Dear Dr. Jabessa,

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 Oct 28 2022 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.

• 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,

Jamie Males

Editorial Office

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

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 .

2. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service.

Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services.  If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free.

Upon resubmission, please provide the following:

The name of the colleague or the details of the professional service that edited your manuscript

A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)

A clean copy of the edited manuscript (uploaded as the new *manuscript* file).

3. Thank you for stating the following financial disclosure:

“NO”

At this time, please address the following queries:

a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c) If any authors received a salary from any of your funders, please state which authors and which funders.

d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

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

4. Thank you for stating the following in the Funding Section of your manuscript:

“Jimma medical center has sponsored for cost of data collection.”

We note that you have provided funding information that is not currently declared in your Funding Statement. However, 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:

“No”

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

5. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.

6. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section.

[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?

Reviewer #1: Partly

**********

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

Reviewer #1: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

**********

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

Reviewer #1: No

**********

Reviewer #1: The comments

It is a great honor to review the manuscript in this well-recognized journal. I am delighted.

Then I have some comments as follows

The paper is nice and tried to assess an important topic. But I have some comments.

1. The author did not make it clear who are the caregivers. The family? The wives? The paid nurses? Or others, and how did the author get those care givers….all accompanying individuals to the hospitals are not the caregivers….

2. PHQ 9 is meant for screening purposes, not for diagnosis. Then how the diagnosis of depression was made?

3. low social support is considered a predictor of depression, but is it for stroke patients or for caregivers?

4. having no health insurance is again a predictor of depression? This is not clear. Paid caregivers or family members?

6. The author did not narrate the details of the caregivers, are they professionals?... nurses,,,,

**********

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

**********

[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.

Dear Dr. Jabessa,

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 31.12.2022. 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.

• 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,

Saurav Basu, M.D.

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: thank you for response. the authors almost responded for the concerns but I have some questions.

what is the practice of health insurance in your set up?

is there any care give who get paid?

Reviewer #2: The study has a focus; however, it lacks clarity on multiple dimensions (differentiation between variables relevant to stroke caregivers vs those of stroke survivors, page 1, keywords), inclusion/exclusion criteria, lines 95-98, 115,116, sampling techniques, lines 94-104). The data collection tool is a combination of multiple scales that adress both stroke survivors and stroke caregivers as well which creates another site of confusion, lines 111-113. Finally, an in-depth proof reading is required to ensure English language errors are fixed, lines 69, 70,71,72,86.

**********

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:  Nariman Ghader

**********

[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.

Dear Dr. Jabessa

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 31.05.2023. 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.

• 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 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,

Saurav Basu, M.D.

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.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: All comments have been addressed

**********

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

Reviewer #3: Partly

**********

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

Reviewer #3: Yes

**********

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

The PLOS Data policy

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

**********

Reviewer #3: Thank you very much for providing this updated version of the article.

In paragraph Data processing and analysis, please explain with more detail how you built the muktivariate regression model, was it backward or forward?

In the Discussion section, please provide the limitations due to the sampling (facility-based), how Berkson's bias can be present in the study and the overall effect on the OR estimation that this study provides, compared to a population-based study.

**********

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 #3: No

**********

[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

Dear Dr. Jabessa,

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 Oct 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.

• 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 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,

Nega Degefa Megersa, msc

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:

1. Avoid italicizing your text in the abstract section unless particularly requested.

2. Consider the proper and consistent use of analysis method in your study. I think the difference between multivariate and multivariable logistic regression analysis be noted and used accordingly.

3. Line (30): you can make it, the association between depression and associated factors was estimated using odds ratio with its 95%CI and p-value.

4. Line (32): a total of 306 family caregivers participated in the study, making a response rate of 98.7%.

5. Line (39): it is good to put the meaning of your finding in the conclusion. What does more than 1/3rd prevalent mean in the study’s context. It is also good to highlight the implication of this finding to the study’s context.

6. Line 57: It is a long-standing and weakening condition that has a profound negative effect on their families. It looks grammatically incorrect, please make sure the sentence is coherent with preceding one.

7. Line72: Although depression is very common among stroke caregivers, little is found in literature. Since most stroke patients spend most of their time at home, they need extensive physical and emotional care. Correct as underlined and red marked in the sentence.

Line 76: The finding revealed that every year around 33% of people left uunemployed due to depression, more than non-depressed. Correct the spelling as unemployed. The background doesn’t adequately address context of the problem in an orderly pattern (from global, to local)

Line 83: So, our study was aimed to assess the prevalence and associated factors of depression among study participants at specified area. Put the area instead.

Line 81: Worldwide, the overall pooled prevalence of depressive symptoms among stroke family caregivers was 40.2%, this is a report from a systematic review, which seems inconsistent with the idea on line 72, which states that little is found on literature (Although depression is very common among stroke caregivers, little is found on literature). So, I advise the authors to resolve this inconsistency.

Line (168): Chi-square and odds ratio were done to determine the association of variables. The model goodness of fit was checked by Hosmer and Lemeshow.

Suggestion to improve clarity.

The association between the outcome and explanatory variables were measured using Chi-square and odds ratio.

Please specify the value of the model fitness test, to show whether the model adequately fits the data.

Line (184): Avoid reciting referenced table by using indicative terms like see table1. I think it is enough to cite the table or figure like (table 1) or (figure 1).

Line (77): I think you need to extend you’re the limitation of your study by adding the nature of your sampling method (consecutive sampling) and the generalizability of your study as well as the geographical limitation of your study which is not representative of the wider context.

Line (82): suggestion to improve your conclusion.

Make sure your conclusion captures the interpretation and the possible implication of the finding instead of putting the value as indicated in the result. Instead of mentioning as more than one third which is vague, you can present the finding as high, consistent or low relative to the previous study, which highlights the trend and relative importance of the finding.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #4: (No Response)

**********

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

Reviewer #4: Partly

**********

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

Reviewer #4: Yes

**********

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

The PLOS Data policy

Reviewer #4: Yes

**********

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

Reviewer #4: No

**********

Reviewer #4: Title: Prevalence and associated factors of depression among stroke family caregivers on follow up at Jimma medical center, southwest, Ethiopia: A cross-sectional study

Thank you for considering me to review this manuscript. The paper raises a significant problem since caretakers pass through several challenges, including mental issues, while caring for patients with stroke. I put my concerns as follows:

Abstract

The background section of the abstract must show the burden of the problem, the gap, and the intention of this study. You can merge the objective here.

Add the study period under the method section. Appropriately use words like "multivariate and multivariable." The sample size you put under the method and result sections are the same; if so, why is the response rate 98.7%?

Correct the upper limit of the confidence interval for the factor "spending more than 13 hours per day on care (AOR = 5.72, 95% CI: 2.32-1.12)."

Introduction

The introduction section lacks critical components, and intensive revisions are mandatory. The figures (prevalence of depression among caretakers of stroke patients) from previous studies must be addressed in a global-to-local context approach. Keep coherence and avoid contradicting ideas. For example, in line 72, you write, "…little is found on literature…" On the other hand, you put the pooled prevalence of depression from lines 81 to 83. In addition, the risk factors are not well addressed. Furthermore, some information is about stroke patients and others about their caretakers; be focused on your title.

The risk factors of depression among caretakers must also be included,and add citations appropriately. Previously proposed solutions at the national level or in any means, if any, should be included. The limitations of previously published studies and the gaps identified must also be included.

Furthermore, it is better to start with the global and national burden and impacts of stroke in different dimensions, including the economic consequences.

Methods

There are critical problems in this section. The source and study population are not appropriately defined. You write parents, offspring, siblings, spouse, and other relatives are the sources population, and if you get two during the visit, you select one of them by lottery method. Imagine if the stroke patient is married and his partner and his relative come together for the follow-up visit their relative has a 50% chance to be included in this study. I think this is unacceptable because his partner lives with him and she suffers a lot more than the relative. So, from the outset, the lottery method must be for equal relationships; otherwise, the findings are either over or underestimated. You tried to see it as a factor; however, the sampling approach is unacceptable.

Sampled and study populations are different; hence, you must modify your study population.

