separate paragraph explaining the variables that were assessed.

6. Throughout the manuscript, I suggest the authors use either Kavre or its full name.

7. Please correct “convenient” to “convenience” on line 116.

8. Could the authors explain why they sought ethical approval from B.P. Koirala Institute of Health Sciences sought rather than the NHRC?

9. Please correct “life-style” to “lifestyle” on line 135 and throughout the manuscript.

10. Authors mentioned interquartile range on line 174 but it does not appear anywhere else in the manuscript. Is there a reason to mention it?

11. Results: What was the response rate?

12. The authors reported Tamang, Bhote, and Sherpa as ethnic groups on line 180 but this classification was not shown in the tables. It would be helpful if the authors could provide an explanation of how the classification of ethnicity was made and if applicable, the reference for it.

13. Could the authors explain how was the multivariate logistic regression performed and why?

14. Odds ratios in univariate and multivariate analyses are not correctly interpreted. I suggest the authors revise it.

15. Could the authors provide a reference to Kobotoolbox?

16. Line 273, 'Nepalease' should be changed to 'Nepalese,' and 'Vrahamin' should be changed to 'Brahmin,' as well. Line 282: please spell socioeconomic correctly.

17. Tables description should explain all the symbol in the table body like CI, n, COR, AOR etc.

18. Line 234, I suggest that authors also include the digits following the decimal.

19. Discussion: What could be the future research direction after this study?

20. Lines 303-305: please complete the sentences.

21. Authors should also expand the limitations and biases associated with the sampling strategy.

22. The recommendation ‘to develop and implement evidence-based and appropriate community-based mental health prevention programs for laborers and construction workers’ needs some further explanation.

23. Attaching a STROBE checklist would strengthen your study.

24. There were several grammatical errors in the manuscript. The authors should use professional editing services to edit the manuscript.

Reviewer #2: In the present work, the authors preformed the study on mental health of construction workers of Nepal and the topics is relevant to current context. This is a study of a neglected population and on sensitive topics, however, the manuscript needs revision before it is published in the journal. There is concerns multicollinearity issues and revision of tables of the result section. References need to be revised as par journal.

Abstract

Methods

Please explained why the study is community based cross sectional study. Is it necessary to add the process of ethical review in the abstract section?

Results

Please add adjusted OR when presenting the results section.

Introduction

Line 71-72, what does the information (International Labor Office in Nepal 2005) means?

Line 80, there are some error, please revise it.

Methods

I am not sure why the study is community based cross sectional study.

The author calculates the sample size of 284, however the author use 402 construction workers. It may create the confusion among the readers. So, it is suggested to revise this sentence.

In the statistical analysis section, it is suggested to do multicollinearity before doing the logistic regression whether to check whether there is correlation of the variables.

Results

It is suggested to use respondents or construction workers instead of participants.

In Table 1, it is suggested to write the number in the relevant section as well.

It is also suggested to merge castes into less category.

It is recommended to revise the table. Please make the logistic table showing the results of crude and adjusted odd ratio of depressive symptoms, similar table for anxiety and similar table for stress

It is suggested to revise the analysis if relevant. Please do the multivariate logistic regression analysis of the variable that was found to be significant in univariate logistic regression analysis.

Discussion

Please compare the prevalence of depression, anxiety and stress with National Mental Health Survey, Nepal 2020 that many reflect whether the prevalence is high, moderate and low.

Line 246-249, please revised the writing style

Line 265-266, please revise the writing style

Line 288-298, please review whether this sentence is importance and relevant to the manuscript.

References

Please revise the reference and follow the referencing style based on the journal requirement. In the reference section, some journals are in full name and some journals are in abbreviations.

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Reviewer #1: No

Reviewer #2: No

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Attachments

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Submitted filename: Comments on PLOS.docx

PONE-D-22-12690R1Prevalence and factors associated with depression, anxiety and stress symptoms among construction workers in NepalPLOS ONE

Dear Mr. Adhikari,

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 Apr 06 2023 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,

Shyam Sundar Budhathoki

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.

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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: (No Response)

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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 #3: Yes

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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: No

Reviewer #3: (No Response)

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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 #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: I appreciate your thorough responses to reviewer questions and concerns. In my previous comment, I suggested that authors rephrase the objective as “…..to assess psychological distress (depression, anxiety and stress) and associated factors among construction workers in Kavre district, Nepal”. The authors stated in their response that they have changed as per the suggestion; however, Kavre has not been mentioned in the objectives of the abstract and introduction. Results, 41.3% is not a majority, revise the wording. Besides these points, the authors have addressed my comments.

Reviewer #3: This is a cross-sectional study conducted among 402 construction workers in Banepa and Panauti municipalities of Kavre district, Nepal aimed to assess psychological distress (depression, anxiety and stress symptoms) and its association with socio-demographic, lifestyle, and occupational factors among construction workers in Nepal. I have mentioned few suggestions below:

Abstract

1. Introduction: In line 35, i suggest authors to use aimed instead of aims.

2. Introduction: From line 86-94, same reference 6 has been used by the author. I recommend author to add any other reference article with similar information if its available. I suggest the authors to write the objectives as written in the abstract section: to assess the prevalence of depression, anxiety and stress symptoms and its association with socio-demographic, lifestyle and occupational factors among construction workers in Nepal.

3. Methods: I recommend authors to mention the study as cross-sectional study. community based is not required to be mentioned.

4. Data collection: Could the authors explain regarding translation of english questionnaire into the local language and back-translation into English. I would suggest to provide information regarding pre-testing if it was performed. In line 148, 'b' is to be added in 'uddhism'.

5. Line 177, mention as 'depression, anxiety and stress symptoms'.

6. In line 196, for statistical analysis authors mentioned use of 'SPSS version 20' whereas in abstract section in line 45, its mentioned 'R version 3.6.2'. Please clarify.

7. Line 217, 61.25% is missing.

8. In Univariate and Multivariate analysis table, what does 1 denote? You may also signify it as Ref. Mention at the end of table, Ref: Reference group if relevant.

9. Line 221, its better to use 'depression' than 'depressive'.

10. In description of Table 2, authors should also add regarding ethnicity and stress symptoms as it is significant as shown in table.

11. Tables description should explain only the symbol used in the table body like CI, COR or AOR etc. Authors can also mention Title of the table and in bracket total study population as (N=402).

12. There are grammatical errors in the manuscript. The authors are requested to go through it and edit the manuscript where required.

13. I suggest authors to revise the references as per the referencing style based on the journal. Also fonts of the text should be similar. Please consider.

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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: No

Reviewer #3: No

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[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.

Prevalence and factors associated with depression, anxiety and stress symptoms among construction workers in Nepal

PONE-D-22-12690R2

Dear Dr. Adhikari,

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,

Shyam Sundar Budhathoki

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The manuscript will improve its readability by proof reading and ediing for english language. Please find a fluent academic english user if possible.

Reviewers' comments: