PONE-D-22-03677Self-reported emotional and behavior problems in Nepali adolescents - a general population-based studyPLOS ONE

Dear Dr. Adhikari,

Thank you for submitting your manuscript to PLOS ONE. I sincerely apologise for the unusually delayed review timeframe. Your manuscript has been assessed by one reviewer, whose comments are appended below. 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 note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. However, we will aim to proceed on the basis of this single review if possible.

Please submit your revised manuscript by Feb 04 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Emily Chenette

Editor in Chief

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

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2. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“We would like to acknowledge the NORPART 2018/10039 project (“Collaboration in Higher Education in Mental Health between Nepal and Norway”) and CWIN -Nepal for supporting this study. The charges for online publication of this paper have been funded by a grant from the publication fund of UiT the Arctic University of Norway. We are grateful to all participating Nepali adolescents and their teachers and to the team of data enumerators and supervisors for making this study possible. Further, we would like to extend our gratitude to Dr. Arun Raj Kunwar and the child and adolescent psychiatry team at Kanti Children’s Hospital, Kathmandu, for their support. “

We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

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:

“This study led by Sirjana Adhikari is funded by the Norwegian Partnership Program for Global Academic Cooperation (NORPART) 2018/10039 project (“Collaboration in Higher Education in Mental Health between Nepal and Norway”) and Child Workers In Nepal (CWIN)-Nepal. The NORPART project funded for the entire research work and the CWIN-Nepal funded for the salary of the principal investigator.

URL:

1. NORPART : https://diku.no/en/programmes/norpart-norwegian-partnership-programme-for-global-academic-cooperation

2. CWIN-Nepal: https://www.cwin.org.np/

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

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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: Partly

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

Reviewer #1: 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

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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

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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 presents a report of findings on emotional and behavioral problems based on a school based survey of adolescents in Nepal. The population coverage and the relatively large sample size are very good. The authors have presented the magnitude of EBP and the factors associated with it. Although the report has some merit, there are some issues the authors need to address to improve its scientific value.

1. The introductory section cites several prevalence estimates of EBP in the youth. In this section, it is important to present the validity of the measures used with respect to clinical diagnoses. Self reports are general used as screening tool and generally tend to overestimate prevalence. This is important because the authors conclude that the results may be relevant for clinicians.

2. While the data presented in Table 3 shows that the clinical degree of EBP based on T-scores is higher among boys than girls for the Total, Internalizing and Externalizing categories, the authors rather chose to discuss only the results in Table 4. It would be more appropriate to discuss the findings in Table 3 or provide a good reason why the authors chose not to.

3. The discussion section emphasizes too much the cultural aspects of why externalizing symptoms are lower in prevalence. This is probably only one of the several reasons. Biological factors such as sex hormones especially among adolescents play an important role in regard to aggressive behaviors. The discussion should include the potential role of biological factors in the expression of symptoms from earlier publications.

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Reviewer #1: No

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PONE-D-22-03677R1Self-reported emotional and behavioral problems in Nepali adolescents - a general population-based studyPLOS ONE

Dear Dr. 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 May 27 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,

Yubaraj Adhikari, PhD

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.

Additional Editor Comments:

Dear Ms. Adhikari,

This is to inform you that your article - PONE-D-22-03677 - "Self-reported emotional and behavioral problems in Nepali adolescents - a general population-based study - Revision 1" went through a peer review process.

Plos One team acknowledges the efforts of the authors and reviewers to review and enhance the quality of this research paper. Thanks to the authors for their valuable work. Plos One editorial team and reviewers concluded that the revised manuscript incorporated many concerns raised during the review process of the original submission. The quality of the manuscript has improved. However, this manuscript requires addressing some of the issues in relation to language, referencing, writing style, and formulation of conclusions. The reviewers have underlined the following major concerns.

The revised manuscript still requires the correction of typos and grammatical errors. The writing style and presentation of the findings need revisions before its final publication process.

The ethical and funding-related issues concerning this research paper are now adequately addressed in the revised manuscript. Authors are asked to rework the comments and suggestions of the reviewers and resubmit the manuscript for the next steps.

You can find a summary of comments presented by the reviewers. Please review them, address the concern of the reviewers, and submit the revised manuscript with appropriate explanations to the reviewers stating details on addressing their comments.

Comments to the Authors

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Reviewer #2

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.

Accept. All comments have been addressed.

2. Is the manuscript technically sound, and do the data support the conclusions?

Yes

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

I don’t know

4. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Yes

6. Review Comments to the Author

The reviewed version has addressed all the previous comments. The article is presented in a comprehensible way, which is easy to follow.