Appropriately organize the headings and the information within each header. For example, the information under the data collection and procedure from lines 131 to 149 does not align with the title. You have to modify it with other appropriate headings. Moreover, how did you organize your tool? Several missed variables may affect depression, so why do you extensively include them from the outset? Some variables were not appropriately measured, e.g. How did you assess alcohol use? In general, the method section needs further detailed clarification.

Results and discussion

Paraphrase the sentences and appropriately link the tables and figures; do not write as see Table 1 below; instead, put like (Table 1). Where is figure one?

Modify fragmented paragraphs under the discussion section. The majority of the references are outdated; please replace them with recent ones.

**********

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

**********

[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

Dear Dr. Jabessa, 

Please submit your revised manuscript by Nov 03 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 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,

Nega Degefa Megersa, msc

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:

Line #20: So, our aim was to assess.

Suggestion: make it; the aim of this study was to assess.

Line #23: An institution-based cross-sectional study involving 306 family caregivers of stroke patients selected through a consecutive sampling method were employed.

Suggestion: an institution-based cross-sectional study of 306 family caregivers of stroke patients was conducted using a consecutive sampling method.

Line #24: An interviewer- administered technique using a structured questionnaire was conducted.

Suggestion: A structured interviewer-administered questionnaire was used to collect data.

Line #39: This study found that the prevalence of depression among family caregivers of stroke patients was almost in similar range with the pooled prevalence of world report.

Suggestion: I suggest that it is important to present the meaning of your findings in the context of your study. This means explaining what your findings mean for the participants in your study, and for the broader field of research.

As your study focuses on a specific population, it is not appropriate to make general comparisons to the global context.

Line #80: So, our study was aimed to assess the prevalence and associated factors of depression among study participants at Jimma Medical Center.

Suggestion: This study aimed to assess the prevalence and associated factors of depression among family caregivers of patients with stroke at Jimma Medical Center.

Line #182 and 195: Nearly two-third, 64.7% (n=198) of family caregivers and more than half,

182 54.2% (n=166) of stroke patients were males. (See table 1 below). Among users of khat, alcohol, and tobacco over the past three months, about 29.3% (n=48), 29.4%(n=50) and 44.9%(n=61) were found to have depression respectively. (See table 2 below)

Consider my former comment and make it (table 1) and (table 2).

Line #251; UK university of 251 Glasgow (29)(30).

Suggestion: consider merging the citations. Apply the same format to line 256; this is supported by study done in Japanese (27)(32)

Line #275: As it was interviewer administered social desirability bias might be evident and being facility-based study may decrease the generalizability of the result of the finding.

Suggestion: consider re-writing as since the study was interviewer-administered, social desirability bias was a potential concern. Additionally, the facility-based nature of the study may limit its generalizability.

Line #276: Some of the information was gathered from the patient's hospital case folder, which is secondary data.

Yes, using secondary data can be a limitation, but it is not necessarily a limitation in and of itself. The quality and reliability of secondary data can vary broadly. Instead, it is good to consider some of the potential limitations of using secondary data in research including:

- The data may not have been collected in a way that is fitting for your research question.

- The data may be incomplete or inaccurate.

- The data may be biased.

- The data may not be generalizable to your population of interest.

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

Dear Dr. Jabessa,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 11 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.

• 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 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,

Nega Degefa Megersa, Msc

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:

Comments to authors

The document still contained some grammatical errors, typos, and punctuation mistakes. Here are some of the flaws:

Line # 24: capitalize “a” in the beginning of the sentence.

Line # 28: The association between depression and associated factors was estimated using an odds ratio at 95%CI and p-value of 0.05 on the final model. The sentence has grammatical problems. Modifications should be considered as follows:

The association between depression and associated factors was estimated using an odds ratio of 95%CI and a p-value of 0.05 in the final model.

Line # 31: conclusion and recommendation.

Look at the manuscript formatting and give a heading accordingly. For instance, there is no portion, namely the conclusion and recommendation. Instead, it is a conclusion.

Line # 84: from July 15–Sept 15, 2021. Make it September.

Line #88: Currently it provides service for more than 15 million populations.

Modify the sentence as follows: Currently, it provides service for over 15 million people.

