Linguistic analysis of health anxiety during the COVID-19 pandemic

Alexandra D. Peterson; Mindy M. Kibbey; Samantha G. Farris

doi:10.1371/journal.pone.0299462

Peer Review History

Original SubmissionSeptember 4, 2023
2 Nov 2023 Decision Letter - Syed Hassan Ahmed, Editor PONE-D-23-27003Linguistic analysis of health anxiety during the COVID-19 pandemicPLOS ONE Dear Dr. Farris, 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 Dec 17 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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PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: Kindly adjust manuscript formatting in accordance with the journal's guidelines. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors should consider the following. 1. definition of health anxiety (how is it different from anxiety disorder?) 2. definition of covid stress syndrome and adjustment disorder 3. Every paragraph should be starting with ''topic sentence or words''. 4. the authors should consider explaining ''distress vs normal stress'' and the differences in bodily reaction amongst individuals. Exploring other risk factors to distress will also be great. Reviewer #2: 1. The authors mention excluding "small/limited" responses. It would be helpful, if they can mention that what no of words or characters were deemed as a small response from the participants. 2. The discussion section could highlight studies that covered platform like Reddits (if available for similar domain) and can draw a comparison with your own study as this can also give an insight to future researchers as to which method is more objective or could be explored more. Personal surveys or already posted comments. ****** 6. 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 #2: Yes: Summaiyya Waseem ******** [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. https://doi.org/10.1371/journal.pone.0299462.r001
Revision 1
22 Dec 2023 Author Response Manuscript Number: PONE-D-23-27003 Title: Linguistic analysis of health anxiety during the COVID-19 pandemic 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. RESPONSE: We have reviewed the PLOS ONE style templates at the links provided and updated the manuscript to meet the specified requirements, which can be viewed via the “track changes” markup. 2. Note from Emily Chenette, Editor in Chief of PLOS ONE, and Iain Hrynaszkiewicz, Director of Open Research Solutions at PLOS: Did you know that depositing data in a repository is associated with up to a 25% citation advantage (https://doi.org/10.1371/journal.pone.0230416)? If you’ve not already done so, consider depositing your raw data in a repository to ensure your work is read, appreciated and cited by the largest possible audience. You’ll also earn an Accessible Data icon on your published paper if you deposit your data in any participating repository (https://plos.org/open-science/open-data/#accessible-data). RESPONSE: We have received approval from our Institutional Review Board that our consent form and protocol as written allow us to share the de-identified study data. Data was uploaded to the Open Science Framework (OSF) repository, and is available here: https://osf.io/kfh53 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. a. If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. RESPONSE: We have received approval from our Institutional Review Board that our consent form and protocol as written allow us to share the de-identified study data. Thus, we have removed the language from our paper (line 191): The archived dataset is available from the corresponding author upon reasonable request. Although the collection of personally identifiable information was limited, and no data that can be used to readily identify participants was collected, the researchers do not wish to release the data publicly due to the qualitative nature of participant responses. We replaced this language with the following language: Consent for publication of raw data was not obtained, but dataset is anonymous in a manner that can easily be verified by any user of the dataset. Publication of the dataset clearly and obviously presents minimal risk to confidentiality of study participants. b. If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. RESPONSE: Data was uploaded to the Open Science Framework (OSF) repository, and is available here: https://osf.io/kfh53 4. 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. RESPONSE: We thank the reviewers for noting discrepancy of references cited. A review of the manuscript was conducted to update the reference list. A review of the reference list was then conducted, and no articles were found to be of retracted status. All references are fully cited in the reference list. Reviewer #1: 1. The authors should consider the following: definition of health anxiety (how is it different from anxiety disorder?) RESPONSE: We have added clarification on the difference between health anxiety and anxiety disorders through the addition of another paragraph. The revised text reads (line 63) as follows: Health anxiety is characterized by fears of being exposed to and contracting a serious illness, or, the belief that one has already developed a serious disease or medical condition [6]. More broadly, health anxiety can refer to the tendency to over-attend to and become alarmed by health-related stimuli [4], and ranges on a continuum from mild to severe. While mild to moderate health anxiety may be adaptive and lead to engagement in appropriate health and safety measures, people with severe health anxiety frequently exhibit high levels of functional impairment, as well as overutilization of healthcare services [7, 8]. Clinically elevated health anxiety is regularly expressed as persistent worry and maladaptive beliefs about health-related stimuli, along with excessive engagement in subsequent compensatory behaviors (e.g., excessive handwashing, reassurance-seeking). Lifetime prevalence of clinical health anxiety ranges from 1.3% to 10% in the general population, and is exhibited in psychiatric disorders such as illness anxiety disorder and somatic symptom disorder [4]. 