Association between post-stroke depression and functional outcomes: A systematic review

Nipaporn Butsing; Jaclene A. Zauszniewski; Suebsarn Ruksakulpiwat; Mary T. Quinn Griffin; Atsadaporn Niyomyart

doi:10.1371/journal.pone.0309158

Peer Review History

Original SubmissionJune 27, 2024
18 Jul 2024 Decision Letter - Masaki Mogi, Editor PONE-D-24-26302Association between post-stroke depression and functional outcomes: A systematic reviewPLOS ONE Dear Dr. Butsing, 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 Sep 01 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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See the Reviewers' suggestions and respond them appropriately. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Reviewer comments re: PONE-D-24-26302 In this study, the authors performed a systematic review and on the association between post-stroke depression and functional outcomes. This is a very important and relevant topic. The study is well-designed and performed. I feel however, there are some issues that need to be addressed before publication. I have included some suggestions for how the paper could be strengthened. 1. An assessment of the risk of bias in observational epidemiological studies in the original studies was omitted. Review authors should categorize risk of bias as low, medium, or high. It would have been important for the review authors to assess the risk of bias among the included studies. 2. No assessment of publication bias among the included studies is presented in the manuscript. It would have been important for the review authors to at least create a scatter (i.e., funnel) plot of the studies plotting precision (standard error) or sample size by the effect size (mean difference) to assess for publication bias. 3. Another concern is a lot of work by the review authors went into performing this systematic review in an attempt to answer the important question about whether or not post-stroke depression is truly associated with functional outcomes. Unfortunately, the blend of different observational study designs most likely led to significant heterogeneity among the studies, due to variability rather than from random chance alone. Based on the finding of this review, please clarify how the review authors concluded that post-stroke depression is significantly associated with poor functional outcomes, rather than attributing these outcomes directly to the stroke itself? Additionally, to what extent does comorbidity influence patients’ functional outcomes? Reviewer #2: The review was done systematically. Please elaborate in the discussion the importance of the findings, and the way forward. In the limitation, please discuss the different research designs in the selected papers, and how this may affect the prevalence and factors associated. ****** 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
3 Aug 2024 Author Response Reviewer 1’s Comments 1. An assessment of the risk of bias in observational epidemiological studies in the original studies was omitted. Review authors should categorize risk of bias as low, medium, or high. It would have been important for the review authors to assess the risk of bias among the included studies. Authors’ Responses: Thank you for your suggestion. In this systematic review, we used Joanna Briggs Institute (JBI) critical appraisal tools for analytical cohort, cross-sectional, and case-control studies to assess the risk of bias among included studies as mentioned in the Methods and Results sections, and details of the assessment are provided in supplementary material S3 Table. Moreover, we added more explanation of methodological quality as follows: In Methods section - Assessment of methodological quality (page 7; line 151). - Studies with a JBI score higher than 70% were categorized as high quality, moderate quality if scored between 50% and 70%, and low quality if scored lower than 50% (page 7; lines 157-159). In Results section - Methodological quality assessment of the included studies which explained that twenty (95.2%) studies were classified as high quality (low risk of bias), one (4.8%) study was classified as moderate quality (unclear risk of bias). No study with low quality (high risk of bias) was included in this review (pages 11-12; lines 222, 227-229). Moreover, the assessment of methodological quality was also added in Table 4 (pages 19-21). 2. No assessment of publication bias among the included studies is presented in the manuscript. It would have been important for the review authors to at least create a scatter (i.e., funnel) plot of the studies plotting precision (standard error) or sample size by the effect size (mean difference) to assess for publication bias. Authors’ Responses: Thank you for your suggestion. Publication bias in the form of a scatter plot could not be provided for this review due to significant variations in study design, timing of assessment, depression assessment tools, functional outcome measures, and form of reporting depression and functional outcomes among included papers. Moreover, PSD was the factor that could not be assigned to participants, so it was difficult to identify the case and control group. Although some studies reported sample size and means of PSD and non-PSD participants, they used different tools in measuring functional outcomes, and only two papers reported the same things in that they used the same assessment measures and times. These did not allow us to create a scatter plot of the studies for publication bias assessment. Therefore, we added more explanation and discussion on these limitations in the Methods and Results sections. The Methods section (page 8; lines 172-173) explained that data synthesis was done narratively since there was heterogeneity in included study characteristics. In the Results section, details are shown as follows: - Degree of dependence using mRS (page 15; line 278-280) explained that all included studies that assessed mRS reported significant variation in terms of timing of assessment (discharge, 3 months, 12 months, and five years), depression assessment tools (6 different tools), form of report degree of dependence (means or binary grouping). Therefore, these results are presented narratively. - Basic ADL (page 16; line 301-303) added that included studies assessed ADL reported significant variation in terms of study designs (cohort, cross-sectional, and case-control), timing of assessment (discharge, 6 weeks, 3 months, 12 months, 2 years, 3 years, five years, and not specific time point), depression assessment tools (7 different tools), form of report ADL (means or groups). Therefore, studies within this group are reported narratively. - IADL (pages 16-17; line 322-324) explained that included studies assessed IADL reported significant variation in terms of study designs (cohort, cross-sectional), timing of assessment (3 months, 2 years, seven years, and unidentified), depression assessment tools (5 different tools), form of report IADL (means or groups). Therefore, these results are presented narratively. - Physical and cognitive function (page 17; line 342-344), there were only three studies that utilized FIM measurement to measure this functional outcome and these three papers had significant variation in terms of study designs (cohort, cross-sectional), timing of assessment (3 months, 2 years, seven years, and unidentified), depression measures (HADS-D, BDI, PHQ-2, CES-D), reporting of physical and cognitive function. Studies within this group were therefore narratively presented. 3. Another concern is a lot of work by the review authors went into performing this systematic review in an attempt to answer the important question about whether or not post-stroke depression is truly associated with functional outcomes. Unfortunately, the blend of different observational study designs most likely led to significant heterogeneity among the studies, due to variability rather than from random chance alone. Based on the finding of this review, please clarify how the review authors concluded that post-stroke depression is significantly associated with poor functional outcomes, rather than attributing these outcomes directly to the stroke itself? Additionally, to what extent does comorbidity influence patients’ functional outcomes? Authors’ Responses: Thank you for your suggestion. We have discussed more about review results and made conclusions based on review findings and limitations as suggested (page 26; lines 455-471). Reviewer 2’s Comments Please elaborate in the discussion the importance of the findings, and the way forward. In the limitation, please discuss the different research designs in the selected papers, and how this may affect the prevalence and factors associated. Authors’ Responses: Thank you for your suggestion. The importance of the findings was elaborated in the Discussion section (page 26; lines 455-471). Moreover, the limitations of selected papers were discussed and explained more as suggested. (page 26; lines 455-471, page 27; lines 477-479). Attachments Attachment Submitted filename: Responses to reviwer comments-R1-PONE-D-24-26302.docx https://doi.org/10.1371/journal.pone.0309158.r002
7 Aug 2024 Decision Letter - Masaki Mogi, Editor Association between post-stroke depression and functional outcomes: A systematic review PONE-D-24-26302R1 Dear Dr. Butsing, 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, Masaki Mogi 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 #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0309158.r003
Formally Accepted
13 Aug 2024 Acceptance Letter - Masaki Mogi, Editor PONE-D-24-26302R1 PLOS ONE Dear Dr. Butsing, 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. Masaki Mogi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0309158.r004

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