Line #89: The study was conducted at a chronic disease follow up clinic, among family caregivers of stroke patients. The sentence has erroneous use of punctuation. Omit the comma and include a hyphen, as follows:

The study was conducted at a chronic disease follow-up clinic among family caregivers of stroke patients.

Line #115: The independent variables associated with caregivers include socio-demographic.

The independent variables in the study are sociodemographic variables,...

Though technically independent in nature, these factors were not specifically tested for their association with the outcome variable in this study. Instead of implying a potential relationship, it's best to simply refer to them as independent variables included in the research.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #5: (No Response)

Reviewer #6: All comments have been addressed

**********

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

Reviewer #5: (No Response)

Reviewer #6: Yes

**********

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

Reviewer #5: Yes

Reviewer #6: No

**********

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

The PLOS Data policy

Reviewer #5: Yes

Reviewer #6: Yes

**********

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

Reviewer #5: No

Reviewer #6: Yes

**********

Reviewer #5: General comment: The authors assessed the prevalence and associated factors of depression among caregivers of patients with stroke in South West Ethiopia. The authors used standardized measures to meet their objectives. They are commended for coming up with this study. The manuscript has a number of typos and grammatical errors. The Authors are advised to do a detailed proof reading before the manuscript is published.

Please see my specific comments below.

Abstract:

Is well written

Background.

Line 69 is not clear, please modify

Check line 72, 75 and 77 (grammatical errors and typos).

Line 78 that starts with “Worldwide” should have come earlier in the background.

Generally, the authors have tried to review the previous literature on the subject. However, the whole background lacks coherence and the rhetoric connection to create a compelling story for carrying out this study. The authors can do better.

Line 87 “Now a day it become under federal Ministry………This sentence makes no sense at all.

Line 94: what do the author mean by source of Population.

97 Whereas,” w should be capital

Line 1115: Caregivers were include?

The results and analysis appear to be well and good.

Reviewer #6: Reviewer comments to authors:

The authors structured the paper nicely to assess the prevalence and associated factors of depression among stroke family caregivers on follow-up at Jimma Medical Center, southwest Ethiopia. I found that this paper intends to fill a gap in the literature related to depression among stroke family caregivers on follow-up. However, I found some issues discussed below:

1. In the introduction:

- There are grammar and/or typing errors in your manuscript. For instance, on line 75, "hahigher..." Please correct it with “have a higher.”.

2. In the methods:

- There are many kinds of logistic regression models. I realized that you have used binary logistic regression. Thus, please replace logistic regression by binary logistic regression analysis in your manuscript.

3. In the results:

- On Table 2, have you presented the results of bivariable and multivariable binary logistic regression analyses together? What does it mean? Please correct the table. If it’s the result of multivariable binary logistic regression analysis, say, “Table 2: Multivariable binary logistic regression analysis for factors associated with depression among family caregivers of patients with stroke follow-up treatment at Jimma Medical Center, southwest Ethiopia, 2021.”.

- What does independent factor mean? Please say either independent variables or factors.

**********

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 #5: No

Reviewer #6: No

**********

[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

Attachments

Attachment

Submitted filename: Reviewer Comments to authors_R5.docx

PONE-D-22-12677R6

prevalence and associated factors of depression among stroke family caregivers on follow up at Jimma medical center, southwest, Ethiopia: A cross-sectional study

PLOS ONE

Dear Dr. Jabessa,

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 Jul 05 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.

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,

Nega Degefa Megersa, Msc

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:

Line 25: A structured interviewer-administered was used to collect data.

Do you mean a structured interviewer-administered questionnaire was used to collect data?

Line 28: The association between depression and associated factors was estimated using an odds ratio of 95%CI and a p-value of 0.05 in the final model.

Logistic regression is a common method to estimate the association between outcomes and independent variables. But it's important to note that a p-value less than 0.05 (not exactly 0.05) is typically used as evidence of a statistically significant association. Additionally, the strength of this association can be measured by an odds ratio, along with its 95% confidence interval.

Line 85 to 90: Although depression is very common among stroke caregivers, little is found on literature regarding to our country.