2. The authors should consider the following: definition of covid stress syndrome and adjustment disorder RESPONSE: We have added clarification on the definitions of covid stress syndrome and adjustment disorder. The revised text reads (line 57) as follows: While an adjustment disorder marks development of behavioral or emotional symptoms in response to an identifiable stressor—that are out of proportion to the intensity of that stressor [4]—COVID Stress Syndrome is a recently proposed adjustment disorder specific to the SARSCoV2 infection, with identifiable domains including: fear of viral infection, excessive worry about the pandemic, and pandemic-related traumatic stress symptoms [5]. These symptoms share characteristics of health anxiety. 3. The authors should consider the following: Every paragraph should be starting with ''topic sentence or words''. RESPONSE: We added a topic sentence at line 67 to provide clarity to readers. The revised text reads as follows: Health anxiety is characterized by fears of being exposed to and contracting a serious illness, or, the belief that one has already developed a serious disease or medical condition. 4. The authors should consider the following: the authors should consider explaining ''distress vs normal stress'' and the differences in bodily reaction amongst individuals. Exploring other risk factors to distress will also be great. RESPONSE: We added the following sentence to line 44 to add clarity to “distress” out of proportion to the norm, as well as to inform risk factors of such distress: Pre-existing daily stressors coupled with the additional stressors associated with the COVID-19 pandemic (e.g., social isolation, financial instability, food insecurity) can create a compounded effect of distress. Reviewer #2: 1. The authors mention excluding "small/limited" responses. It would be helpful, if they can mention that what no of words or characters were deemed as a small response from the participants. RESPONSE: Please see lines 172–178, where we define the required criteria for a complete response. 2. The discussion section could highlight studies that covered platform like Reddits (if available for similar domain) and can draw a comparison with your own study as this can also give an insight to future researchers as to which method is more objective or could be explored more. Personal surveys or already posted comments. RESPONSE: We added the following language to address the topic of language use in other types of platforms, as well as how this may be address in future research (lines 306–312): Although our study was conducted through a systematic scientific survey format, other studies have examined data that is generated in an unprompted fashion, through analysis of online language platforms such as Weibo [14] and Facebook [13], as well as language used in news reports [14]. It is possible that differences in language use exist when comparing data gathered via systematic, experimental methodology versus data that is generated naturalistically. Future research could examine if differences in language use in online platforms, such as Reddit, may be attributed to participant self-selection bias. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0299462.r002
18 Jan 2024 Decision Letter - Syed Hassan Ahmed, Editor PONE-D-23-27003R1Linguistic analysis of health anxiety during the COVID-19 pandemicPLOS ONE Dear Dr. Farris, 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 Mar 03 2024 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, Syed Hassan Ahmed Guest 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. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The use of ''health anxiety'' is still somehow confusing and most professionals trained in mental health might still not be able to understand it. Professionals in mental health and psychiatry communicate either by using Diagnostic and statistical manual (DSM) or the international classification of diseases (ICD). According to the authors definitions of heath anxiety, it might qualify as hypochondriasis or illness anxiety disorder (ICD and DSM 5 respectively). The authors should consider adopting the DSM/ICD nomenclature or adding text to explain the equivalent of health anxiety in ICD or DSM. Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: DR ALEX ZUMAZUMA (MBBS, MMED PSYCHIATRY) Reviewer #2: Yes: Summaiyya Waseem ******** [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. https://doi.org/10.1371/journal.pone.0299462.r003
Revision 2
5 Feb 2024 Author Response Reviewer #1: 1. The use of ''health anxiety'' is still somehow confusing and most professionals trained in mental health might still not be able to understand it. Professionals in mental health and psychiatry communicate either by using Diagnostic and statistical manual (DSM) or the international classification of diseases (ICD). According to the authors definitions of heath anxiety, it might qualify as hypochondriasis or illness anxiety disorder (ICD and DSM 5 respectively). The authors should consider adopting the DSM/ICD nomenclature or adding text to explain the equivalent of health anxiety in ICD or DSM. RESPONSE: We have added clarification on the definition of health anxiety as a transdiasgnostic vulnerability factor exhibited in multiple DSM-5 diagnoses. The revised text reads (line 62) as follows: Clinically elevated health anxiety is regularly expressed as persistent worry and maladaptive beliefs about health-related stimuli, along with excessive engagement in subsequent compensatory behaviors (e.g., excessive handwashing, reassurance-seeking). Lifetime prevalence of clinically elevated health anxiety ranges from 1.3% to 10% in the general population [4]. Studies have shown that elevated health anxiety is a transdiasgnostic vulnerability factor exhibited in multiple DSM-5 psychiatric disorders such as illness anxiety disorder and somatic symptom disorder as well as panic disorder and obsessive-compulsive disorder [4, 5]. Attachments Attachment Submitted filename: Reviewer_Response.docx https://doi.org/10.1371/journal.pone.0299462.r004
12 Feb 2024 Decision Letter - Syed Hassan Ahmed, Editor Linguistic analysis of health anxiety during the COVID-19 pandemic PONE-D-23-27003R2 Dear Dr. Farris, 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, Syed Hassan Ahmed Guest Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0299462.r005
Formally Accepted
16 Feb 2024 Acceptance Letter - Syed Hassan Ahmed, Editor PONE-D-23-27003R2 PLOS ONE Dear Dr. Farris, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Syed Hassan Ahmed Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0299462.r006

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