Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population

Catarina Vitorino; Maria Cristina Canavarro; Carlos Carona

doi:10.1371/journal.pone.0301527

Peer Review History

Original SubmissionJune 5, 2023
11 Jan 2024 Decision Letter - Flávia L. Osório, Editor PONE-D-23-17263Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general populationPLOS ONE Dear Dr. Vitorino, 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. ============================== The reviewers raised small points that need adjustments/clarifications ============================== Please submit your revised manuscript by Feb 25 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. 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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: This is a 6-month longitudinal cohort study comparing the questionnaire responses of a sample of 180 nurses to those from a sample of 158 persons in the general population during the Covid pandemic. Questions covered issues of depressive, anxiety, trauma and fear of Covid-19 symptoms. The objective is to evaluate the stability or change in adaptation outcomes between these groups at two time points separated by 6 months. Comment It would be good to know the power of the study as it would add to the validity of the study. The attrition rate of 75% between T1 and T2 is high and this would affect the validity of the study and introduce bias into the study. So have there been attempts to use the "intention to treat" protocol to account for the attrition and has this been planned for in the planning phase of the study? On data presentation, data presented in the tables need not be repeated in the text but significant points should be highlighted in the text. You have highlighted some of the biases and shortcomings of the study. In Fig 1, the slopes of the lines for depression, anxiety and trauma were divergent between the nursing group and the general population. This suggests that over time, the symptoms continued to rise in the nursing group in contrast to the general population where the symptoms tended to decline over time, between T1 and T2. Fear of the pandemic tended to decline over time for both groups Reviewer #2: The manuscript entitled "Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population” is well organized and written clearly. The main goals of the paper are clear, and the research is relevant to the field of health psychology, specifically to the study of the impact of COVID-19 outbreak on health professionals. The research has a longitudinal design, which makes the results more valid and meaningful. The abstract is well structured and summarizes the methodology and results of the study. The authors did a good review of previous literature to support their research. Regarding the Method, the description of the characteristics of the general population sample could be enriched so that it was clearer who the participants were (e.g., professional status or job), also because sample was collected through online recruitment. In Measures, the authors of the scales “ODSIS”, “OASIS”, “IES-6” and “The Fear of COVID-19 Scale” should be specified in the text. The data analysis is in line with the research goals. Nevertheless, the analysis of the variable Risk group for COVID-19, that was ignored in the results, could provide interesting findings. The discussion of the results is appropriate and based on recent studies. The authors report the limitations of the study and its implications. ****** 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. 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Revision 1
1 Mar 2024 Author Response Reviewer #1 This is a 6-month longitudinal cohort study comparing the questionnaire responses of a sample of 180 nurses to those from a sample of 158 persons in the general population during the Covid pandemic. Questions covered issues of depressive, anxiety, trauma and fear of Covid-19 symptoms. The objective is to evaluate the stability or change in adaptation outcomes between these groups at two time points separated by 6 months. Comment It would be good to know the power of the study as it would add to the validity of the study. The attrition rate of 75% between T1 and T2 is high and this would affect the validity of the study and introduce bias into the study. So have there been attempts to use the "intention to treat" protocol to account for the attrition and has this been planned for in the planning phase of the study? • Thank you for raising this point. We do endorse your concern. The influence of the attrition rate on the results is depicted in the Limitations section, especially due to “research fatigue” in the aftermath of a mass traumatic event such as the COVID-19 pandemic (Patel et al. 2020). However, the literature suggests that the intention-to-treat protocol usually applies to randomized clinical trials (Fisher et al, 1990). According to your note, we tried to clarify this topic (“However, the literature shows that estimates of associations between variables do not seem to be affected by attrition rate when it is dependent on follow-up variables, which may support the generalizability of the present study. Nevertheless, future studies should address this issue by using more sophisticated analysis to handle missing values and reduce bias (e.g., multiple imputation