PONE-D-24-27390Sickness absence and disability pension trajectories among individuals on sickeness absence due to stress-related disorders. Two prospective population-based cohorts with 13-month follow-upPLOS ONE

Dear Dr. Gémes,

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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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: No

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: Comments

1. The analysis does not include data from Swedish primary healthcare. This could be significant since primary care is often the first point of contact for patients with stress-related disorders also in Sweden.

2. The study relies on diagnoses set by Swedish physicians for stress-related disorders, but it acknowledges the possibility of misdiagnosis. The overlap in symptoms between stress-related disorders and other mental or somatic diseases could lead to inaccuracies in the classification, potentially biasing the estimates that are presented in the paper.

3. The analysis only considers the main diagnosis at the start of the sickness absence spell. This implies that changes in diagnosis during the follow-up period are not accounted for in the analysis. This overlooks any shifts in the health status of individuals, affecting the interpretation of the results that are presented in the paper.

4. The study focuses on sickness absence spells longer than 14 days, excluding individuals with shorter-term absences who may have different characteristics and recovery trajectories. This could lead to biased estimates of the population’s overall stress-related disorder burden in Sweden.

5. Although the study includes some work-related variables, it does not account for specific occupational factors such as job stress levels, work environment, or employer support. These most likely have substantial influence the duration and recurrence of sickness absence.

6. The follow-up period of 13 months may not be sufficient to capture long-term trajectories of sickness absence and disability pension, especially for chronic stress-related conditions.

7. The trajectory analysis relies on several model specifications and technical assumptions (e.g., choice of the number of trajectory groups, polynomial shapes). The results could be sensitive to these choices, raising some concerns about the robustness of the empirical findings that are presented in the paper.

8. There are earlier empirical studies relevant to this topic from other Nordic countries that are not covered in this paper (see https://doi.org/10.1136/oemed-2020-106660).

9. What is the external validity of the estimation results that are presented in the paper for other high-income countries than Sweden?

10. Are there practical policy implications for other countries than Sweden?

Reviewer #2: Gémes et al. have analysed trajectories of sickness absence and disability pension following an initial sickness absence due to stress-related mental disorders. Overall, the manuscript is well written and well structured. Some questions / comments may be considered:

1. Was the outcome disability pension specific for stress-related disorders or general, due to all diseases? The outcomes (SA and DP) are missing in table1.

2. In the methods, authors describe how they handled missing values in general. Is there a reason to combine missings with one category in the education variable? Maybe, missing education could at least be included in table 1.

3. As the trajectories for both cohorts look very similar, were they calculated completely separately?

4. Many results are presented, partially redundant. As a suggestion, figures 2-4 (on p.8 accidentally “Figures 1, 2 ,3”?) could be placed in the supplement. If I understood correctly, trajectories were assigned to different degrees of severity of SA/DP, this could be used for ordering the trajectories in the figures rather than alphabetical ordering.

There is a typo in the title (‘sickeness’).

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Reviewer #1: No

Reviewer #2: No

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Sickness absence and disability pension trajectories among individuals on sickness absence due to stress-related disorders. Two prospective population-based cohorts with 13-month follow-up

PONE-D-24-27390R1

Dear Dr. Gémes,

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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Kind regards,

Thomas Behrens

Academic Editor

PLOS ONE

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

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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 #2: Yes

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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 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: No

Reviewer #2: 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 #2: Yes

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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: I am happy with the revisions made in the paper and with the effort you put in replying to my comments.

Reviewer #2: (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: Yes: Petri Böckerman

Reviewer #2: No

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