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. 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.

Yes: Bhava Poudyal

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Reviewer #3:

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.

Accept. All comments have been addressed

2. Is the manuscript technically sound, and do the data support the conclusions?

Yes

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

Yes

4. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Yes

6. Review Comments to the Author

Not Available

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. 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.

Yes: Professor Dr. AJAY RISAL

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Reviewer #4

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.

Minor Revision. All comments have been addressed

2. Is the manuscript technically sound, and do the data support the conclusions?

Yes

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

Yes

4. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

No

6. Review Comments to the Author

I think this paper is an important addition to the child and adolescent psychiatry literature. Congratulations to all authors! However, I would like to recommend a few changes in all parts of the manuscript in terms of grammar/language, conciseness in writing, and the addition of a few pieces of information.

I. Though the author has mentioned thorough proofreading of language being carried out in response to the previous reviewer’s comments there are still typographical and grammar mistakes in the manuscript which need correction.

eg:

Line 120 “child competences”-should have been competencies.

In line 173 “TRF”-should have been “YSR”

There are still grammatical errors that need to be addressed like needs the addition of ‘the’; ‘for’; ‘a’; the need to change the word ‘from’ to ‘in’, and the correct plural/singular forms.

II. Regarding conciseness in writing for clear understanding;

• Lines 75-76 need revision;

• Lines 116-117 need correction;

• Lines 136-137 need to be re-written;

• Line 183 needs to be rewritten

• Lines 205-206 need revision,

• Lines 315-316 need revision.

III. Addition of information:

Introduction 1st paragraph needs elaboration on EBP and an explanation of how EBP is related to the mental health of adolescents. The manuscript seems to lack this point creating confusion between EBP and mental health problems as these terms are independently written.

There is not much background information regarding adaptive functioning however, items related to adaptive functioning have been explored. Similarly, it has not been discussed much in the discussion section questioning its pre-requisite.

Is it correct YRF has 105 items and TRF has a total of 128 items which has been mentioned in the manuscript?

The manuscript has not mentioned copyright issues of both YRF and TRF. Neither has it been mentioned in the manuscript by Ma and colleagues.

The description of YRF and TRF are very imprecise. What are the items related to adaptive functioning within TRF?

Were the physical illnesses and life events assessed by only one question or there were further questions? Like duration for chronic illness and disabilities.

What was the result of chronic illnesses and disabilities in terms of types?

What was the result of serious life events in terms of types? Since the question was asked to parents, how do you justify its reliability, especially for traumas like sexual abuse?

Why do you think the internal consistency of some item syndrome scales of YSR and the correlation between some sub-items-syndrome scales was weak?

Line 235-236, how is the mention of the sample population to be in accordance with the overall Nepal population distribution justifiable when your sampling was purposive?

Since YSR was not validated in Nepali and did not have the norms, I am interested to know what could have been the finding of EBP if the norms from a culturally similar country were applied!

Did you explore the relationship between EBP and two broad-band scales? It would have been interesting to know if internalizing problems were common in adolescents suffering from severe traumas.

Lastly, as you have explained the reasons for the increased prevalence of internalizing problems in adolescents our culture of discouraging verbal expression and emotional expression from childhood additionally might have played the role in the occurrence of internalizing problems.

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. 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.

Yes: No

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Reviewer #5

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.

Accept. All comments have been addressed

2. Is the manuscript technically sound, and do the data support the conclusions?

Yes

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

Yes

4. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Yes

6. Review Comments to the Author

The Abstract clearly describes the study's aims, methods, and results. The title of the article is informative and relevant. Relevant references have been listed.

Introduction and Method:

The introduction and background list what are already known about this topic, and are clear on the research question, which is justified considering what is presently known. Subject selection is clearly stated, and the variables are defined and measured appropriately. The noted study methods are valid and reliable with the provision of enough detail to replicate the study.

Results:

Results are presented appropriately, with the provided text adding further context to the data. It is clear to the reader in terms of findings what is statistically significant and practically meaningful.

Discussion:

Results were discussed well, and placed in context, without being overinterpreted. Conclusions answer the aims of the study and are supported by results and references. The limitations of the study listed are opportunities to inform future research.

Overall:

This journal article aims to explore the prevalence of EBPs and associated adolescent factors among school-going adolescents in Nepal. It contributes to the dearth of information on this topic from an LMIC in the South Asian context and allows for the comparison of Adolescent EBPS in this region. The study design was appropriate to answer the aims, and the results do justice in adding the Nepali adolescent experience of EBPs and filling in missing information on associated factors in the country context as well as providing other relevant data on the topic. The previous reviewers’ comments have been addressed adequately and the article remains consistent with itself. The article is recommended to be accepted for publication.

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. 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.

No

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Reviewer #6

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.

Minor Revision. All comments have been addressed

2. Is the manuscript technically sound, and do the data support the conclusions?

Yes

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

Yes

4. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Yes

6. Review Comments to the Author

• Was there any feasibility criteria used for the purposive sampling method?

• Please clarify the statement "since assent by the youths themselves was not mandatory at that time"

• In table 1 "geographic region of residence"; in methods authors have mentioned about Kathmandu as a separate entity. Kindly clarify.

• Table 1: Physical illness present or absent is very vague term. what physical illness were included? May be clarified in method section.

• The claim of being the first study in Nepal would be very misleading. There has been national mental health survey in 2020 and data are available on mental health of adolescent as well.

• You may add some important points in discussion like the treatment gap and implication of findings to the practicing psychiatrists.

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. 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.

Yes, Dr. Pawan Sharma

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Reviewer #7

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.

Minor Revision. All comments have been addressed

2. Is the manuscript technically sound, and do the data support the conclusions?

Not Available

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

4. Not Available

5. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

6. Is the manuscript presented in an intelligible fashion and written in standard English?

Not Available

7. Review Comments to the Author

Over all comment-

Pertinent, useful, important and well designed study; and well written manuscript, which needs to address a few issues for publication.

Some issues-

• Regarding title, ‘Self-reported emotional and behavioral problems in Nepali adolescents - a general population-based study’, is it

- in Nepali adolescent students?

- A school- based study?

- As discussed by the authors themselves, whether enrolled in community or school may have implication.

• Concern regarding section ‘Introduction’ is only word count/limit, if it is as per journal format? Or may make a succinct introduction from current one.

• Minor language and punctuation errors, e.g. better use past tense than present in ‘Materials and Method’ section (e.g., in line- 193 previous version of manuscript).

• Authors wrote in discussion, ‘Consistent with some studies [24], we found that Externalizing Problems seemed to rise with increasing age.’ (line 401). Please indicate based on which result (table No.?), this has been inferred? I do not see any such result, i.e. distribution as per age groups so that we can infer it.

• What was done for those adolescent students with EBP? (An ethical concern.)

• References need to follow the proper style consistently, e.g. in references 10, 16, 19.

8. 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. 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.

Yes, Dhana Ratna Shakya

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Reviewer #8

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.

Minor Revision.

2. Is the manuscript technically sound, and do the data support the conclusions?

Yes

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

I don’t know

4. Have the authors made all data underlying the findings in their manuscript fully available?

Yes

5. Is the manuscript presented in an intelligible fashion and written in standard English?

No

6. Review Comments to the Author

Title:

The title says the study is a general population-based study. The methodology says the study

sample is school attending population. The school-attending population, however, is not the

same as the general population. School students, asylum, jail inmates, etc. are special

population groups that differ from the general population and they do not represent the general

population. I mean adolescents in the general population are not the same as adolescents who

go to school/college. Therefore, the title of this article seems to be misleading.

Abstract:

The first sentence of the conclusion section (of the abstract) is the repetition of what is already

mentioned in the background section (of the abstract).

Introduction:

Order of information can put in better way. Intially part: What is EBPs, why is it important to

know? What does the existing studies say about prevalence and correlates of EBPs and in the

later part what are the lacunae in current research and why you want to do this study?

Materials and methods:

In section ‘Participants and procedure’: I think it is not good to tell readers to search for

another article to see the detailed procedure and methodology of this study. The second

sentence has the word ‘analytical sample’. I do not think ‘analytical sample’ means anything.

Are YSR and TRF Nepali translations are validated?

References:

Referencing styles are not uniform.

Example:

Sahayaraj.R W. Behavioural and emotional problems in school going adolescents.

International Research journal of Management Sociology & Humanities, 2015; 6(12):357-363.

Doi: https://doi.org/10.32804/IRJMSH

In the above referencing, you can omit 3 in 363 to write it like below

Sahayaraj.R W. Behavioural and emotional problems in school going adolescents.

International Research journal of Management Sociology & Humanities, 2015; 6(12):357-63.

