PONE-D-23-37009Too much focus on your health might be bad for your health! – Reddit user’s communication style predicts their Long COVID likelihoodPLOS ONE

Dear Dr. Gloor,

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 manuscript has been evaluated by two reviewers, and their comments are available below.

The reviewers have raised a number of major concerns, mostly relating to methodological and analytic aspects of your submission.

Could you please carefully revise the manuscript to address all comments raised?

Please submit your revised manuscript by Mar 18 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.

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Senior Editor, PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Partly

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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

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

Reviewer #1: Yes

Reviewer #2: No

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors conducted an interesting study to explore social predictors influencing the potential for long COVID-19 among Reddit users. They used text and Social Network Analysis on 6,107 Reddit user profiles and comments. The testing of 5 hypotheses adds a structured approach to their analyses. A few suggestions for the authors' consideration to enhance the clarity and impact of their work.

1. The study categorized the users into those who had Long COVID, those never contracted covid, and those who claimed to have covid without developing long covid. To strengthen the reader's confidence in these classifications, it would be beneficial to detail how they verified the accuracy of these groups. For instance, how did they ensure that individuals in the COVID group did not exhibit long covid symptoms? Was there a validation process using a secondary dataset? Clarifying these aspects would substantiate their findings and methodologies.

2 While the paper is rich in data and analysis, the organization of the results could be enhanced for better reader comprehension. Aligning the presentation of results with the respective hypotheses they test would streamline the narrative and highlight your key findings more effectively. This re-organization could prevent important insights from being overshadowed by the extensive information provided.

Reviewer #2: Review of the article PONE-D-23-37009

"Too much focus on your health might be bad for your health! – Reddit user's communication style predicts their Long COVID likelihood"

This study is interesting. The theoretical background is well-explained and comprehensive. Unfortunately, there is a lack of reporting on the methods and the results section. Moreover, crucial confounding factors are not discussed in the study's limitations.

Methods

There is no description of the study design.

Settings: from which part of the world were the Reddit posts?

Page 14. In the methodology section, How was the random selection process performed?

How many people were identified as members of a Covid-long and Covid forum? How many of them were followed up?

Page16. About language complexity. Nothing is mentioned about language complexity being highly influenced by education.

I did not find any mention of inclusion criteria. Which were they? There is mention of English auxiliary verbs. Does it mean this study includes only English posts?

Page 18. The use of more formal language. Again, the use of more precise and formal language can be strongly determined by education.

Page 20, table 1. H2 Why is the dependent variable here COVID-19 and not Long Covid? The hypothesis H2 concerns Long COVID.

H3 Why is No Covid the control variable?

Page 22, It is likely there is bias. Maybe the long COVID group suffered more frequently from comorbidity. See this publication. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9816074/

How many posts were extracted by participant? All of them before pandemic?

Results

Page 24 Table 2. It says "Session 2". It should say "Section 2."

The models are not explained. The results are explained neither. Describe all values in the footnote or the title. For example, the values are coefficients. There are no confidence intervals of these coefficients. Why is it reported coefficients (I guess so, looking at the values) and not Odds ratios (+- 95% confidence intervals?)? The tables should be explained so they are understood independently from the manuscript text.

Page 25. What were the statistical criteria for choosing the "best" model? McFadden's R2 is higher in model 6 than in model 7.

Figure 1. It is misleading to name the control group a "Randomized control group". This name is used for experimental studies.

Page 26.

Discussion

"Table 4 provides an overview of the differences in the communication style distinguishing Long Covid users from COVID and No-COVID users." This sentence should be moved to the results section.

Page 29 discussion. The section "limitations" lacks a lot of reporting. Nothing is discussed about essential confounders, such as education, socioeconomic status, and comorbidity.

Nothing is commented on selection bias, which is very likely in these studies. No efforts have been made to deal with bias.

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Reviewer #1: No

Reviewer #2: Yes: Gloria A Aguayo

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PONE-D-23-37009R1Too much focus on your health might be bad for your health! – Reddit user’s communication style predicts their Long COVID likelihoodPLOS ONE

Dear Dr. Gloor,

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 Jun 27 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,

Michal Ptaszynski, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

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

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

Reviewer #1: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #3: 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 #3: No

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors made an effort to address previous comments and contributed to the advancement of the manuscript. The study provides insights into the classification of Reddit users into distinct COVID-19 groups through text analysis and Social Network Analysis. Additionally, the exploration into the potential psychological profiles of these groups based on social media interactions presents an innovative approach to understanding public health dynamics in digital spaces. To further refine the manuscript and maximize its contribution to the field, please considering the following suggestions:

1. Clarification of Public Health and Clinical Implications: The feasibility and effectiveness of the proposed approach in classifying users into different COVID-19 groups have been well demonstrated. The subsequent analysis that reveals diverse psychological profiles among these groups is equally intriguing. However, the broader implications of these findings, particularly in the context of public health and clinical settings, remain somewhat unclear. It would greatly benefit readers to have a clearer exposition of how these insights could be operationalized to inform public health strategies, clinical interventions, or policy-making. Elaborating on these aspects would not only enhance the practical relevance of the work but also underline its significance within the broader discourse on managing health crises through social media analytics.

2. Methodological Transparency and Participant Selection Bias: The key findings regarding the differential engagement and linguistic patterns among the identified COVID-19 groups are compelling. However, the methodology underlying participant identification and group classification warrants further elaboration. Specifically, a more detailed description of the criteria and processes used to allocate users to specific COVID-19 groups would be valuable. This includes any validation mechanisms employed to ensure the accuracy of group assignments. Additionally, considering a significant portion of the study population appears to have been sourced from specific COVID Reddit forums (i.e., 'covidlonghauler' and forums dedicated to COVID-19 positive patients), there is a potential risk of selection bias influencing the results. Providing a breakdown of the participant distribution across these forums and discussing the steps taken to mitigate any resultant bias would strengthen the credibility of the study findings.

Reviewer #3: This paper explores a novel approach to predicting Long COVID, a post-viral condition following COVID-19 infection. The authors investigate whether a user's communication style on the social media platform Reddit can be used to identify individuals at higher risk.

The idea of using communication style to predict a health outcome is innovative and potentially valuable. Utilizing Reddit data allows for access to a large and diverse population, potentially leading to more generalizable findings.

The study needs to address whether communication style is a cause or effect of Long COVID. Individuals experiencing Long COVID symptoms might naturally gravitate towards health-focused online communities.

The paper should clarify how well the communication style markers predict Long COVID compared to other factors: Are these markers specific to Long COVID, or do they indicate general health anxiety?

The findings would benefit from external validation using a different population or data source to assess generalizability.

This paper presents an intriguing concept with the potential to improve early identification of Long COVID. However, further research is needed to address the limitations mentioned above and strengthen the causal link between communication style and Long COVID risk.

The paper would be strengthened by including detailed information on sample size and demographic characteristics of the Reddit user population studied.

It would be also helpful to know what specific aspects of communication style were analyzed.

More importantly, the authors should discuss potential ethical considerations of using social media data for health predictions.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

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[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.

Too much focus on your health might be bad for your health! – Reddit user’s communication style predicts their Long COVID likelihood

PONE-D-23-37009R2

Dear Dr. Gloor,

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.

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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,

Michal Ptaszynski, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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

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

Reviewer #1: Yes

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #3: Yes

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

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

Reviewer #1: Yes

Reviewer #3: Yes

**********

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have addressed the reviewer's main concerns in this revision. However, the clean version of their submitted manuscript has track changes.

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #3: No

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