PONE-D-24-11475Disability and depression among stroke survivors attending rehabilitation facilities at three designated tertiary care hospitals in Bangladesh: A cross-sectional studyPLOS ONE

Dear Dr. Ahmed,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Palash Chandra Banik, MPhil

Academic Editor

PLOS ONE

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3. We are unable to open your Supporting Information file [Disability and depression.sav  ]. Please kindly revise as necessary and re-upload.

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Reviewers' comments:

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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: 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: No

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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: A good study with a sound study design which addresses an important issue in LMICs. Suggest language editing so that it meets international standards. The limitations section can be expanded. The predictors of depression can be analysed more scientifically.

Reviewer #2: Review Comments to the Author

Thank you for the opportunity to review the manuscript titled “Disability and depression among stroke survivors attending rehabilitation facilities at three designated tertiary care hospitals in Bangladesh: A cross-sectional study.” Please see my points below.

Abstract:

1) Revise the background of the abstract as follows” Poststroke depression (PSD) is a highly prevalent and serious mental health condition affecting a significant proportion of stroke survivors worldwide. While its exact causes remain under investigation, managing PSD presents a significant challenge”.

2) Revise “Depression and disability were measured using the Patient Health Questionnaire-9 and Modified Rankin Scale” with “Depression and disability were measured using the Patient Health Questionnaire-9 and the Modified Rankin Scale, respectively”

3) Authors stated “58.1% of them experienced a moderate to significant level of depression”. What does significant means here. It should be severe/extremely severe or something like that.

4) Revise “ Participants whose medical expenses not participants who had.

5) Rewrite the conclusion section. This part should include a brief summary of all the findings along with recommendations based on the data.

Introduction:

1. While the global context is important, consider emphasizing the urgency of understanding depression in Bangladeshi stroke patients due to limited data (lines 74-75).

2. Strengthen the transition by explicitly stating how your study addresses the identified gap (line 76).

3. Consider combining lines 61-63 to improve readability.

Methodology

1. Add reliability statistics for the modified Rankin scale (mRS) and The Patient Health Questionnaire-9 (PHQ-9) for the current study.

2. Add Hosmer–Lemeshow test value for the present study

3. Add VIF values in the respective table as a new column.

4. While the exclusion criteria are clear, some might be subjective (e.g., communication challenges).

5. While experience is mentioned, it would be beneficial to specify if data collectors received training on using the questionnaires and ensuring consistency.

6. The manuscript should address how missing data (if any) was handled during analysis.

7. Further details on the type and duration of rehabilitation services received could be helpful.

Results:

1. In Table 1, note where you performed the Fisher's Exact test and the Chi-square test.

2. The authors reported Prevalence of disability and depression in the "Prevalence of disability and depression among stroke survivors" section. However, I failed to find any supporting tables or figures in the manuscript.

3. Cite the table number in the section on factors associated with depression among stroke survivors.

4. The section titled "Correlation between disability and depression" does not appear to have any supporting tables or figures.

Discussion:

1. The authors compared the prevalence to two studies in the first section of the discussion, but a more comprehensive comparison is required. Also, simply showing similarities with previous studies is insufficient here.

2. The second paragraph of the discussion seems peculiar to me. Authors must identify the significant variables within their study and rigorously compare them to those identified in other relevant studies. This comparative analysis should be closely aligned with the study objectives and framed within the context of existing literature. By delineating the key variables and exploring how they intersect with those identified in prior research, authors can elucidate the underlying mechanisms driving their findings and contextualize their contribution to the field.

3. Lines 256–264 compared the results to numerous other investigations. The authors should provide a thorough explanation for the observed similarities and differences between their findings and those of previous studies.

4. I found some other factors associated with depression and align with study objectives not discussed in the discussion section.

5. In my opinion discussion section need extensive revisions before considering publication in the PLOS ONE.

6. The "Importance and clinical significance for public health" section warrants a more specific and rigorous treatment, augmented by thorough referencing to substantiate its claims. It is essential to provide a comprehensive analysis of the practical implications of the study's findings within the realm of public health. the authors should strive to enrich this section with precise, evidence-based insights that resonate with the overarching objectives of the study and contribute meaningfully to the advancement of public health knowledge and practice.

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Reviewer #1: Yes: Chathurie Suraweera

Reviewer #2: No

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PONE-D-24-11475R1Disability and depression among stroke survivors attending rehabilitation facilities at three designated tertiary care hospitals in Bangladesh: A cross-sectional studyPLOS ONE

Dear Dr. Ahmed,

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 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.

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,

Palash Chandra Banik, MPhil

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 #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 #3: Yes

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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 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 #3: Yes

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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 #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 #3: The design, settings, periods and participants are well described

The eligibility criteria are properly addressed

Outcome variables are described and used appropriate tool for data collection. The Statistical methods employed is sufficient. Nevertheless, Authors need to describe how data quality was assured (mention pretesting, standardization of data collection method, was training given etc. The key findings are summarized with reference to study objectives

The strength and limitations of the study is well described, taking into account sources of potential bias or imprecision.

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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: Yes: Jemal Haidar Ali (Prof)

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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.]

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Attachments

Attachment

Submitted filename: jeviwer_j-stroke-1.docx

Disability and depression among stroke survivors attending rehabilitation facilities at three designated tertiary care hospitals in Bangladesh: A cross-sectional study

PONE-D-24-11475R2

Dear Dr. Ahmed,

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,

Palash Chandra Banik, MPhil

Academic Editor

PLOS ONE

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