Doi: https://doi.org/10.32804/IRJMSH

General comments:

The manuscript is better to be proofread by a professional English editor. For text clarity, we

can refrain from using additional words, mostly filler words/connecting words, which can be

omitted, e.g. "respectively", "thus", "hence", "therefore", "however, "indeed", etc. Long

sentences can be converted into more than one shorter sentence to make them more readable.

There are a few spelling mistakes. Eg Analyses of variance should be spelled correctly as

Analysis of variance (plz see abstract). Hedges’ g should be spelled as Hedges’ G. References

numbers are generally to be put at the end of the sentences. There are a few instances where

reference numbers are put in the middle of the sentences.

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. 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.

Yes, Khagendra Kafle, MBBS, MD

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Plos One requests the author to resubmit the revised manuscript within 30 days so that the publication and review process remains robust for this manuscript.

With warm regards,

Yubaraj Adhikari, PhD

Academic Editor

Plos One

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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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

Reviewer #5: All comments have been addressed

Reviewer #6: All comments have been addressed

Reviewer #7: (No Response)

Reviewer #8: (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 #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: (No Response)

Reviewer #8: Yes

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

Reviewer #2: I Don't Know

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: I Don't Know

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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 #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: (No Response)

Reviewer #8: 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 #2: Yes

Reviewer #3: Yes

Reviewer #4: No

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: No

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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 #2: The reviewed version has addressed all the previous comments. The article is presented in a comprehensible way, which is easy to follow.

Reviewer #3: (No Response)

Reviewer #4: (No Response)

Reviewer #5: Abstract, title, references:

The Abstract clearly describes the study's aims, methods, and results. The title of the article is informative and relevant. Relevant references have been listed.

Introduction and Method:

The introduction and background list what are already known about this topic, and are clear on the research question, which is justified considering what is presently known. Subject selection is clearly stated, and the variables are defined and measured appropriately. The noted study methods are valid and reliable with the provision of enough detail to replicate the study.

Results:

Results are presented appropriately, with the provided text adding further context to the data. It is clear to the reader in terms of findings what is statistically significant and practically meaningful.

Discussion:

Results were discussed well, and placed in context, without being overinterpreted. Conclusions answer the aims of the study and are supported by results and references. The limitations of the study listed are opportunities to inform future research.

Overall:

This journal article aims to explore the prevalence of EBPs and associated adolescent factors among school-going adolescents in Nepal. It contributes to the dearth of information on this topic from an LMIC in the South Asian context and allows for the comparison of Adolescent EBPS in this region. The study design was appropriate to answer the aims, and the results do justice in adding the Nepali adolescent experience of EBPs and filling in missing information on associated factors in the country context as well as providing other relevant data on the topic. The previous reviewers’ comments have been addressed adequately and the article remains consistent with itself. The article is recommended to be accepted for publication.

Reviewer #6: 1. Was there any feasibility criteria used for the purposive sampling method?

2. Please clarify the statement "since assent by the youths themselves was not mandatory at that time"

3. In table 1 "geographic region of residence"; in methods authors have mentioned about Kathmandu as a separate entity. Kindly clarify.

4. Table 1: Physical illness present or absent is very vague term. what physical illness were included? May be clarified in method section.

5. The claim of being the first study in Nepal would be very misleading. There has been national mental health survey in 2020 and data are available on mental health of adolescent as well.

6. You may add some important points in discussion like the treatment gap and implication of findings to the practicing psychiatrists.

Reviewer #7: Over all comment-

Pertinent, useful, important and well designed study; and well written manuscript, which needs to address a few issues for publication.

Some issues-

1. Regarding title, ‘Self-reported emotional and behavioral problems in Nepali adolescents - a general population-based study’, is it

- in Nepali adolescent students?

- A school- based study?

- As discussed by the authors themselves, whether enrolled in community or school may have implication.

2. Concern regarding section ‘Introduction’ is only word count/limit, if it is as per journal format? Or may make a succinct introduction from current one.

3. Minor language and punctuation errors, e.g. better use past tense than present in ‘Materials and Method’ section (e.g., in line- 193 previous version of manuscript).

4. Authors wrote in discussion, ‘Consistent with some studies [24], we found that Externalizing Problems seemed to rise with increasing age.’ (line 401). Please indicate based on which result (table No.?), this has been inferred? I do not see any such result, i.e. distribution as per age groups so that we can infer it.

5. What was done for those adolescent students with EBP? (An ethical concern.)

6. References need to follow the proper style consistently, e.g. in references 10, 16, 19.

Reviewer #8: Title:

The title says the study is a general population-based study. The methodology says the study

sample is school attending population. The school-attending population, however, is not the

same as the general population. School students, asylum, jail inmates, etc. are special

population groups that differ from the general population and they do not represent the general

population. I mean adolescents in the general population are not the same as adolescents who

go to school/college. Therefore, the title of this article seems to be misleading.