analysis) (Gustavson et al., 2012).”). On data presentation, data presented in the tables need not be repeated in the text but significant points should be highlighted in the text. • As you recommended, information presented in tables were better described in the text (e.g., “Regarding the clinical levels of symptoms presented in Table 2, nurses reported higher levels than the general population for all measures, ranging between 22.8% and 31.7% at T1, and 21.7% and 43.3% at T2. Among the general population, symptoms with clinical significance ranged between 15.8% and 29.1% at T1, 11.4% and 24.7% at T2.”) You have highlighted some of the biases and shortcomings of the study. • Thank you for acknowledging our best efforts to provide to the PloS One‘s readers with a clear, and reliable research outcome. In Fig 1, the slopes of the lines for depression, anxiety and trauma were divergent between the nursing group and the general population. This suggests that over time, the symptoms continued to rise in the nursing group in contrast to the general population where the symptoms tended to decline over time, between T1 and T2. Fear of the pandemic tended to decline over time for both groups. • Thank you for sharing your insights on the analysis of these results, which are very much aligned with the comments that we have elaborated in the Discussion section: “The main findings may be summarized as follows: first, nurses generally reported higher levels of symptoms than the general population; second, the mental health outcomes of nurses tended to deteriorate over time, except for fear of COVID-19; third, all mental health outcomes of the general population tended to improve from T1 to T2; fourth, the difference in depressive, anxiety, and trauma symptoms over time was significant between nurses and the general population; and finally, fear of COVID-19 significantly decreased over time for both groups, but especially for the general population.”. Reviewer #2 The manuscript entitled "Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population” is well organized and written clearly. The main goals of the paper are clear, and the research is relevant to the field of health psychology, specifically to the study of the impact of COVID-19 outbreak on health professionals. The research has a longitudinal design, which makes the results more valid and meaningful. The abstract is well structured and summarizes the methodology and results of the study. The authors did a good review of previous literature to support their research. Regarding the Method, the description of the characteristics of the general population sample could be enriched so that it was clearer who the participants were (e.g., professional status or job), also because sample was collected through online recruitment. • Thank you so much for your careful and comprehensive review. The general population was better described in the Results section (“As for the general population, most individuals had an academic degree (47.5%) and worked on-site (53.2%).”) with additional information that was collected in the sociodemographic questionnaire. In Measures, the authors of the scales “ODSIS”, “OASIS”, “IES-6” and “The Fear of COVID-19 Scale” should be specified in the text. • The authors of the scales were identified in the description of each one of them (please check subsection Measures, section “Methods”). The data analysis is in line with the research goals. Nevertheless, the analysis of the variable Risk group for COVID-19, that was ignored in the results, could provide interesting findings. • Thank you for your note. As you mention, being part of the risk group may have a strong effect on mental health outcomes. Thus, the importance of considering this factor when interpreting the results of the longitudinal impact of the pandemic was further detailed in the revised version of the manuscript (“Having underlying medical conditions, living in poor housing settings, or integrating a social minority represented a higher risk for those who got sick from COVID-19, making them more vulnerable to develop acute infection and clinical levels of psychological symptoms [65]. Therefore, the longitudinal effects of the study should be interpreted with caution within the context of the pandemic.”). The discussion of the results is appropriate and based on recent studies. The authors report the limitations of the study and its implications. • Thank you for recognizing our efforts in contributing with an informative and honest submission. Attachments Attachment Submitted filename: Response Letter_Longitudinal_PLOS.docx https://doi.org/10.1371/journal.pone.0301527.r002
18 Mar 2024 Decision Letter - Flávia L. Osório, Editor Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population PONE-D-23-17263R1 Dear Dr. Vitorino 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at http://www.editorialmanager.com/pone/ and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Flávia L. Osório, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0301527.r003
Formally Accepted
3 Apr 2024 Acceptance Letter - Flávia L. Osório, Editor PONE-D-23-17263R1 PLOS ONE Dear Dr. Vitorino, 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. Flávia L. Osório Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0301527.r004

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