Generally, the caregivers’ are more vulnerable to develop emotional, physical related problems 88 and limited social life than the general population (14). This study was aimed to assess the 89 prevalence and associated factors of depression among family caregivers’ of patients with stroke 90 at Jimma Medical Center (JMC).

To strengthen your writing, consider combining the existing paragraphs into a single, unified one. This new paragraph should clearly explain the gap in current research (what's missing) and how your study aims to fill that gap (the purpose). Additionally, you might want to review the paragraphs for any grammatical errors to ensure clarity and readability.

Although depression is very common among stroke caregivers, little is found in literature regarding our country. Generally, caregivers are more vulnerable to developing emotional, physical related problems and limited social life than the general population (14). This study was aimed at assessing the prevalence and associated factors of depression among family caregivers of patients with stroke at Jimma Medical Center (JMC).

Line 112: sample size determination

To ensure adequate power for both objectives in your study,

Did you calculate the sample size needed to identify significantly associated factors for your second objective? Compare this sample size to the one calculated for your first objective? If the sample size required for the first objective is larger, then you should use the larger sample size for your entire study.

Consider clearly outlining these steps in your sample size determination.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #7: (No Response)

**********

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

Reviewer #7: Yes

**********

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

Reviewer #7: Yes

**********

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

The PLOS Data policy

Reviewer #7: Yes

**********

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

Reviewer #7: No

**********

Reviewer #7:  Dear editor,

Thank you very much for giving me the chance to read and review this important manuscript. Overall, the authors reported important findings, but the English language and grammar should be improved.

Abstract:

“A structured interviewer-administered (What?)…………was used to collect data” Please improve this sentences.

“The Patient Health Questionnaires-9 (PHQ-9) was used to screen outcome variables (i.e., depression)” It's good to say variable instead of variables since your outcome variable one/depression.

“This study found that the prevalence of depression among family caregivers of stroke patients was 35.9% and almost the same with similar study design conducted across different countries of the world.” Please remove 35.9% here and modify the sentences. In addition, could you please write a specific and applicable recommendation (who will be responsible for detecting it early)?

Introduction

Overall, it needs proofreading in language and grammar. “Depression has the greatest decrement in the health status of the population either alone or in conjunction with other chronic medical illnesses such as Asthma, Angina, and/or diabetes.” Please make this sentence clear and meaningful.

“Most of the time, caregivers have been considered as one of the overlooked patients and this could result in poor health outcomes among caregivers (10).” Caregivers are not patients; it is also an offensive word. Please modify it.

Please explain the gap in the study since there are multi center studies in Ethiopia, for example https://doi.org/10.2147%2FNDT.S418074). Your study is limited to an institution and a specific place. What is new about this study?

Methods

What is the reason behind including caregivers who attend for two weeks or more?. Do you believe the degree of depression is similar between the different groups of family members, for example, the mother and other relatives?

Why did you use the Nigerian study to calculate the sample since there is a study in Ethiopia?.

Result and discussion:

“From the total family caregivers about 46.4%(n=142), 44.4%(n=136) and 44.4% (n=136) of them were used khat, tobacco and alcohol over the past three months respectively” Please see your data again for this report, since you are reporting that 44.4% of caregivers are smokers.

Please proofread the grammar in your discussion. While interpreting your findings with other literature, please give clear justification for why your study is lower or higher than other studies. For example, consider how socioeconomic differences between countries contributed to depression. How using PHQ-9 and BDI varies on prevalence of depression, etc.

“The other supporting reason might be in that, the study was conducted among family caregivers of stroke patient whose illness duration was less than six months in which the depression status increased during the acute phase of the illness(26).” Modify sentences and no need of coma.

Conclusion

“This study found that the prevalence of depression among family caregivers of stroke patients 295 was almost in similar range with the pooled prevalence of world report” Why do you compare it with a global study since there are local studies? If there is a pooled study, what is the value of doing this single study?

**********

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 #7: Yes:  Alemayehu Molla Wollie

**********

[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

prevalence and associated factors of depression among stroke family caregivers on follow up at Jimma medical center, southwest, Ethiopia: A cross-sectional study

PONE-D-22-12677R7

Dear Dr. Jabessa,

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 Editorial Manager®  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,

Nega Degefa Megersa,  

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: