Peer Review History

Original SubmissionMarch 13, 2023
Decision Letter - Muhammad Shahzad Aslam, Editor

PONE-D-22-35714Cross-culturally adapted psychological  interventions for the treatment of depression and/ or anxiety among adolescents: a scoping reviewPLOS ONE

Dear Dr. Mishu,

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Kind regards,

Muhammad Shahzad Aslam, Ph.D.,M.Phil., Pharm-D

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: N/A

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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

Reviewer #3: 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

Reviewer #3: 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 well written and interesting piece of research which highlights the need for depression and/or anxiety interventions delivered to adolescents to be culturally and contextually sound.

General comments:

While generally well written and intelligible, there are a few grammatical errors in the article which need to be paid attention to. For example, in the Study Participants section, the first sentence does not make sense without a comma after the word ‘studies’. This happens at various occasions, and needs to be corrected, otherwise it is difficult for the reader to understand what the sentence means.

Some abbreviated words are used without their full name in the first use, e.g RCT and USA. USA also needs to be kept for consistency e.g in the discussion, the authors write ‘US’ instead of ‘USA’ which is used earlier in.

Introduction

It would be helpful to define ‘adolescence’ in the introductory section. Also, the authors include studies of those aged 8 to 18 years old. It would be helpful to understand why this age range is included, when adolescence is most commonly defined as 10 to 19 (World Health Organization).

Also, sometimes the word ‘children’ is included, which confuses the reader e.g in the sentence ‘psychological interventions have the potential to improve the mental health of children and adolescents’. I suggest changing the phrasing throughout to young people, as per age criteria and definition, or sticking to adolescents.

Methods

The methods section is very detailed and meets the PRISMA-ScR guidelines. It would be useful to include a PRISMA-ScR checklist in the supplement or figures to show where each item has been included: http://www.prisma-statement.org/documents/PRISMA-ScR-Fillable-Checklist_11Sept2019.pdf

There needs to be some clarity on the recruitment of stakeholders, where they were sampled from, why they were chosen, which culture/country, and ethics used for adolescent involvement. Where the authors wrote ‘participants shared their perspectives on the need and acceptability of cross-culturally adapted interventions and made recommendations’, this needs more clarity. What interventions? Why are their opinions valid or useful here?

For the eligibility criteria, what makes a population or study ‘wrong’? This needs to be better phrased. Also, no restriction is placed on language. How many studies were written in a language other than English, and how did you read these? It would also be good to understand and include a sentence on why grey literature was not included (rationale for eligibility criteria is a key feature of the PRISMA-ScR guidelines). There is bias in using western databases to report interventions delivered to non-western populations, which needs some recognition. The authors could be missing key literature.

For the data extraction section, it would be useful to define ‘any relevant outcome’, as this is quite vague.

Results:

I suggest putting the results/outcomes from Tables 3a and b into Table 1, rather than lots of different tables, as this allows the reader to have all information of each study in one place.

Discussion

The paragraph which says that there is ‘little or no consideration of cost-effectiveness’ of culturally adapted vs. non adapted interventions needs some references. Is there any evidence to support this?

I suggest including a note that the studies were from a range of different populations and cultures/contexts. Your article groups together a wide range of very different populations, which may oversimplify individual cultural needs and be seen as problematic.

Section on ‘A participatory approach’ – do we know why three of the seven young people dropped out of the programme? I think there should be some reference to participatory involvement in your stakeholder interviews and results section, not just in the discussion and conclusion.

Reviewer #2: Thank you so much for choosing me to review this eminent focus review article

The research article gives me holistic knowledge about the psychologically adapted intervention used to treat depression and anxiety among adolescents.

Even though the article's focus is not original, and I read a lot of review papers focusing on the same variables, no one focuses on adolescents, the most crucial developmental stage in human life. See the link below:

https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00212/full

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00118-9/fulltext

https://www.sciencedirect.com/science/article/pii/S0165032720327464

https://pubmed.ncbi.nlm.nih.gov/35168650/

The authors prepared this work very well.

So thank you for your effort; the discussion and conclusion are to the point and reflect what the scoping review papers focused on.

Reviewer #3: The authors summarize current research on cross-culturally adapted psychological interventions for (pre-)adolescents with focus on the treatment of symptoms of anxiety and depression. This is a topic of growing importance, especially bearing in mind that global prevalence rates of mental disorders recently sharply increased in youth populations in connection to Covid-19.

However, there are a number of issues concerning the article‘s main focus of interest , the chosen methodology, and the derived conclusions from the data collected that should be clarified before puplication.