Abstract:

The first sentence of the conclusion section (of the abstract) is the repetition of what is already

mentioned in the background section (of the abstract).

Introduction:

Order of information can put in better way. Intially part: What is EBPs, why is it important to

know? What does the existing studies say about prevalence and correlates of EBPs and in the

later part what are the lacunae in current research and why you want to do this study?

Materials and methods:

In section ‘Participants and procedure’: I think it is not good to tell readers to search for

another article to see the detailed procedure and methodology of this study. The second

sentence has the word ‘analytical sample’. I do not think ‘analytical sample’ means anything.

Are YSR and TRF Nepali translations are validated?

References:

Referencing styles are not uniform.

Example:

Sahayaraj.R W. Behavioural and emotional problems in school going adolescents.

International Research journal of Management Sociology & Humanities, 2015; 6(12):357-363.

Doi: https://doi.org/10.32804/IRJMSH

In the above referencing, you can omit 3 in 363 to write it like below

Sahayaraj.R W. Behavioural and emotional problems in school going adolescents.

International Research journal of Management Sociology & Humanities, 2015; 6(12):357-63.

Doi: https://doi.org/10.32804/IRJMSH

General comments:

The manuscript is better to be proofread by a professional English editor. For text clarity, we

can refrain from using additional words, mostly filler words/connecting words, which can be

omitted, e.g. "respectively", "thus", "hence", "therefore", "however, "indeed", etc. Long

sentences can be converted into more than one shorter sentence to make them more readable.

There are a few spelling mistakes. Eg Analyses of variance should be spelled correctly as

Analysis of variance (plz see abstract). Hedges’ g should be spelled as Hedges’ G. References

numbers are generally to be put at the end of the sentences. There are a few instances where

reference numbers are put in the middle of the sentences.

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

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Reviewer #2: Yes: Bhava Poudyal

Reviewer #3: Yes: Professor Dr. AJAY RISAL

Reviewer #4: No

Reviewer #5: No

Reviewer #6: Yes: Dr. Pawan Sharma

Reviewer #7: Yes: Dhana Ratna Shakya

Reviewer #8: No

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Attachments

Attachment

Submitted filename: Comment for PLOS ONE.docx

Self-reported emotional and behavioral problems among school going adolescents in Nepal - a cross-sectional study

PONE-D-22-03677R2

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.

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,

Yubaraj Adhikari, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for all your efforts to incorporate all the concerns of reviewers. There are still a few recommendations from the reviewers. Kindly address those comments outlined by the reviewers (#7 and 8) below in section 6. After incorporating them in the final version, this manuscript is ready to publish.

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 #4: All comments have been addressed

Reviewer #6: All comments have been addressed

Reviewer #7: All comments have been addressed

Reviewer #8: 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 #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: Yes

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

Reviewer #4: Yes

Reviewer #6: I Don't Know

Reviewer #7: (No Response)

Reviewer #8: I Don't Know

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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 #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: 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 #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: 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 #4: (No Response)

Reviewer #6: (No Response)

Reviewer #7: I leave it to editorial committee to ensure word limit/ style of introduction section to the journal style.

Great work for the context of subject setting and country.

Some of the suggested punctuation and typo errors (still present) are better to be corrected.

Reviewer #8: Most of the suggestions are incorporated. Title of the research has been changed as per the study was done among school going adolescents only. Spellings and grammar mistakes are corrected. However there are still minor things which are better if corrected. Examples: Referencing styles are yet to be in uniform style. In line no 500 (reference 6), the reference text should have 'Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022 Jan;27(1):281-95."

Usually you ignore the web address and give the reference as you would for a printed journal article.

You should only use the electronic journal article format when the journal has no volume, issue and page numbers, or

it is not available as a print version at all (or you’re not sure), or when the article is "forthcoming”, “in press” or “online ahead of print”, so that it is available electronically but has not yet been given a place in a print issue and assigned page numbers.

You have mentioned on some occasions 'This study focuses on the prevalence, magnitude, and type of.......' For me it is not clear what you mean by 'magnitude'. If it is same as prevalence, the word 'magnitude' is not necessary to be put here.

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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 #4: No

Reviewer #6: Yes: Dr. Pawan Sharma

Reviewer #7: Yes: Dhana Ratna Shakya

Reviewer #8: No

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