PONE-D-24-20854School-based interventions to prevent anxiety and depression in children and adolescents in low- and middle-income countries: A systematic reviewPLOS ONE

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: N/A

Reviewer #2: N/A

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Reviewer #1: Yes

Reviewer #2: No

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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: This is a well-written manuscript and the authors have a very clear objective which they carry out with the appropriate methodology for systematic reviews, including an assessment of the risk of bias and of the quality of the evidence. The results are discussed in a clear, organized manner and valuable conclusions are drawn. Considering that this is a systematic review with a narrative synthesis of the results no statistical analyses were performed. All data were available for review either in the main text or as supplementary documents.

Below are some additional comments for the authors or points for improvement in the text.

1. Method: Is there Prospero registration? If so, include the registration information and mention in the Method section.

2. In the narrative synthesis of the findings (270-370) study findings are discussed individually for each study. It would be helpful to also include a summary statement for each section (depression and anxiety, only depression, and only anxiety), that brings together the findings. For instance, in the narrative synthesis for depression it would be helpful to summarize in a sentence, either at the beginning or at the end, that both studies found that the interventions led to a reduction in depressive symptoms, although for one of them the reduction did not reach a level of significance.

3. The heterogeneity of outcome measures (450-451 and elsewhere in the text) especially in RCTs including minors has been noted in the literature before and highlighted as a problem in other systematic reviews—it would be helpful to highlight it further and cite some examples since it seems to be a big problem in being able to compare findings and ultimately address ‘what works for whom’ in terms of interventions.

4. The review focuses on school-based interventions in low and middle-income countries but the reviewed literature does not include any low-income countries since no studies were available for these. This finding deserves to be further highlighted in the discussion, not as a limitation of this review but as a worrisome finding for the lack of studies (and perhaps the lack of such interventions) in countries that may need it the most.

5. 488-491: It is unclear what is meant here by “the constraints imposed by the timeframe of this research” and how “given that studies with positive findings tend to have a higher likelihood of being published this review is susceptible to publication bias.” Perhaps rephrase. Is the intended statement that the studies included in this review may have been susceptible to publication bias?

And finally some typos in need of correction:

149: “condition” instead of “conditions”

155: “assessors” instead of “accessors”

163: only English language studies as a significant limitation since many of the LMICs (and perhaps local research) may not be in English

172: ideally include the precise date

194: “assessors” instead of “accessors”

276: “was observed” instead of “were observed”

323: “that involved” instead of “that involving”

368: “reduction” instead of “reductions”

374: “were due” instead of “was due”

394: “was deemed” instead of “were deemed”

405: remove “exist”

475: “reflects” instead of “reflects”

476: “interventions” instead of “intervention”

492: “the exclusion” instead of “the omission”?

504: remove “a” from “a longer-term”

516: remove “a” from “a more stringent inclusion criteria”

522: “school-based measures” or “school-based prevention programs”?

Reviewer #2: I agree that many, if not all, of the systematic reviews are done on studies from Western countries with sound economic income. Studies of anxiety and stress prevention in children and adolescents in countries outside these criteria are scarce, as this study has shown.

Suppose the reason they have chosen such studies in countries with middle or low-income levels is that it is assumed that there is a greater likelihood of pre-anxiety or pre-depressive symptoms simply because they have fewer resources. However, this assumption may be erroneous. The factors leading to these symptoms may differ between developed and developing countries. Social pressure is more significant in developed countries, and the protective role and values associated with the family may be higher in developing countries such as Brazil or China.

Some aspects should be taken into account:

1.- Table 2 points out the cut-off point of anxiety and/or depression that marks the measure used to understand the previous levels better.

2.- Does this review require a code of Prospero or similar? This condition is usually necessary before its acceptance.

3.- To justify the inclusion of these countries, ILMCs should have gone more profound in the discussion section of the similarities and differences with other reviews that would have included developed Western countries. They may share explanatory mechanisms, and differences in different aspects may also be observed.

Otherwise, the work meets the standards of a systematic review and is pleasant and comprehensive to read.

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Reviewer #1: No

Reviewer #2: Yes:  Jose M Mestre

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School-based interventions to prevent anxiety and depression in children and adolescents in low- and middle-income countries: A systematic review

PONE-D-24-20854R1

Dear Dr. Masuma Pervin Mishu, 

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.

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