Abtract:

• After revision of the article, an adaptation of the abstract‘s content has to follow

Introduction:

• The authors should pay attention for a consequent use of a cultural sensitive and political correct language. Thus, attributions like „brown“, „black“ and „white“ (p.4) should be appropriately replaced. Same applies to „original country“ (p.5) for which the term „country of origin“ is suggested, instead.

• The theory behind culturally adapting a psychological intervention is just briefly described in the introduction. Instead of introducing common frameworks/models (e.g. Bernal & Sáez-Santiago; „surface vs. deep stractuture adaptations“) within the results, it would be helpful for the reader to give more information about ways of adapting an intervention already within the introduction.

• The authors don’t provide information why they decided for preparing a scoping reveiw instead of a systematic review.

Unfortunately, the study’s main purpose is not clear to the reader, yet. From the abstract and the introduction, it reads as if the authors are primarily interested in examining the effectiveness of culturally adapted interventions for adolescents (although, if this ist he case, the intention could be formulated more concisely). However, going through the discussion, the authors mainly focus and give recommendations on the concrete process and different approaches of culturally adapting an intervention, so that the common thread is missing. A revision in the sense of creating a coherent structure is advised.

Methods:

• The authors provide full information on the algorhythm used for their literature research. For the interest of transparency, it would be helpful, however, if they could explain the underlying principles for their search strategy in a few sentences.

Results:

• Consistent use of italic letters for statistical letters (e.g. „M“, „SD“)

• Table 1: Consistent use of bold letters for headings; consistent, equal structure of table cells (e.g. column „setting and sample“ – please provide information on diagnoses and country of implementation for every study – if unknown, this can be noted accordingly); about adding a column mentioning the kind of cross-cultural adaptation process used by each study should be thought

• Table 3 a-c: These tables all are a bit too confusing for the reader. It should be visible on first sight, which numbers are representing levels of anxiety and which levels of depression. Also, significant changes (pre vs. post as well as treatment- vs. control-group) should be detectable directly for the reader. The column „change reported“(3a)/“significance“ (3b) ist very word-heavy. Table 3c can be omitted completely as it provides almost exclusively text content which can be presented within the article’s written results just as well.

• Figure 2: The benefit from this illustration is arguable as the authors desribe the shown adaptation processes in detail within the results.

• In general, the information provided within the tables 3 a-c are repetitive compared to the written results, to a great extend. Due to the large methodological heterogenity of the reviewed studies, the authors chose a narrative synthesis for the presentation of the studies‘ results. However, an abbreviated and focused display of either the written results or the table contents is advisable.

• p. 23: The authors describe having consulted various stakeholders for discussing their preliminary review findings. From the information shared in the current article, it isn’t clear, however, whether the discussion followed any kind of structured frame or was intentionally kept open. Furthermore, the discussion’s goal and thus the benefit for the current article doesn’t really stand out, so far. Concerning the last paragraph on p. 23, it’s not recognizable whether the authors reproduce the stakeholders‘ points or summarize their own thoughts (which would be misplaced within the results).

Discussion:

• As mentioned above, the discussion’s focus is orientated differently than indicated by abstract and introduction. If the study aims to access the effectiveness of culturally adapted psychological interventions, then the authors have to allow way more space for this topic and discuss their findings critically (e.g. efficacy pre/post, efficacy treatment/non-treatment, (dis-)advantages of different types of control groups, etc.).

• The authors‘ remarks concerning the benefits of a participatory approach when designing culturally adapted interventions was enlightening. However, the initial observation that „bottom-up“ interventions tend to be more effective than „top-down“ interventions cannot be derived from the results that are presented. Similar applies to the conclusion about emic and etic dimensions by Rosselló and colleagues (p.27), which isn’t mentioned in the article before and is accepted as fact by the authors without further discussion or referencing other supporting literature

• Results of the stakeholders discussion (if it shall remain within the article) aren’t discussed at all.

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Reviewer #1: Yes: Sophia Lobanov-Rostovsky

Reviewer #2: Yes: Ayman Mohamed El-Ashry, Lecturer of psychiatric and mental health nursing, faculty of nursing, Alexandria University, Egypt

Reviewer #3: No

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Attachments
Attachment
Submitted filename: Review_Mishu et al., 2023_PLOS ONE_submitted.docx
Revision 1

We would like to thank the peer reviewers for their valuable comments. We are submitting a revised version of the manuscript that addresses the points raised during the review process. The response to all the comments are listed in the attached 'Response to Reviewers' Table.

Response to reviewer 1 comments:

In response to the general comments:

2.We have now added a comma into the ‘study

participants’ and have identified and

corrected similar errors.

We have now ensured that all abbreviated

words are presented in full when first used.

We have changed ‘US’ to ‘USA’ in the

discussion for consistency.

Introduction: 3.As suggested by the reviewer, we have

changed the phrasing throughout to ‘young

people’. However, when describing

referenced studies, we have used the term

employed by the study (children and/or

adolescents).

To clarify this, we have now added the

following sentence into the abstract:

‘defined here as children and adolescents

aged between 8-18 years’ and in the

introduction.

Methods: 4. We have now added the PRISMA-ScR as

supplementary file 2. However, the page

number will need to be revised when the

article will be published as per the journal’s

requirement.

5. We have added some additional text to the

‘stakeholder consultation’ section. Ethical

approval was not required as it was part of

Patient and Public involvement (PPI), in the

form of consultation and participants were

selected from within existing networks.

We clarified, what interventions and why

their opinions are useful here:

Alongside the scoping review, we consulted

with one adolescent and three parent

stakeholders, each of them from an ethnic

minority community living in the UK and

with lived expertise of depression and/or

anxiety (either having experienced this

themselves or having looked after someone

experiencing this). The purpose of this was to increase our accountability to the

members of the communities we are

researching, by allowing them the

opportunity to dispute or endorse our

findings, to add in their own voices and

perspectives, and also to help us identify

what further research should be prioritised.

6.We have now added more clarification into

the section ‘excluded studies’:

‘…,18 were excluded. Reasons for exclusion

included: having the wrong population (age

group more than 18 years old) (n=9), wrong

publication type (conference abstract,

review, report, editorial, study protocol, any

grey literature) (n=1), not mentioning

cultural adaptation/related

process/effectiveness (n=7), and

unobtainable full text (n=1).’

One study title was written in Arabic but the

abstract was written in English. That study

was excluded at the abstract screening stage

due to not meeting our inclusion criteria.

We have now acknowledged the limitation

relating to bias and not including grey

literature in the discussion section: ‘We

used the main international databases for

conducting our search, however, there might

be bias in using these databases to report

interventions delivered to non-western

populations. It was beyond the scope of the

study to conduct searches in different

regional or country-specific databases and

those which included grey literature’.

7. We have clarified what outcome data were

included:

‘any relevant outcome data (depression

and/or anxiety)’.

Results: 8. We have moved tables 3a-c (containing detailed

outcome reports) into a supplementary file

and updated the findings in Table 2. We have

chosen not to amalgamate the tables as we

feel this will make the table too busy and

difficult to follow.

9. Response to comment: 'The paragraph which says that there

is ‘little or no consideration of cost-effectiveness’ of culturally adapted vs.

non adapted interventions needs some

references. Is there any evidence to

support this?': This statement came from the findings of our

review as none of the 17 identified studies

assessed cost-effectiveness, therefore no

reference was made. We have added some

text into the discussion:

‘There is little or no consideration in the

reviewed studies of the cost-effectiveness of

culturally adapted over un-adapted

interventions as none of the 17 identified

studies attempted to assess cost effectiveness and this is an area of much

needed research’.

10. We have now added this point as one of the limitations of

the review: ‘Finally, we acknowledge that, in

grouping together studies from a wide range

of different populations and from different

cultures and contexts, there is a risk that we

overgeneralise and oversimplify the actual

complexity of individual cultural needs’.

11.

In response to the comment, 'Section on ‘A participatory

approach’ – do we know why three of

the seven young people dropped out of

the programme? I think there should

be some reference to participatory

involvement in your stakeholder

interviews and results section, not just

in the discussion and conclusion' : Morsette et al. (2009) paper mentioned the

reasons for why young people dropped out

and it was not related to the intervention:

“One participant moved out of the school

district, one’s parents removed the student

from the program after child protective

services were contacted, and one participant

encountered serious medical problems and

was hospitalized.”

As the reasons for why the young people

dropped out was not related to the

interventions, we have removed the

sentence- ‘In spite of this, however, three

out of seven of the young people dropped

out of the programme’ from our manuscript.

In the Results section, we added related text.

In the stakeholder’s section we added that:

‘Based on the feedback of our stakeholder

consultations we found that a ‘participatory

approach’ by engaging different community

level stakeholders in the process of

adaptation was highly recommended'.

As suggested, we have added participatory

involvement in the results and stakeholder

sections, and have revised the related part

in the discussion.

Reviewer 2:

Many thanks to the reviewer for their encouraging comments. No improvements were

recommended.

Response to the comments of Reviewer 3:

1.We originally used these terms as these were

used in the original papers that we

referenced. However, we have now

replaced several words as appropriate.

2.We

originally used these terms as these were

used in the original papers that we

referenced. However, we have now

replaced several words as appropriate.

3. We adopted a scoping review as this is a

more exploratory approach and the

research area is still in a preliminary

stage and very broad. We now added

related text in the Introduction.

4. In response to the comment, Unfortunately, the study’s main purpose

is not clear to the reader, yet.: We

have now clarified the point and made

the following changes. Objectives:

1. Identify available studies that tested

the cross-culturally adapted interventions

for the treatment of depression and/or

anxiety among young people.

2. to explore the cross-cultural adaptation

process and frameworks used for the

cultural adaptation.

3. to examine the effectiveness of these

adapted interventions in the treatment of

depression and/or anxiety disorders

among young people.

We have also ensured that these changes

are reflected in our abstract.

Methods: 5. We have

added the following section explaining

the underlying principles for the search

strategy in the ‘information sources and

search strategy’ section:

‘The search strategy was developed using

phrases and keywords of “psychological

interventions related to depression”,

“children and adolescent populations”

and “cross-cultural adaptation”. These

terms were connected using Boolean

operators and truncations where

appropriate.’

Results: 6. We have

made the changes in Table 1.

We have added information about

diagnosis for the study by Morsette

(2009).

Country of implementation: Bernal et al.

(2019), Rossello , Bernal & Rivera-Medina

(2008) , Morsette (2009), Duarte -Ve lez

and Bernal & Bonilla (2010).

However, we have not added a column

mentioning the kind of cross-cultural

adaptation process used by each study

because adding more columns will make

the table too busy and difficult to follow.

This information has been presented

separately in Figure 2.

7.We have now moved Tables 3 a-c to a

supplementary file. Owing to this, we felt

it important to retain Table 3c for

consistency. Therefore, we present the

following: Table 3(a) for reporting RCTs,

3(b) for reporting non-RCTs and 3(c) for

reporting case studies.

Where possible we have condensed the

information presented in the tables and

have presented all anxiety measures in

italics to make it easier for the reader to

identify the different measures.

8.As this

Figure provides an idea of cultural

processes used in the included studies at

a glance, we felt it important to retain this

Figure for readers who prefer a visual

presentation of information.

9. As previously mentioned, we have now

presented Tables 3 (a-c) within a

supplementary file. This can be viewed

by readers if they prefer to see results

presented in a tabulated format. We have

however condensed the information

presented within these tables.

10. We have

now added some additional sentences to

the text:

‘Some questions were open-ended, for

instance asking participants for their

thoughts about the findings from the

existing research, whilst others were

more focused’.

Discussion: 11.As per our response to comment number

4, our updated objectives now

correspond to what is presented in the

discussion.

We have

now added the following section relating

to the participatory approach:

‘However, as a comparatively new area of

research, further well-designed studies

are needed to show the effectiveness of

these processes’.

We have also updated the e following

sentences about emic and etic

dimensions:

‘This concept of etic and emic norms

however only appeared in this study and

was only taken so far. As a comparatively

new area of research, further work is

needed to uncover which elements fall

into which category’.

We have now added sentences based on

stakeholder consultation findings

presented in the discussion section:

‘The overall positive picture of cultural

adaption drawn from the studies aligns

with the viewpoint of the stakeholder

group that we consulted. They

highlighted that such adaptations have

the potential to increase the engagement

of the participant in intervention delivery

and therefore the intervention’s efficacy.

It is worth repeating however the group’s

cautioning that such an approach needs

to go hand in hand with increasing efforts

in public, school and community education to improve awareness and

understanding of mental health and to

challenge stigma.’

Response to academic editor’s comment:

1.The manuscript meets PLOS ONE's style requirements and file naming.

2.We addressed the financial disclosure by stating that: “The authors received no

specific funding for this work.”

3. We added captions for our Supporting Information files at the end of your manuscript,

and update any in-text citations to match accordingly

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Muhammad Shahzad Aslam, Editor

Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety amongyoung people: a scoping review

PONE-D-22-35714R1

Dear,

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,

Muhammad Shahzad Aslam, Ph.D.,M.Phil., Pharm-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

Reviewer #3: 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 #3: Yes

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

Reviewer #1: Yes

Reviewer #3: N/A

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

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

**********

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: No concerns. All my comments have been addressed in this revision. It is an important and interesting piece of work, which is methodologically sound.

Reviewer #3: Dear authors, thank you for your thorough revision of the manuscript. Well noted, that all issues have been adressed. This version of the manuscript is acceptable for publication.

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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

**********

Formally Accepted
Acceptance Letter - Muhammad Shahzad Aslam, Editor

PONE-D-22-35714R1

Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety among young people: a scoping review

Dear Dr. Mishu:

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